What Causes BV?

The vagina normally contains protective bacteria, primarily lactobacilli, which help maintain an acidic environment and prevent harmful organisms from overgrowing.

BV develops when there is a reduction in these protective bacteria and an overgrowth of other organisms, such as Gardnerella vaginalis and Mycoplasma hominis. This imbalance disrupts the normal vaginal flora and can lead to symptoms.

The vaginal microbiome plays an important protective role, acting as a first line of defence against infections. When this balance is disturbed, susceptibility to other infections may increase.

Is BV a Sexually Transmitted Infection?

BV is not considered a traditional STI. It can occur in women who are not sexually active.

However, it is more frequently seen in sexually active women and may be associated with new or multiple partners. It is also more common in women who use intrauterine devices (IUDs), smokers, and in certain ethnic groups.

Symptoms

Some women with BV have no symptoms.

When symptoms are present, they may include:

• Thin white or grey vaginal discharge with a noticeable “fishy” odour, particularly after sex; mild vaginal irritation; or a change in normal discharge consistency.

Unlike thrush, BV does not usually cause significant itching or soreness.

Why Treatment Matters

Although BV is not usually serious, it can cause discomfort and distress due to odour and discharge.

Importantly, BV is associated with an increased risk of acquiring other STIs, including HIV. It may also increase the risk of pelvic inflammatory disease (PID) and pregnancy-related complications in certain cases.

For women who experience recurrent BV, further assessment may be needed to identify contributing factors and reduce recurrence risk.

Risk Factors

Factors associated with BV include:

• Sexual activity (particularly new or multiple partners), use of intrauterine devices (IUDs), smoking, vaginal douching or use of internal cleansing products, and disruption of normal vaginal bacteria.

Avoiding internal vaginal cleansing products and maintaining natural vaginal balance can help reduce recurrence.

Diagnosis and Treatment

BV is diagnosed based on symptoms, examination, and sometimes laboratory testing.

Treatment typically involves a short course of antibiotics, either as oral tablets or vaginal gel. Symptoms usually improve quickly with appropriate therapy.

In recurrent cases, longer or repeated treatment courses may be recommended.

When to Seek Medical Advice

You should seek assessment if:

• You have new or persistent abnormal discharge
• There is a strong odour
• Symptoms are recurrent
• You are unsure whether symptoms are BV, thrush, or an STI

Accurate diagnosis ensures appropriate treatment and reduces the risk of complications.

Maintaining Vaginal Health

The vaginal microbiome is delicate and self-regulating. Avoiding unnecessary antibiotics, stopping smoking, and avoiding douching or perfumed products can help maintain balance.

If you experience frequent episodes of BV, a personalised consultation can help develop a preventative strategy tailored to your sexual health and lifestyle.