By Dr. Rachel Villanueva
Should you be concerned about bacterial vaginosis (BV)? The short answer to this question is yes. BV is common and if left untreated can increase other health complications, but no because it can be effectively treated and new treatment options that may make it easier are on the horizon. Well, what exactly does that mean, you wonder?! While quite common, bacterial vaginosis is an important health issue disproportionately impacting African-American women. Educating yourself about the signs and symptoms is your best tool for staying healthy.
Bacterial vaginosis is the most common gynecologic infection. It is caused by an imbalance of the normally occurring vaginal bacteria and an overgrowth of other pathogenic or “bad” bacteria. You may have symptoms of a strong, unpleasant vaginal odor or thin, greyish discharge, as well as pain and itching. Though 21 million women are affected with BV annually, only 4 million receive treatment despite available options. It is important that women understand that left untreated, this seemingly simple infection can have significant and lasting consequences for their vaginal, reproductive, and overall health including increased risk of contracting sexually transmitted infections (STIs) including HIV, pelvic inflammatory disease, surgical complications, and adverse pregnancy outcomes. BV is not a sexually transmitted infection, but sexual activity and number of sex partners can impact its prevalence. Inadequate washing is not a cause of BV, though a commonly held misconception. Finally, bacterial vaginosis can affect your quality of life, cause unnecessary anxiety, and lead to limited intimate relations with your partner. Partner awareness and education is important, so keep them informed.
As with many health issues, racial disparities play a significant role in the prevalence of BV. It affects one-quarter of white women, half of African-American women, and one-third of Hispanic women. Given the potential for long-term consequences, African-American women should stay particularly informed regarding BV. Research studies have suggested that the prevalence of bacteria, particularly those associated with bacterial vaginosis, vary among different racial groups. Bacteria associated with BV have been shown to occur in higher incidences among Hispanic and African-American women. Additionally, It is well known that bacterial vaginosis results in a loss of normally occurring lactobacilli or “good bacteria.” Though requiring further evaluation, some studies have also suggested the predominance of certain lactobacillus in white women that support a healthier vaginal environment, as opposed to the lactobacilli found in African-American women.
While available treatments for other vaginal infections, such as yeast, include a convenient one-day, single dose option, treatment for BV is more involved. Currently, BV treatments options include either a 7-day oral medication or 5-day vaginal gel. Challenges to these options include tolerability, duration, and ease of use. Side effects can include nausea, gastrointestinal discomfort, metallic taste, and limitation of no alcohol consumption while taking the oral antibiotic. These unpleasant side effects can also lead to decrease compliance with the full course of medication and increased risk of recurrence. With challenges to current prescription options, women may turn to ineffective home remedies. Douching, a common practice among Black women, may worsen symptoms and has been implicated as an independent risk factor of bacterial vaginosis. Fortunately, new treatments may become available that will offer a simple, effective solution for BV with a short course of treatment and good tolerability.
If you think you may have BV, DON’T panic and NEVER self-diagnose. Remember, bacterial vaginosis is simply an imbalance in vaginal bacteria experienced by many women. Common misconceptions about BV exist but must be dispelled. So, NEVER feel stigmatized about bacterial vaginosis. It is however, important that you make an appointment with your OB/GYN or other health care provider if you have an abnormal vaginal discharge. Many vaginal infections, including some that are sexually transmitted, can have similar symptoms as BV, yet require much different treatment. Since we are at greater risk, African-American women should obtain proper diagnosis, treatment, and follow-up to maintain good vaginal and overall health. Please don’t be embarrassed by the diagnosis of BV and keep the lines of communication open with your health care provider. ALWAYS stay informed and educated to ensure you maintain well balance vaginal health.
Rachel Villanueva, MD FACOG, is affiliated with the ROSH Maternal Fetal Medicine and is a clinical assistant professor of OB/GYN at the NYU School of Medicine.