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Something’s Fishy

Bacteria overgrowth

A common condition that brings many patients to my clinic with symptoms like abnormal vaginal discharge and unpleasant vaginal odour, is bacterial vaginosis. In the past, the condition was called Gardnerella vaginitis, after the bacteria that were thought to cause the condition. However, the newer name, bacterial vaginosis, reflects the fact that there are a number of species of bacteria that naturally live in the vaginal area and may grow to excess. The Gardnerella organism is not the sole culprit causing the symptoms. When these multiple species of bacteria become imbalanced, a woman can have a vaginal discharge with a ‘fish smelling’ foul odor.

Bacterial vaginosis is an infection of the vagina, caused by an overgrowth of normal bacteria in the vagina. The reason I say “normal” bacteria is because the vagina normally contains “good” bacteria, which helps keep the body’s immune system in balance. However, there are conditions that can lead to the normal balance of bacteria being disrupted and replaced by other “bad” bacteria.

Bacterial vaginosis is the most common vaginal infection in women of reproductive age. It is not a dangerous infection but it can cause symptoms that disrupt a woman’s quality of life. Fortunately, it is a condition that is easily treated by your doctor.

How does it occur

Scientists have determined that this form of infection is not caused by a single bacteria alone, but a combination of multiple bacteria in the vagina. There are certain factors that could increase your risk of developing this bacterial imbalance. If you have multiple or new sexual partners, you may be at increased risk.

However, it is not a sexually transmitted infection, so women who have not had sexual intercourse or in a monogamous relationship can also get bacterial vaginosis. Vaginal douching (rinsing the vagina with liquids) and cigarette smoking are two practices known to increase the risk of developing this bacterial infection.

To correct some common misconceptions, bacterial vaginosis does not occur from using common toilet seats, bedding, swimming pools, or from touching objects around them.

What are the symptoms?

The most common symptom of bacterial vaginosis is abnormal vaginal discharge, accompanied by an unpleasant odour. A certain amount of vaginal discharge is normal in every woman, but you should be on the lookout for discharge that is more than usual, especially after sexual intercourse. It may have a thin texture and is grey-ish white in colour.

For some women, the discharge may also smell unpleasant, carrying a fishy odour. Other symptoms include burning during urination or itching around the outside of the vagina. Bacterial vaginosis may also occur without any symptoms at all. There may also be instances where the above symptoms are actually due to other, more serious, infections so it is always important to go for a medical check-up.

At the clinic

When you see your doctor with the above symptoms, he or she will make sure that you don’t have other serious conditions, by checking that you don’t have a fever, pelvic pain or a history of sexually-transmitted infections.

The doctor will also perform a pelvic exam, to check the condition of your vaginal lining, cervix, ovaries and uterus. During the pelvic exame, the doctor can take a swab of the vaginal lining to check for Chlamydia or gonorrhea infection.

Vaginal infections can also be caused by other pathogens, so the doctor may also want to examine the vaginal discharge to make sure that it is not yeast vaginitis (candidiasis) or trichomonas (a type of sexually transmitted infection) to ensure that the right treatment is given.

Bacterial vaginosis can resolve completely without complications if it is properly treated. As it is caused by bacteria, antibiotics are the best course of action. The more commonly used antibiotics – metronidazole and clindamycin – are given in pill form, or a gel or cream that is applied to the vagina.

The antibiotic pills may produce some minor side effects, while the gels may cause yeast vaginitis to occur as a side effect. Some of my patients come back to my clinic with a recurrence of bacterial vaginosis even though the antibiotics worked in treating the first infection. This is perfectly normal, although the cause is not understood. When this happens, doctors will prescribe another course of antibiotics.

Preventing complications

Bacterial vaginosis is nothing to be unduly alarmed about, but neither should it be ignored, especially in pregnant women. If the infection occurs during pregnancy, it can cause premature labour, premature birth, infection of the amniotic fluid, and infection of the uterus after delivery.

The potential complications of bacterial vaginosis in non-pregnant women include an increased risk to HIV infection if exposed to the virus, increased risk of transmitting HIV through sexual intercourse, increased risk of developing an infection following a surgical procedure, and increased risk of other sexually transmitted diseases such as herpes, chlamydia and gonorrhea.

Like any other bacterial infections, bacterial vaginosis is very common and very easily treated. So don’t let it get to a point where complications may occur.