Bacterial Vaginosis: Clinical Manifestations
Background: Women’s health can be equated with “the health of a society” and is distinct from that of men’s health because it can also be affected by a culture of silence and shame aside from biological factors and socioeconomic factors including lack of awareness/knowledge. These factors are major contributors in weakening our society w.r.t women’s health and disease prevention.
The ecology of normal vaginal microflora plays an important role in maintaining female reproductive health by extending protection against harmful micro-flora. However disruption of the above ecology makes the body vulnerable to infections and one such condition is bacterial vaginosis.
Bacterial Vaginosis (BV) is an unstable change in the vaginal microflora of human females in the age group of 15 to 44 years i.e. adolescents to adults (Bradshaw et al., 2016 and Madhivanan et al., 2008). In this condition, hydrogen peroxide producing Lactobacilli are replaced by other harmful anaerobic bacteria such as G. vaginalis, Mycoplasma hominis, Prevotella, Porphyromonas. Bacteroides also grow in large numbers. Lactobacilli plays a very important role in maintaining the acidic pH of the vagina (>4.5) by secreting hydrogen peroxide and it also helps in fighting vaginal harmful pathogens (Bradshaw et al., 2016). In simpler words, BV causes an imbalance in the ecology of natural and harmful vaginal bacteria. The condition is characterized by excessive and bizarre vaginal discharge also known as leucorrhoea.
If BV left undiagnosed and untreated, it can increase the risk of sexually transmitted infections (STIs) like HPV, HIV etc. (Madhivanan et al., 2008). Some of the known complications associated with BV include preterm delivery, tubal infertility, miscarriage, pelvic inflammatory disease (PID) and cervical intraepithelial neoplasia. It is generally harboured by the female partner. However upon association with other STI’s it can be transferred to male partner as well (Sobel et al., 2000 , Hodiwala et al., 2015 and Bradshaw et al., 2016).
As mentioned above, it is marked by excessive and bizarre vaginal discharge which is foul-smelling and greyish-white in colour. Vaginal pH also increases (>4.5) which disturbs the vaginal micro-flora severely. Other symptoms may include pain in the pelvic region, discomfort & Itching and burning in and around the genitalia, fever with nausea, increased vaginal discharge, pain or burning sensation during sexual intercourse and/or urination. These symptoms occur commonly in women of reproductive age (Rajamanoharan et al., 1999, Bradshaw et al., and Sobel et al., 2016) although some women do not show any symptoms at all. BV is more common among black Caribbean women in comparison to white women. (Rajamanoharan et al., 1999).
The exact causes are still unknown, although the risk factors which imbalances the vaginal microflora are: Vaginal douching i.e. washing or cleaning out the inside of the vagina with water or a mixtures of fluids, multiple sexual partners, antiseptic vaginal washes, scented soaps, sex toys, bubble baths, intrauterine devices, smoking, etc. (Rajamanoharan et al., 1999 and Bradshaw et.al., 2016). In lesbian couples, it can be easily transmitted through sexual contact (via vaginal secretion).
Diagnostic indicators are increased vaginal pH, discharge and foul smell. Vaginal secretion is analysed for the growth of anaerobes under a microscope. There aren’t any specific diagnostic tests available for BV and therefore it is diagnosed on the basis of symptoms only. As a result, it is mostly misdiagnosed, under-treated or over-treated (Sobel et al., 2000, Hodiwala et al., 2015, Truter et al., 2013 and Bradshaw et al., 2016). The need of the hour is therefore tools that enable early and accurate diagnosis of BV because even though it may start from basic symptoms, when untreated can lead to severe infections.
Treatment and Prevention:
Medicines are prescribed by the physician after careful observation and laboratory tests. BV is largely lifestyle and hygiene related. Therefore the disease can recur even after treatment in the absence of sustained lifestyle changes. (Joke et al., 2016).
Some measures that could be preventative are abstinence from multiple sexual partners and use of latex or polyurethane condoms for protection against STI’s. Avoiding vaginal douching, washing the vaginal region during bath with water or a mild soap is sufficient; no extra cleaning is required with special vaginal washes available commercially. Avoiding wearing excessively tights jeans or trousers on a regular basis and the use cotton panties.
If there is excessive vaginal discharge with a foul smell, pain while urination or sexual intercourse and/or pain in the pelvic area should be considered cause enough to see a doctor not just because they can be due to BV but also because they could also be associated with other infectious diseases which can be fatal.
Sarita Swami, M.Sc (Biosciences), Banasthali University, Rajasthan, India.
June 21, 2019
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