Bacterial Vaginosis

Bacterial Vaginosis is a health issue known well by many women. This condition is caused by Candida bacteria. The infection causes irritation and soreness in vagina. Thrushcan be treated with antibiotics in the form of tablets or as vaginal cream/gel.

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What is Bacterial Vaginosis?

Bacterial Vaginosis is a type of inflammation in your vagina caused by the multiplication and overgrowth of the microorganisms that are naturally found in your vagina, called Lactobacilli. It is also known as nonspecific vaginitis.

Commonly known as BV, is considered to be one of the most common vaginal affection in women of reproductive age (14-49 years old). Normally, the vaginal flora consists of different microorganisms, being one of the most important Lactobacilli. Lactobacili have different sub-types and are different according to your ethnicity. These microorganisms maintain your vagina in an acidic environment (pH levels), preventing harmful bacteria to reproduce. When this barrier fails, “bad” bacteria start multiplying and that’s when the bacterial vaginosis occurs.

How common is it?

For BV to occur, different aspects need to be taken into consideration.  If there is a change in a normal pH value of the vaginal flora (3.8-4.4), there is more risk of suffering Bacterial Vaginosis.

According to recent studies bacterial vaginosis affects one third of women in reproductive age. Other microorganisms that are included in the normal vaginal flora are Candida species that come from the skin and the gut, and other anaerobic or aerobic bacteria, (anaerobic bacteria are types that don’t need oxygen to survive, different from aerobic that need oxygen to reproduce and grow) such as Gardnerella vaginalis, Prevotella, Mycoplasma hominis, Streptococcus viridans, Fusobacterium and others.

Its prevalence will also differ, depending on your ethnicity. It is considered to be more common in women of African descent (2.4 times more common than Hispanic and Caucasian descent women) and prevalence in Europe ranges from 5-30%. Gardnerella vaginalis has been found in 100 % of women with signs and symptoms of bacterial vaginosis.

What are the risk factors of contracting BV?

  • Changes in your body: Pregnancy can lead to a higher prevalence and it is found that around 7-22% of pregnant women will suffer from this condition.
  • Multiple sexual partners throughout your lifetime
  • New sexual partner.
  • Birth control devices such as IUD (intrauterine device)
  • Vaginal hygiene products that contain perfume:  vaginal deodorants, perfumed bubble baths
  • Vaginal douches
  • Use of strong detergents to wash underwear
  • Tight clothing such as underwear or pants.
  • Underwear made out of synthetic fibers.
  • Smoking
  • Obesity
  • History of induced abortion
  • Recent antibiotic treatment for other infections.
  • Recent studies have identified vitamin D deficiency as a risk factor in pregnant women
  • BV can be associated with hormonal factors since it develops most often around the time of menstruation, and may resolve spontaneously mid-cycle.
  • Natural lack of Lactobacilli.

It is important to know that bacterial vaginosis can’t be transmitted from using public toilet seats, swimming pools, bed sheets or through contact. Sexual activity has an indirect role in this disease. Women who have never had any type of sexual intercourse including oral, vaginal or anal sex can still be affected by this disease, but the prevalence of BV has a significant increase based on the number of sexual partners throughout your lifetime.

What are the signs and symptoms of BV?

  • The most common symptoms are usually recognized after sexual intercourse and include:
  • Distinctive “fish-like” vaginal odor
  • Increase in vaginal discharge
  • Change in color of vaginal discharge: White to grayish color.
  • Vulvar irritation or itching
  • Burning pee sensation or pain decrease in the amount of urine. (Less commonly.)

What are the complications if you don’t get treated?

BV can be spontaneously cure because of the hormonal changes that occur throughout your menstrual cycle, but it is important to take certain precautions and use medicine so that complications do not develop and mostly in pregnant women.

