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Health Matters: Here's What You Need To Know About Bacterial Vaginosis
The condition often goes misdiagnosed, as many mistake it for a yeast infection. Here's what you should know about bacterial vaginosis and how to treat it.
Bacterial vaginosis (BV) affects 1 in 3 women, causing embarrassment and discomfort. However, according to a recent study, BV occurs in nearly 29% of 14‐ to 49‐year‐old women in the United States, with an approximate 50% infection rate in Black women. It's a common vaginal infection that happens when bacteria that live in your vagina overgrow, causing a bacterial imbalance. It's mainly uncomfortable, as symptoms include an off-white or gray vaginal discharge that smells "fishy." Despite its inconvenient discomfort, BV is easily treatable with antibiotics from a trusted healthcare provider. Organon recently announced the availability of XACIATO (clindamycin phosphate) vaginal gel, 2%, a treatment for the gynecologic condition bacterial vaginosis (BV) in females aged 12 and older. This is important news for the 21 million women in the United States affected by BV, which disproportionately affects non-Hispanic Black and Mexican Americans. Prior to diagnosis, women often mistake BV for a yeast infection and do not seek medical attention. ESSENCE learned more about often misdiagnosed condition and the available treatment, XACIATO, from Dr. Kameelah Phillips, a Board-Certified Obstetrician and gynecologist with over 13 years in private practice.
ESSENCE: What is bacterial vaginosis?
Dr. Kameelah Phillips: Bacterial vaginosis, also known as BV, is the most common vaginal infection, affecting about 21 million women (and disproportionately affecting Black and Hispanic women). A lot of my patients are surprised to learn they have BV because many mistake the common symptoms of odor and discharge for a yeast infection and often delay coming in for diagnosis. Something that can be very frustrating and embarrassing for my patients is that BV has a high rate of recurrence – 58% of women who have BV will get another BV infection within the next year.
How is it caused?
BV results from an overgrowth of certain bacteria, which upsets the balance of the natural vaginal microbiome (environment) and can lead to symptoms of odor and discharge. There are some activities that can increase a woman's risk of BV, such as sexual activity (multiple or new partners and/or unprotected sex), cigarette smoking, and douching.
Why is bacterial vaginosis often misdiagnosed?
Despite being the most common vaginal condition of women of reproductive age, BV symptoms (odor, discharge) are often mistaken for a yeast infection. I have seen many patients attempt to self-treat at home, thinking it is a yeast infection, and then end up at my office when symptoms persist.
Are Black women more susceptible to bacterial vaginosis?
While any woman can get BV, Black and Hispanic women are disproportionately impacted, though it is unclear why some women of color have higher rates of BV. The vaginal microbiome is a complex environment made up of different bacteria, and the balance between them is not the same for all women. This is why continued women's health research is critically important, particularly among women of color.
How can XACIATO help?
XACIATO is a colorless single-dose vaginal gel that can be applied any time of day and is formulated with the goal of limiting leakage and increasing time spent in place in the vagina. Two-thirds of BV cases will need medical attention, and XACIATO is an additional treatment option to consider whether a woman is experiencing BV for the first time or dealing with a recurrence. I encourage women to reach out to their healthcare provider if they notice any unusual-for-them vaginal changes so that, together, they can diagnose and discuss an appropriate treatment plan for that individual.
Bacterial Vaginosis And HIV
Key pointsBacterial vaginosis (BV) is a condition which occurs when the normal balance of bacteria in the vagina becomes disrupted. This can result in an over-growth of certain bacteria, which can be accompanied by unpleasant symptoms.
It is a very common condition and can affect any woman or person with a vagina. It is not a sexually transmitted infection (STI) and is easily treated with antibiotics.
Having bacterial vaginosis increases your risk of acquiring HIV and STIs including herpes, human papillomavirus (HPV), chlamydia and gonorrhoea. For people living with HIV, having bacterial vaginosis increases the risk of passing on HIV during sex and childbirth. However, this is not the case if you are receiving HIV treatment and have an undetectable viral load.
