Bacterial Vaginosis ("Gardnerella")
Essential facts
Bacterial vaginosis is caused by excessive bacteria that
may normally be present in the vagina. When these bacteria are present in
large numbers, they may cause symptoms such as a discharge or odour. One
such bacterium is Gardnerella vaginalis, hence another common name
for the condition: Gardnerella vaginitis.
Symptoms
Normal vaginal secretions may change to a watery, pearly
grey discharge. There may be a strong odour from the vagina, and the smell
may be worse after unprotected sex. However, these symptoms are not always
present.
A woman has bacterial vaginosis only if she has:
- overgrowth of vaginal bacteria
and
- vaginal discharge or odour
If both are present, treatment is required.
Diagnosis
During a medical examination, the doctor may notice a
discharge and/or odour (sometimes, even when the woman has not noticed any
symptoms). The vaginal fluid may be more alkaline than usual.
Swabs taken from the vagina during the examination may
show many bacteria resembling Gardnerella.
Transmission
It is not clear whether bacterial vaginosis is sexually
transmitted, but it can be associated with other sexually transmitted
diseases. It is more common in women with multiple sexual partners and it
often develops soon after intercourse with a new partner. Bacterial
vaginosis is relatively common among women with female partners, where the
condition may be triggered by the insertion of fingers or shared sex toys.
There is no condition equivalent to bacterial vaginosis
in men. Bacterial vaginosis can occur in monogamous relationships, and it
can occur even when the woman’s partners always use condoms.
So, it seems that a sexual partner doesn’t
"give" a woman bacterial vaginosis, but it occurs as a result of
sexual contact.
Treatment
If a woman has no symptoms, even if Gardnerella
is present in the vagina, usually no treatment is required.
Treatment may be necessary when:
- the woman has symptoms, or the doctor has noticed
signs of bacterial vaginosis and bacteria including Gardnerella are
present,
- the woman is about to have a medical procedure which
could allow bacteria into the uterus,
- the woman is pregnant (In this case, an obstetrician
may need to be consulted about treatment).
Metronidazole
Treatment is usually metronidazole (Flagyl)
tablets, taken for five days.
-
Do not drink alcohol during treatment or for 3 days
afterwards, or you may get a severe hangover.
-
Metronidazole may cause nausea or an upset stomach.
Taking the tablets after meals can reduce these effects.
-
Some people notice an unusual taste in the mouth
while taking metronidazole. This taste resolves when the antibiotic
course is completed.
Other treatments
If someone is unable to take metronidazole, other
treatments are available. These may not be as effective as metronidazole,
but usually have fewer side effects.
-
Tinidazole (Fasigyn)
tablets are taken as a single dose.
The side effects may be similar to those of metronidazole.
-
Clindamycin (Dalacin V) vaginal cream
is available from pharmacies with a prescription. This cream is used
nightly for 7 days.
-
Miconazole (Monistat)
vaginal pessaries are an effective
treatment for vaginal thrush, but also have some activity against
bacterial vaginosis. They are available from Clinic 275 or from
pharmacies without a prescription. Insert one pessary each night for 7
nights.
-
Aci-jel vaginal cream alters the acidity of
the vagina, making it more difficult for bacterial vaginosis organisms
to multiply. This cream is available from pharmacies without a
prescription.
Recurrences
If the symptoms of bacterial vaginosis return within a
few weeks of treatment, it may mean the original infection is active
again. A recurrence several months after treatment may be due to
reinfection.
Some women experience repeated cases of bacterial
vaginosis. The reason for this is not known, and there is no known
treatment for eradicating the condition. Sometimes changing from one
treatment to another (e.g. from metronidazole to clindamycin) is helpful.
Treating the partner of an infected woman does not seem
to prevent recurrences.
Prevention
It is not clear how women get bacterial vaginosis. While
some cases occur without sexual exposure, most cases appear to be
associated with sexual activity.
Although no infection like bacterial vaginosis is found
in men, using condoms may provide some protection because semen may make
the vagina more alkaline. Condoms will also protect against other sexually
transmitted infections.
Any sex toys which are inserted into the vagina should
not be shared. |
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