Bacterial Vaginosis: Practice Essentials, Background, Pathophysiology
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Bacterial vaginosis a condition in which there will be more growth of normal bacteria in the vagina part. In this case, there will be a thin and grey or white pus will be coming out. The females who are infected have the possibility of other sexually transmitted infections, and there is a high risk of premature delivery. When there is a high amount of discharge, there will be a fussy odor that can be smelled.
This mainly happens because there is a reduced population of lactobacilli bacteria that is producing hydrogen peroxide and also an increased growth of anaerobic bacteria. Previously it was noted that it is Gardnerella vaginalis and the possibility of spreading through sex and sharing sex toys. The term is commonly used because of the reason that various bacteria that naturally inhabit the vagina contribute to this condition. The exact transmission mechanism for bacterial vaginosis is not fully clear, although it is not typically classified as a sexually transmitted infection.
It is hypothesized that the transmission of the bacteria can alter the balance of flora in the vagina flora and leads to bacterial vaginosis. The foul smell of vaginal discharge is the main problem of the majority of women with bacterial vaginosis, and usually, it is more seen in sexual intercourse. There are some more symptoms that can include pain during urination, pain that happens during sexual intercourse, and continuous inching in the vagina. There is also a chance that many of the women will not experience this at all.
A healthcare practitioner should gain more information about the risk factors and patient case history while evaluating a patient with bacterial vaginosis. The risk factors that should noted are douching, multiple sex partners, and the use of drugs or intrauterine devices. Vaginal douching is strictly banned and discouraged by the U.S. Department of Health and Human Services. It is essential to note that there is an increased chance of a high risk of bacterial vaginosis if having a sexual partner, and this is not tagged as a sexually transmitted infection since there is an overgrowth of normal vaginal bacteria it causes. The chances of bacterial vaginosis can rarely happen for those who never engaged in any sexual intercourse.
A thorough physical examination should include a pelvic exam to assess the characteristics of the vaginal discharge and rule out other similar conditions such as candidiasis, cervicitis, chlamydia, gonorrhea, herpes simplex virus, and trichomoniasis. It is crucial to note that bacterial vaginosis itself is a risk factor for pelvic inflammatory disease, HIV, other STIs, and certain obstetric disorders. Therefore, the healthcare provider should also assess for signs of cervical friability and cervical motion tenderness.
To rule out more serious conditions, it is important to evaluate the presence of fever, pelvic pain, and a history of sexually transmitted infections. Cervical swabs may be collected to test for chlamydia or gonorrhea infection.
Bacterial Vaginosis: Practice Essentials
Bacterial vaginosis (BV) is a common vaginal infection characterized by an overgrowth of normal vaginal flora, particularly anaerobic bacteria, and a decrease in the number of hydrogen peroxide-producing lactobacilli. Although it is not considered a sexually transmitted infection (STI), the role of transmissibility is still not completely understood. BV is associated with a range of symptoms, including malodorous vaginal discharge, dysuria, dyspareunia, and vaginal pruritus. However, many affected women may be asymptomatic.
ngal infections, often known as yeast infections, arise when a fungus called Candida overgrows. Candida is found naturally in our bodies, especially in warm regions like the mouth, vaginal area, and skin. Under normal conditions, the body’s immune system keeps candida away.
Certain conditions, however, might upset this balance, resulting in overgrowth and fungal infection. Let’s begin by deconstructing yeast infections. The mix of yeast and bacteria normally keeps everything in check, but when this equilibrium is upset, an infection can arise.
- BV is diagnosed based on clinical criteria, including the presence of a thin, grayish-white vaginal discharge with a fish-like odor, as well as the absence of inflammation. A pH greater than 4.5 is also indicative of BV. Microscopic examination of vaginal fluid can further confirm the diagnosis by revealing the presence of clue cells, which are epithelial cells covered with adherent bacteria.
- The exact etiology of BV remains unclear, but several risk factors have been identified. These include vaginal douching, multiple sexual partners, recent antibiotic use, cigarette smoking, and the use of an intrauterine device. Female sexual partners may also spread BV, either through direct contact of mucous membranes or via shared sex toys. It is important to note that BV can rarely occur in individuals who have never engaged in sexual intercourse.
- BV is associated with several complications and adverse outcomes. It increases the risk of acquiring other STIs, such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), chlamydia, and gonorrhea. Pregnant women with BV are more likely to experience early delivery and are at an increased risk of developing pelvic inflammatory disease. BV has also been linked to an increased risk of postoperative infections and complications following gynecologic surgeries.
- The management of BV involves both pharmacologic and non-pharmacologic interventions. Antibiotics, such as metronidazole or clindamycin, are commonly prescribed to treat BV. However, recurrence rates are high, and prolonged or suppressive therapy may be necessary in some cases. Non-pharmacologic interventions, such as avoiding vaginal douching and using barrier methods during sexual intercourse, may help reduce the risk of BV recurrence.
- Healthcare providers play a vital role in the management of BV. A thorough history and physical examination, including a pelvic exam, are essential for accurate diagnosis and to rule out other similar conditions. It is important to assess for other STIs and to educate patients about safe sexual practices and risk reduction strategies. Regular follow-up is recommended to monitor treatment response and to address any recurrent or persistent symptoms.