Causes of bacterial vaginosisWhat causes the imbalance of bacteria in the vagina which leads to bacterial vaginosis is not fully understood. Since you can develop bacterial vaginosis without having ever had sex it is not classified as an STI, but sexual activity appears to increase the likelihood of developing it. For reasons that remain unclear, there are higher rates of bacterial vaginosis among lesbian, bisexual and other women who have sex with women than among heterosexual women.
These activities can increase the risk of developing bacterial vaginosis:
Bacterial vaginosis is common during pregnancy.
These activities can reduce the risk of developing bacterial vaginosis:
Studies have also shown a reduced risk of bacterial vaginosis in women whose male sexual partners are circumcised.
SymptomsBacterial vaginosis is often asymptomatic, meaning you experience no symptoms at all. When they do occur, symptoms can include changes to vaginal discharge, including turning grey or whitish, watery or developing a fishy smell. This may be worse after sex.
Bacterial vaginosis is not usually associated with itchiness, irritation, sores, blisters, or vaginal bleeding. If you have any of these symptoms, seek advice from your GP or sexual health clinic.
DiagnosisIf you think you have bacterial vaginosis, you can go to your GP or a sexual health clinic. A doctor or nurse will examine you to look for signs of bacterial vaginosis. They may be able to diagnose bacterial vaginosis straight away because of the distinctive appearance of the discharge.
If not, they will probably use a swab to collect a sample from your vagina. A swab looks like a cotton bud and collecting a sample only takes a minute or two. It shouldn't be painful, but it may feel a little uncomfortable. The sample will then be sent to a lab for testing and you should get your results within a few days.
They may also test you for sexually transmitted infections if the symptoms are similar.
Sexual health screens are freely available from NHS genitourinary medicine (GUM) and sexual health clinics. Many HIV clinics also provide sexual health screens and tests for bacterial vaginosis as part of their routine care.
TreatmentBacterial vaginosis sometimes goes away by itself as the balance of bacteria in the vagina corrects itself. If bacterial vaginosis is not bothering you, it is not always necessary to have it treated. However, it can increase the chance of acquiring HIV or passing it on if you have a detectable viral load. Treatment for bacterial vaginosis is recommended if you have a different HIV status from your partner and one of you has a detectable viral load.
Glossary bacterial vaginosisA condition caused by the overgrowth of certain species of the bacteria that are normally present in the vagina.
symptomAny perceptible, subjective change in the body or its functions that signals the presence of a disease or condition, as reported by the patient.
sexually transmitted infections (STIs)Although HIV can be sexually transmitted, the term is most often used to refer to chlamydia, gonorrhoea, syphilis, herpes, scabies, trichomonas vaginalis, etc.
detectable viral loadWhen viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners.
It is also important to be treated if you are going to have a surgical procedure that involves going through the neck of your womb (the cervix). If bacterial vaginosis is transmitted from the cervix into the womb during a procedure, you can develop a serious condition called pelvic inflammatory disease.
If you are pregnant or thinking about becoming pregnant, you may also want to be treated. There is some evidence that bacterial vaginosis can increase the risk of premature birth, especially if you have had a miscarriage, premature baby or baby with a low birth weight before. There is also a greater risk of passing on HIV to a baby during delivery. You can safely take treatment during pregnancy.
If you have a same-sex partner, your doctor or nurse may also recommend that they are treated.
Treatment is with antibiotics, usually either metronidazole or clindamycin. It can be given as tablets (a single larger dose or doses over seven days) or a vaginal gel over five to seven days. It is important that you take all the treatment prescribed to you. You will need to avoid alcohol during treatment and for 48 hours after you have finished it, as it will make you feel very sick.
There is a lot of information online about complementary therapies to prevent or treat bacterial vaginosis, such as probiotics. However, the evidence of their effectiveness is inconclusive and therefore their use is not recommended by clinicians.
It is common for bacterial vaginosis to recur after treatment, so you may require another course of treatment at a later date. If you have frequent bouts of bacterial vaginosis, your doctor may recommend preventive treatment with antibiotics.
Using condoms can help reduce the risk of bacterial vaginosis recurring. The vaginal gel can weaken latex, so you will need to use non-latex condoms while using this treatment.
Acknowledgements
Thanks to Dr Phillip Hay for his advice.
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