Bacterial vaginosis

Bacterial vaginosis
Other namesAnaerobic vaginositis, non-specific vaginitis, vaginal bacteriosis, Gardnerella vaginitis[1]
Vaginal squamous cell with normal vaginal flora versus bacterial vaginosis on Pap stain. Normal vaginal flora (left) is predominantly rod-shaped Lactobacilli whereas in bacterial vaginosis (right) there is an overgrowth of bacteria which can be of multiple species.
SpecialtyGynecology, infectious disease
SymptomsVaginal discharge that often smells like fish, burning with urination[2]
ComplicationsEarly delivery among pregnant women[3]
CausesImbalance of the naturally occurring bacteria in the vagina[4][5]
Risk factorsDouching, new or multiple sex partners, antibiotics, using an intrauterine device[5]
Diagnostic methodTesting the vaginal discharge[6]
Differential diagnosisVaginal yeast infection, infection with Trichomonas[7]
PreventionProbiotics[6][8]
MedicationClindamycin, metronidazole, tinidazole, secnidazole, boric acid, probiotics[9][6][10]
Frequency~ 5% to 70% of women[11]

Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria.[6][12] Common symptoms include increased vaginal discharge that often smells like fish.[2] The discharge is usually white or gray in color.[2] Burning with urination may occur.[2] Itching is uncommon.[2][6] Occasionally, there may be no symptoms.[2] Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS.[11][13] It also increases the risk of early delivery among pregnant women.[3][14]

BV is caused by an imbalance of the naturally occurring bacteria in the vagina.[4][5] There is a change in the most common type of bacteria and a hundred to thousandfold increase in total numbers of bacteria present.[6] Typically, bacteria other than Lactobacilli become more common.[15] Risk factors include douching, new or multiple sex partners, antibiotics, and using an intrauterine device, among others.[5] However, it is not considered a sexually transmitted infection and, unlike gonorrhoea and chlamydia, sexual partners are not treated.[16] Diagnosis is suspected based on the symptoms, and may be verified by testing the vaginal discharge and finding a higher than normal vaginal pH, and large numbers of bacteria.[6] BV is often confused with a vaginal yeast infection or infection with Trichomonas.[7]

Usually treatment is with an antibiotic, such as clindamycin or metronidazole.[9][6] These medications may also be used in the second or third trimesters of pregnancy.[6] The antiseptic boric acid can also be effective.[10] BV often recurs following treatment.[6] Probiotics may help prevent re-occurrence.[6][8] It is unclear if the use of probiotics or antibiotics affects pregnancy outcomes.[6][17]

BV is the most common vaginal infection in women of reproductive age.[5] Prevalence differs by countries and demographics, with a systematic review and meta-analysis finding global prevalence in reproductive aged women ranges from 23 to 29%.[18][19] While BV-like symptoms have been described for much of recorded history, the first clearly documented case occurred in 1894.[1]

  1. ^ a b Borchardt KA (1997). Sexually transmitted diseases: epidemiology, pathology, diagnosis, and treatment. Boca Raton [u.a.]: CRC Press. p. 4. ISBN 9780849394768. Archived from the original on 10 September 2017.
  2. ^ a b c d e f "What are the symptoms of bacterial vaginosis?". National Institute of Child Health and Human Development. 21 May 2013. Archived from the original on 2 April 2015. Retrieved 3 March 2015.
  3. ^ a b Queena JT, Spong CY, Lockwood CJ, eds. (2012). Queenan's management of high-risk pregnancy: an evidence-based approach (6th ed.). Chichester, West Sussex: Willey-Blackwell. p. 262. ISBN 9780470655764.
  4. ^ a b Bennett J (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  5. ^ a b c d e "Bacterial Vaginosis (BV): Condition Information". National Institute of Child Health and Human Development. 21 May 2013. Archived from the original on 2 April 2015. Retrieved 3 March 2015.
  6. ^ a b c d e f g h i j k l Donders GG, Zodzika J, Rezeberga D (April 2014). "Treatment of bacterial vaginosis: what we have and what we miss". Expert Opinion on Pharmacotherapy. 15 (5): 645–57. doi:10.1517/14656566.2014.881800. PMID 24579850. S2CID 19241611.
  7. ^ a b Mashburn J (2006). "Etiology, diagnosis, and management of vaginitis". Journal of Midwifery & Women's Health. 51 (6): 423–30. doi:10.1016/j.jmwh.2006.07.005. PMID 17081932.
  8. ^ a b Chieng WK, Abdul Jalal MI, Bedi JS, Zainuddin AA, Mokhtar MH, Abu MA, Chew KT, Nur Azurah AG (2022). "Probiotics, a promising therapy to reduce the recurrence of bacterial vaginosis in women? a systematic review and meta-analysis of randomized controlled trials". Front Nutr. 9: 938838. doi:10.3389/fnut.2022.938838. PMC 9530327. PMID 36204368.
  9. ^ a b Faught BM, Reyes S (September 2019). "Characterization and Treatment of Recurrent Bacterial Vaginosis". J Womens Health (Larchmt). 28 (9): 1218–1226. doi:10.1089/jwh.2018.7383. PMID 31403349.
  10. ^ a b Cite error: The named reference LærkeholmMüllerDamstedPetersenSaunte2024 was invoked but never defined (see the help page).
  11. ^ a b Kenyon C, Colebunders R, Crucitti T (December 2013). "The global epidemiology of bacterial vaginosis: a systematic review". American Journal of Obstetrics and Gynecology. 209 (6): 505–23. doi:10.1016/j.ajog.2013.05.006. PMID 23659989.
  12. ^ Sharma H, Tal R, Clark NA, Segars JH (January 2014). "Microbiota and pelvic inflammatory disease". Seminars in Reproductive Medicine. 32 (1): 43–9. doi:10.1055/s-0033-1361822. PMC 4148456. PMID 24390920.
  13. ^ Bradshaw CS, Brotman RM (July 2015). "Making inroads into improving treatment of bacterial vaginosis - striving for long-term cure". BMC Infectious Diseases. 15: 292. doi:10.1186/s12879-015-1027-4. PMC 4518586. PMID 26219949.
  14. ^ "What are the treatments for bacterial vaginosis (BV)?". National Institute of Child Health and Human Development. 15 July 2013. Archived from the original on 2 April 2015. Retrieved 4 March 2015.
  15. ^ Nardis C, Mosca L, Mastromarino P (September–October 2013). "Vaginal microbiota and viral sexually transmitted diseases". Annali di Igiene. 25 (5): 443–56. doi:10.7416/ai.2013.1946. PMID 24048183.
  16. ^ "Bacterial Vaginosis – CDC Fact Sheet". Centers for Disease Control and Prevention. 11 March 2014. Archived from the original on 28 February 2015. Retrieved 2 March 2015.
  17. ^ Othman M, Neilson JP, Alfirevic Z (January 2007). "Probiotics for preventing preterm labour". The Cochrane Database of Systematic Reviews. 2012 (1): CD005941. doi:10.1002/14651858.CD005941.pub2. PMC 9006117. PMID 17253567.
  18. ^ "Bacterial vaginosis". www.who.int. Retrieved 19 July 2025.
  19. ^ Peebles, Kathryn; Velloza, Jennifer; Balkus, Jennifer E.; McClelland, R. Scott; Barnabas, Ruanne V. (May 2019). "High Global Burden and Costs of Bacterial Vaginosis: A Systematic Review and Meta-Analysis". Sexually Transmitted Diseases. 46 (5): 304–311. doi:10.1097/OLQ.0000000000000972. ISSN 0148-5717.
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