Bacterial Vaginosis Pathophysiology
The pathophysiology of bacterial vaginosis (BV) involves a disruption in the normal balance of vaginal flora, leading to an overgrowth of certain bacteria and a decrease in beneficial lactobacilli. The exact mechanisms behind this disruption are not fully understood, but several factors are thought to contribute to the development of BV. Normally, the vaginal microbiota is predominantly composed of lactobacilli, particularly species such as Lactobacillus crispatus, Lactobacillus jensenii, Lactobacillus gasseri, and Lactobacillus iners.
These lactobacilli play a crucial role in maintaining a healthy vaginal environment by producing lactic acid, hydrogen peroxide, and other antimicrobial substances. They help to keep the vaginal pH acidic (around 3.8-4.5), creating an inhospitable environment for pathogenic bacteria.
In BV, there is a shift in the vaginal microbiota composition, characterized by a decrease in lactobacilli and an overgrowth of anaerobic bacteria, including Gardnerella vaginalis, Prevotella species, Mobiluncus species, and Atopobium vaginae. These anaerobic bacteria produce enzymes called sialidases and proteases that can break down protective factors in the vagina, disrupt the normal vaginal epithelium, and contribute to the characteristic symptoms of BV. Several factors can disrupt the balance of vaginal flora and contribute to the development of BV.
- Vaginal douching, which involves rinsing the vagina with water or other substances, can alter the vaginal pH and remove beneficial lactobacilli, allowing pathogenic bacteria to thrive.
- Sexual intercourse, especially with a new partner or multiple partners, has been associated with an increased risk of BV, possibly due to the introduction of new bacteria or semen altering the vaginal environment.
The use of antibiotics, particularly broad-spectrum antibiotics, can disrupt the vaginal microbiota by killing off both beneficial and harmful bacteria. This disruption can create an environment conducive to the overgrowth of anaerobic bacteria. Other risk factors for BV include smoking, which may alter the vaginal immune response, and the use of an intrauterine device (IUD), although the exact mechanisms are not fully understood.
The shift in vaginal microbiota composition in BV results in an increase in vaginal pH, typically above 4.5. This alkaline pH allows the overgrowth of anaerobic bacteria and creates an environment that is less hostile to pathogenic organisms. The breakdown of protective factors in the vaginal epithelium by the enzymes produced by anaerobic bacteria contributes to the characteristic symptoms of BV, such as malodorous vaginal discharge. In summary, the pathophysiology of bacterial vaginosis involves a disruption in the normal balance of vaginal flora, with a decrease in lactobacilli and an overgrowth of anaerobic bacteria. This imbalance is thought to be influenced by factors such as vaginal douching, sexual intercourse, antibiotic use, smoking, and the presence of an intrauterine device. The resulting shift in vaginal microbiota composition and increase in vaginal pH contribute to the development of BV and its characteristic symptoms.
Conclusion
Bacterial vaginosis (BV) is a common vaginal infection characterized by an overgrowth of certain bacteria and a decrease in beneficial lactobacilli, leading to a disruption in the normal balance of vaginal flora. This imbalance is influenced by various factors such as vaginal douching, sexual intercourse, antibiotic use, smoking, and the presence of an intrauterine device. Normally, the vaginal microbiota is dominated by lactobacilli, which help maintain a healthy vaginal environment by producing lactic acid and other antimicrobial substances. In BV, there is a shift in the vaginal microbiota composition, with a decrease in lactobacilli and an overgrowth of anaerobic bacteria like Gardnerella vaginalis, Prevotella species, Mobiluncus species, and Atopobium vaginae. These anaerobic bacteria produce enzymes that can break down protective factors in the vagina and disrupt the vaginal epithelium.
The disruption of vaginal flora and the overgrowth of anaerobic bacteria results in an increase in vaginal pH above 4.5, creating an environment favorable for pathogenic organisms. This leads to symptoms such as malodorous vaginal discharge, dysuria, dyspareunia, and vaginal pruritus. BV is associated with various complications and adverse outcomes, including an increased risk of acquiring other sexually transmitted infections (STIs) such as HIV, herpes simplex virus (HSV), chlamydia, and gonorrhea. Pregnant women with BV are more likely to experience premature delivery and develop pelvic inflammatory disease. BV has also been linked to an increased risk of postoperative infections and complications following gynecologic surgeries.
The management of BV involves both pharmacologic and non-pharmacologic interventions. Antibiotics like metronidazole or clindamycin are commonly prescribed to treat BV, but recurrence rates are high. Non-pharmacologic interventions, such as avoiding vaginal douching and using barrier methods during sexual intercourse, may help reduce the risk of BV recurrence. Healthcare providers play a crucial role in the diagnosis and management of BV. A thorough history, physical examination, and pelvic exam are essential for accurate diagnosis and to rule out other similar conditions. Education about safe sexual practices, risk reduction strategies, and regular follow-up are crucial aspects of BV management.
Overall, understanding the pathophysiology of BV and implementing appropriate management strategies can help improve outcomes for individuals affected by this condition.