Some of the complications are:

  • Susceptibility to other sexually transmitted infections such as chlamydia, gonorrhea, HIV, herpes simplex virus and others.
  • Pelvic Inflammatory disease: also known as PID, is a complication of sexually transmitted disease that affects the uterus and Fallopian tubes that increase the risk of being infertile.
  • Cervicitis: inflammation of the cervix, usually goes hand in hand with other infections such as gonorrhea, chlamydia and HSV (herpes simplex virus)
  • Endometritis: Inflammation of the endometrium which can cause abnormal bleeding
  • Higher predisposition to suffer from urinary tract infections
  • Spontaneous abortions
  • Salpingitis: inflammation of Fallopian tubes
  • Bacteremia: Presence of bacteria in the bloodstream

What are the complications if you are pregnant?

There is a higher correlation of:

  • preterm birth
  • low weight in newborns
  • Post partum endometritis
  • premature membrane rupture that can lead to: 1) chorioamnionitis, also known as the infection of the intramniotic and chorionic membranes that protect the fetus. (Amniotic liquid) and 2) Olygohidramnios: which is the decrease of the amniotic liquid that gives support and protects your fetus.

When should I visit a doctor?

You should make an appointment with your doctor if you

  • notice that your vaginal discharge is different in color and or smell
  • presence of fever
  • you’ve tried over the counter medicines and symptoms are still persistent
  • if you present the symptoms and have a new sexual partner
  • if you have had vaginal infections in the past but this time it appears different
  • if you are pregnant or plan to get pregnant
  • if you are breastfeeding
  • if you experience abdominal or pelvic pain

How to make a proper diagnosis?

To confirm the clinical diagnose, different studies will be made, including laboratory studies, and a vaginal physical examination.

What should you expect when you visit a doctor?

  • Your GP will make questions about the starting period of your symptoms and signs, when did you notice the vaginal discharge, if you have had a new sexual partner or the number of sexual partners, if you have had previous vaginal infections or sexually transmitted diseases. He/she will also ask if you are pregnant or planning to have a baby.
  • A Pelvic exam will be made. The doctor will look for signs of infection, while wearing sterile gloves, she or he will insert two fingers into your vagina at the same time with the other hand will apply pressure to your abdomen to look for signs that will confirm the diagnosis. An amount of your secretion will be taken to examine the vaginal discharge and confirm the presence of clue cells through the microscope.

Confirmation of clinical diagnose should include three out of four important criteria

  • vaginal fluid pH >4.5
  • Whiff test: fish like odor of the vaginal discharge after adding 10% of KOH (potassium hydroxide solution)
  • presence of clue cells in microscopic examination taken from a swab or a small plastic loop taken from a routine Papanicolaou or “Pap smear”
  • presence of thin, white to gray discharge that covers the vaginal wall.

What is the management and treatment for Bacterial Vaginosis (BV)?

Oral antibiotics or vaginal suppositories are the most common form of therapy for bacterial vaginosis (BV), but asymptomatic women do not necessarily need treatment. Pregnant women should always get treatment even if they do not present the symptoms.

What type of medications are out there in the market?

Some of the medications include:

Metronidazole 500 mg Metronidazole 500 mg Metronidazole 7.5 mg/g 40 g
Dose: Orally, twice a day for 7 days Dose: One single oral dose of 2 gm Dose: 1 vaginal tube once day for 5 days, preferably at night.
Most effective, used in pregnant women after first trimester, or breastfeeding women. Recurrence of disease is more common Take hygienic precautions before using this product. Wash your hands thoroughly before using it. Place the disposable applicator on to the tube and fill it. Insert the tube inside the vagina, and empty the gel. Dispose the empty tube and applicator.
Avoid alcohol consumption during and 48 hours after finishing treatment. Use with caution if you have a history of heart, renal or hepatic failure, and H. pylori infection, evidence of agranulocytosis, leukopenia and or neutropenia. May cause gynecomastia with chronic use. Discontinue use if you present neurological symptoms such ataxia, confusion or dizziness.
Be sure to tell your doctor if you are taking dronabinol, fibanserin or lomitapide

