Bacterial Vaginosis
What is Bacterial Vaginosis?
Bacterial vaginosis (BV) is a common condition caused by an imbalance in the vaginal microbiome.
In a healthy vagina, protective bacteria called Lactobacillus dominate the environment. These bacteria produce lactic acid, which keeps the vaginal pH low and helps prevent the growth of harmful organisms. In BV, Lactobacillus levels drop and other bacteria increase, including organisms such as: Gardnerella vaginalis, Atopobium vaginae, Prevotella species, Mobiluncus.
This shift in the vaginal ecosystem is known as vaginal dysbiosis. BV is not strictly classified as a sexually transmitted infection, but sexual activity can influence the vaginal microbiome and contribute to the condition.
Symptoms of Bacterial Vaginosis
Some women experience no symptoms at all. When symptoms occur, they may include: Thin grey or white vaginal discharge, a strong fishy odour, especially after sex, Vaginal discomfort or irritation.
Because symptoms can overlap with other conditions such as thrush or sexually transmitted infections, accurate diagnosis is important.
Why BV can keep coming back ?
Many women experience recurrent BV, where symptoms return after treatment.
This can happen because treatment often targets the bacteria causing symptoms but does not always restore the vaginal microbiome.
Factors that may contribute to recurrence include: Reduced levels of protective Lactobacillus, Biofilm-forming bacteria that are difficult to eradicate, Antibiotic disruption of the microbiome, New or current sexual partners, Hormonal changes & Underlying vaginal dysbiosis.
In some cases, women may experience years of recurrent symptoms, often receiving repeated courses of antibiotics without long-term resolution.
Possible complications of BV
BV is more than just a nuisance infection.
Research shows that vaginal dysbiosis can increase the risk of several important health issues.
These include:
Increased risk of sexually transmitted infections - BV is associated with higher susceptibility to: Chlamydia, Gonorrhoea, HIV, Herpes simplex virus
Fertility and conception - Changes in the vaginal microbiome may affect: sperm survival, embryo implantation, IVF outcomes
Pregnancy complications - BV during pregnancy has been linked with: preterm birth, premature rupture of membranes, miscarriage
Pelvic infections - BV can also increase the risk of pelvic inflammatory disease (PID) following procedures such as IUD insertion or abortion.
Conventional Treatment
BV is usually treated with antibiotics. Common treatments include: Metronidazole: Oral metronidazole tablets for 7 days or Intravaginal metronidazole gel or Clindamycin: Intravaginal clindamycin cream or oral antibiotics.
These treatments are effective at reducing the overgrowth of BV-associated bacteria. However, recurrence rates can be high because antibiotic treatment does not always restore the protective Lactobacillus bacteria that maintain vaginal health.
Integrative approach to BV
In my clinical practice, we take a microbiome-focused approach to recurrent vaginal symptoms.
1. Thorough clinical assessment A detailed consultation explores: symptom history, previous treatments, antibiotic use, sexual health history, hormonal factors, medications, lifestyle factors that may influence the microbiome.
2. Vaginal microbiome testing - Advanced testing can assess: bacterial diversity, levels of protective Lactobacillus species, dysbiotic organisms, patterns of vaginal microbiome imbalance.
This helps guide targeted treatment rather than repeated empirical therapy.
3. Targeted treatment may include: appropriate antibiotics when indicated, treatment of mixed infections, biofilm disruption strategies where relevant.
4. Microbiome restoration- After treating infection, the focus shifts to restoring vaginal microbial balance. This may involve:
targeted probiotic therapy, prebiotic dietary strategies to support beneficial bacteria, lifestyle approaches that support microbiome recovery.
Why a Microbiome approach matterz
Many women presenting with recurrent BV have often had: multiple courses of antibiotics, years of ongoing symptoms, consultations with several clinicians. In some cases, microbiome testing reveals a different underlying pattern of vaginal dysbiosis, which may require a more targeted treatment approach. When the underlying imbalance is addressed, many women experience significant symptom improvement and reduced recurrence.
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