Bacterial vaginosis, or BV, is the most common vaginal infection experienced by women. Traditionally, the Gardnerella bacteria was believed to be the sole bacteria responsible for causing BV. However, we now know better. BV is caused by a variety of different bacteria that naturally live in the vagina but now grow in excess.

Here are some burning questions we’ve received about BV:

What makes the bacteria that cause BV grow in excess in the vagina?

The vagina is a highly manipulated organ, often going through various changes. The vagina is exposed to everything from menstrual blood, physical friction during intercourse and semen from ejaculation to period products like pads and tampons. Let’s not forget that although it is discouraged, many women continue to expose their vagina to douching as well.

All of the above causes imbalances in the vaginal environment, which then encourages the bacteria that cause BV to flourish in excess, producing the foul-smelling and copious discharge that is associated with the infection.

This imbalance also involves a decline in the good, normal bacteria called Lactobacilli, while Gardnerella and its fellow BV accomplices take over.

How do I know if I have BV?

Often, your discharge has a foul smell, likened to a fishy scent. Your discharge may be thin, liquid, yellow green or gray. Your doctor will check if you have BV by using a swab test.

Is BV an STI (Sexually Transmitted Infection)?

No. An STI is caused by something that is otherwise not normally present in the vagina, whereas the bacteria that cause BV are normally present in the vagina, albeit in quantities too small to stir a problem.

With the upset of the vaginal environment, these normally occurring bacteria tend to unscrupulously overpopulate the vagina and result in BV.

Does BV increase my risk of acquiring an STI?

Yes, it can. BV and the inflammation it causes allow for tracking up of STI into the upper portions of your genital track. Therefore, it is best to treat BV to reduce your risk of acquiring an STI when you are exposed to one.

Is there a chance that BV will recur after I have treated it?

Unfortunately, BV can be very stubborn. Recurrence rates can be as high as 80% so do not be surprised if you are infected again after treatment.

Simply update your doctor, get reexamined to ensure that it’s not any other infection and you will need a second round of treatment and more importantly, a discussion on strategies to prevent recurrent infection.

The crux to proper BV prevention lies in the maintenance of a stable acidic vaginal conditions with a dominant good lactobacilli bacterial environment.

How is BV treated?

BV is treated with antibiotics that are either taken orally or vaginally through the use of pessaries. Some common antibiotics we use are metronidazole, tinidazole and clindamycin.

Sometimes, your doctor may also prescribe antifungal treatment for the preemptive prevention of a fungal infection. This is because treatment with antibiotics can also kill good bacteria in the vagina, which increases the growth of fungus.

Currently, there is little data to support the use of vaginal probiotics. I do not commonly use these to manage BV in my clinic.

Is the treatment for recurrent BV different?

If your BV is recurrent, and you continue to have repeat attacks of this vaginal infection despite standard treatment, then your doctor may consider the following:

1. Extending the course of your antibiotic treatment by a few more days

2. Giving you an antibiotic (metronidazole) vaginal pessary to insert the vagina twice a week regularly for about 3-6 months

BV is extremely common and terribly distressing and frustrating. Thankfully, it does not cause permanent detriment to your reproductive organs or your fertility. We want you to know that BV is treatable and one has to be patient with the prolonged treatment that is sometimes required with recurrent infections.