Secnidazole (Solosec)
Dose: Orally, 2 g of granules, one dose. Preferably sprinkle granules in applesauce or yogurt
Adverse Effects: Abdominal pain, diarrhea, vomiting, nausea, headache, vulvovaginal pruritis

Clindamycin (75mg, 150mg 300mg) Clindamycin 2% vaginal cream as phosphate
Dose: 300 mg Orally twice a day for 7 days Dose: 1 vaginal tube once day for 7 days, preferably at night
Adverse Effects: Abdominal pain, agranulocytosis, diarrhea, Stevens-Johnson Syndrome, rashes, Urticaria, neutropenia, polyarthritis, thrombocytopenia, hypotension Take hygienic precautions before using this product. Wash your hands thoroughly before using it. Place the disposable applicator on to the tube and fill it. Insert the tube inside the vagina, and empty the cream. Dispose the empty tube and applicator.
Pregnancy: Used after first trimester, not recommended while breastfeeding. Pregnancy: It is not recommended during the first trimester of pregnancy.

Alternative Regimens:

Tinidazole Tinidazole Clindamycin
Dose: 2 g orally once a day for 2 days Dose: 1 g orally once a day for 5 days Dose: 100 mg Ovules. Vaginally once a day before bedtime for 3 days
Precautions: Avoid sexual contact during treatment and use of latex or contraceptive diaphragms 72 hours after treatment.

When should you stop taking the medication?

Always take the medication as prescribed by your doctor. Never stop the regimen just because you fell better or your discharge has stopped. This will lead to recurrent bacterial vaginosis or bacterial antibiotic resistance that will lead to complications.

What should you do if you took the medicine and the symptoms didn’t disappear?

Recurrent symptoms after 3 months are common in around 30% of women who suffer from bacterial vaginosis and 50% of women may present it in the upcoming 6 months. A 7 day oral or vaginal cream treatment may be used. Either Metronidazole or Clindamycin should work, with the only exception that if the first time you took metronidazole orally, next time change the treatment to Clindamycin in cream prospective and vice-versa. Be sure to visit your doctor if you present more than three bacterial vaginosis episodes in between 12 months, since the treatment will have to change.

Can Bacterial Vaginosis be treated with home remedies?

There is no over the counter medicine that has been approved by the medical board, but there are recent studies that suggest that the use of probiotics may be used while taking counter medicines to help restore the growth of lactobacilli and protect the vaginal flora.

What should you do to prevent having a bacterial vaginosis BV?

To prevent having a bacterial vaginosis, you have to make certain life style changes that put you to risk from suffering from this disease.

  • Always practice safe sex
  • Avoid having multiple sexual partners
  • Avoid using vaginal douches, perfumed soaps or detergents
  • Use other birth control methods instead of IUD (intrauterine device)
  • Avoid synthetic fabric underwear
  • Use hypoallergenic bar soaps

Should my sexual partner be treated as well if I was diagnosed with BV?

It is not necessary for your sexual partner to be treated if he/she does not present any symptoms, so no prophylactic treatment is necessary for this.

Should you be tested for other sexually transmitted diseases?

Since bacterial vaginosis tends to increase the percentage of acquiring a sexually transmitted disease it is recommended for women to be tested for other infections such as gonorrhea, chlamydia, herpes simplex virus (HSV) and HIV depending on the life style habits and risk factors present in the patient. It is important to know that chronic use of metronidazole or clndamycin may alter the flora found in the vagina which may lead to a predisposition to vaginal candidiasis. 

What should you do if you are already diagnosed with HIV and suffer a bacterial vaginosis?

Always consult your general physician if you suffer from a chronic disease. The same treatment is used for all patients, but according to the evolution of your previous disease, your doctor might decide to use a different therapeutic regimen. 

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