Bacterial vaginosis (BV) is a disease of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur. Itching is uncommon. Occasionally there may be no symptoms.Having BV approximately doubles the risk of infection by a number of other sexually transmitted infections including HIV/AIDS. It also increases the risk of early delivery among pregnant women. BV is caused by an imbalance of the naturally occurring bacteria in the vagina. There is a change in the most common type of bacteria and a hundred to thousandfold increase in total numbers of bacteria present. Typically bacteria other than Lactobacilli become more common.Risk factors include douching, new or multiple sex partners, antibiotics, and using an intrauterine device among others. However, it is not considered a sexually transmitted infection. Diagnosis is suspected based on the symptoms and may be verified by testing the vaginal discharge and finding a higher than normal vaginal pH and large numbers of bacteria. BV is often confused with a vaginal yeast infection or infection with Trichomonas. Usually treatment is with an antibiotic, such as clindamycin or metronidazole. These medications may also be used in the second or third trimesters of pregnancy. However, the condition often recurs following treatment. Probiotics may help prevent re-occurrence. It is unclear if the use of probiotics or antibiotics affects pregnancy outcomes.

BV is the most common vaginal infection in women of reproductive age. The percentage of women affected at any given time varies between 5% and 70%.BV is most common in parts of Africa and least common in Asia and Europe. In the United States about 30% of women between the ages of 14 and 49 are affected. Rates vary considerably between ethnic groups within a country. While BV like symptoms have been described for much of recorded history, the first clearly documented case occurred in 1894. Common symptoms include increased vaginal discharge that usually smells like fish. The discharge is often white or gray in color. There may be burning with urination. Occasionally there may be no symptoms. The discharge coats the walls of the vagina, and is usually without significant irritation, pain, or erythema (redness), although mild itching can sometimes occur. By contrast, the normal vaginal discharge will vary in consistency and amount throughout the menstrual cycle and is at its clearest at ovulation—about 2 weeks before the period starts. Some practitioners claim that BV can be asymptomatic in almost half of affected women, though others argue that this is often a misdiagnosis. Healthy vaginal microbiota consists of species which do not cause symptoms, infections, or negatively affect pregnancy. It is dominated mainly by Lactobacillus species. BV is defined by the disequilibrium in the vaginal microbiota with decline in the number of lactobacilli. While the infection involves a number of bacteria, it is believed that most infections start with Gardnerella vaginalis creating a biofilm which allows other opportunistic bacteria to thrive. One of the main risks for developing BV is douching, which alters the vaginal flora and predisposes women to developing BV.[20] Douching is strongly discouraged by the U.S. Department of Health and Human Services and various medical authorities, for this and other reasons. BV is a risk factor for pelvic inflammatory disease, HIV, sexually transmitted infections (STIs), and reproductive and obstetric disorders or negative outcomes. It is possible for sexually inactive persons to develop bacterial vaginosis. Bacterial vaginosis may sometimes affect women after menopause. Subclinical iron deficiency may correlate with bacterial vaginosis in early pregnancy. A longitudinal study published in February 2006 in the American Journal of Obstetrics and Gynecology showed a link between psychosocial stress and bacterial vaginosis persisted even when other risk factors were taken into account. Exposure to the spermicide nonoxynol-9 does not affect the risk of developing bacterial vaginosis. Having a female partner increases the risk of BV by 60%. The bacteria associated with BV have been isolated from male genitalia. BV microbiota has been found in the penis, coronal sulcus, and male urethra, in the male partners of infected females. Those uncircumcised partners may act as a ‘reservoir’ increasing the likelihood of acquiring an infection after sexual intercourse. Another mode of transmission of the BV-associated microbiota is to a female sexual partner via the skin-to-skin transfer. BV may be transmitted via the perineal enteric bacteria from the microbiota of the female and male genitalia. To make a diagnosis of bacterial vaginosis, a swab from inside the vagina should be obtained. These swabs should be tested for: A characteristic fishy odor on wet mount. This test, called the whiff test, is performed by adding a small amount of potassium hydroxide to a microscopic slide containing the vaginal discharge. A characteristic fishy odor is considered a positive whiff test and is suggestive of bacterial vaginosis. Loss of acidity. To control bacterial growth, the vagina is normally slightly acidic with a pH of 3.8–4.2. A swab of the discharge is put onto litmus paper to check its acidity. A pH greater than 4.5 is considered alkaline and is suggestive of bacterial vaginosis. The presence of clue cells on wet mount. Similar to the whiff test, the test for clue cells is performed by placing a drop of sodium chloride solution on a slide containing vaginal discharge. If present, clue cells can be visualized under a microscope. They are so-named because they give a clue to the reason behind the discharge. These are epithelial cells that are coated with bacteria. Two positive results in addition to the discharge itself are enough to diagnose BV. If there is no discharge, then all three criteria are needed. Differential diagnosis for bacterial vaginosis includes the following: Normal vaginal discharge. Candidiasis (thrush, or a yeast infection). Trichomoniasis, an infection caused by Trichomonas vaginalis. Aerobic vaginitis The Center For Disease Control (CDC) defines STIs as a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity. But the CDC does not specifically identify BV as sexually transmitted infection. Treatment is typically with the antibiotics metronidazole or clindamycin. They can be either given by mouth or applied inside the vagina. About 10% to 15% of people; however, do not improve with the first course of antibiotics and recurrence rates of up to 80% have been documented. Recurrence rates are increased with sexual activity with the same pre-/posttreatment partner and inconsistent condom use although estrogen-containing contraceptives decrease recurrence.When clindamycin is given to pregnant women symptomatic with BV before 22 weeks of gestation the risk of pre-term birth before 37 weeks of gestation is lower. Other antibiotics that may work include macrolides, lincosamides, nitroimidazoles, and penicillins. Bacterial vaginosis is not considered a sexually transmitted infection, and treatment of a male sexual partner of a woman with bacterial vaginosis is not recommended. Although previously considered a mere nuisance infection, untreated bacterial vaginosis may cause complications, such as increased susceptibility to sexually transmitted infections including HIV and pregnancy complications. It has been shown that HIV-infected women with bacterial vaginosis (BV) are more likely to transmit HIV to their sexual partners than those without BV. Diagnostic criteria for BV have also been associated with a female genital tract factor that induces expression of HIV. There is evidence of an association between BV and increased rates of sexually transmitted infections such as HIV/AIDS. BV is associated with up to a six-fold increase in HIV shedding. There is also a correlation between the absence of vaginal lactobacilli and infection by Neisseria gonorrhoeae and Chlamydia trachomatis. BV is a risk factor for viral shedding and herpes simplex virus type 2 infection. BV may increase the risk infection or reactivation of human papillomavirus (HPV). In addition, bacterial vaginosis an intercurrent disease in pregnancy may increase the risk of pregnancy complications, most notably premature birth or miscarriage. Pregnant women with BV have a higher risk of chorioamnionitis, miscarriage, preterm birth, premature rupture of membranes, and postpartum endometritis. BV is associated with gynaecological and obstetric complications. Data suggest an association between BV, tubal factor infertility, and pelvic inflammatory disease. Women with BV who are treated with vitro fertilization have a lower implantation rate and higher rates of early pregnancy loss. BV is the most common infection of the vagina in women of reproductive age. The percentage of women affected at any given time varies between 5% and 70%. BV is most common in parts of Africa, and least common in Asia and Europe. In the United States, about 30% of those between the ages of 14 and 49 are affected.Rates vary considerably between ethnic groups within a country.

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