Is Bacterial Vaginosis (BV) an STI?

Key Takeaways

• BV is caused by an imbalance in the vaginal flora and is not an STI.
• Treatment is still necessary to prevent the infection from causing other health concerns, such as exposure to STIs or pregnancy complications.
• Antibiotics are typically prescribed to address a BV infection. Antifungal may be given if BV symptoms overlap with yeast infection.

Commonly affecting sexually active women, bacterial vaginosis (BV) is often debated as to whether it qualifies as a sexually transmitted infection (STI). The short answer is: No, BV isn’t an STI.

Why? Well, because STIs are infections that spread from external pathogens (e.g., bacteria, viruses, and parasites) through sexual contact. Meanwhile, BV develops due to an overgrowth of naturally occurring bacteria in the vagina. Even individuals who have never engaged in sexual activity can develop it.

Let’s break it down and explore why BV is different from an STI.

What is Bacterial Vaginosis (BV)?

Bacterial vaginosis (BV) is a condition where an overgrowth of naturally occurring bacteria happens in the vagina. When one of these bacteria, known as Gardnerella vaginalis, becomes dominant, it disrupts the floral balance and leads to bacterial infection in the vagina.

In a healthy vaginal environment, beneficial bacteria like Lactobacillus are present in much higher amounts. These bacteria help protect against harmful microbiomes by maintaining an acidic environment, with pH levels ranging between 3.8 and 4.5.

In cases of BV, the vaginal pH rises above 4.5, indicating a loss of microbiome balance. Gardnerella vaginalis typically thrives best within this more alkaline environment.

What Causes BV?

The main cause of BV is due to the loss of beneficial bacteria like Lactobacillus, which leads to an overgrowth of other microbiomes that can be harmful. There are several risk factors that increase the likelihood of this happening, including:

Sexual activity

Sexual contact can introduce new bacteria into the vaginal environment. While these bacteria aren’t classified as sexually transmitted infections (STIs), exposure to a partner’s natural microbiome can still disrupt your own.

Having unprotected sex with a new or multiple partners may increase the risk of developing BV. Your partner might not have an STI, but their microbiome is different from yours, which your body may react to as unfamiliar, leading to a shift toward a more alkaline pH level.

Feminine products

The use of certain feminine products like vaginal soaps, wipes, and douches are associated with bacterial infections like BV and yeast infection. Some of these products contain harsh ingredients that can eliminate beneficial bacteria like Lactobacillus, further creating an environment where other microbiomes like Gardnerella vaginalis and fungi thrive.

Unless recommended by your doctor, rinsing with running water is enough. The vagina has its own self-cleansing mechanism and generally doesn’t need added cleansing agents from the outside.

Wearing tight, non-breathable clothing

Tight, non-breathable clothing can easily trap sweat in, especially in a high-humidity climate. This further creates a warm and moist environment that allows bacteria responsible for BV to thrive and multiply.

Tight-fitting clothes also restrict airflow and increase friction in the vaginal area. This combination can potentially lead to irritation or inflammation, making it easier for harmful microbiomes to grow and trigger BV.

Intrauterine devices (IUDs)

The use of intrauterine devices (IUDs) as a birth control has been shown to increase the risk of developing BV in some women. For those with higher sensitivity, the body can treat IUD as a foreign body, which, in turn, triggers an imbalance inside of the vagina.

For some women, IUD strings can also irritate the vaginal walls. This can lead to inflammation and irritation, creating an environment that allows BV-related bacteria to thrive and multiply.

Smoking

Cigarettes contain harmful compounds that are not only carcinogenic (causing cancer), but also trigger a negative impact on the immune system. When the immune system is compromised, the body becomes less effective at maintaining the balance of the vaginal flora.

Studies have shown that smokers are more likely to have lower levels of Lactobacillus. This imbalance can make it easier for disruptive bacteria, like Gardnerella vaginalis, to overgrow and lead to BV.

Obesity

While obesity doesn’t directly cause BV, women who are obese or overweight have a higher risk of developing the infection. Excess body fat can lead to hormonal imbalances and chronic low-grade inflammation, both of which may disrupt the natural balance of vaginal bacteria.

In addition, increased skin folds and friction around the genital area can trap heat and moisture. This creates an ideal environment for harmful bacteria to thrive and upset the vaginal microbiome.

What are the symptoms of BV?

While most cases of BV are asymptomatic, there are several signs that may point to an infection. You may be experiencing BV if one or more of these symptoms of BV appear:

• Greyish-white vaginal discharge that is thin and watery
• Unusual discharge that smells strong and fishy, particularly after sex
• Consistent vaginal itching
• Burning sensation during urination

How to Prevent BV?

There are ways that you can relieve symptoms of BV and prevent the infection from coming back. These include:

Practise safe sex

Safe sex practices like using condoms and limiting the number of partners can lower your risk of BV. Condom helps prevent bacterial transmission as it acts as a barrier, while reducing the number of partners can decrease exposure to different bacteria that can upset the vaginal flora.

Choose loose-fitting clothes

Loose-fitting clothes give room for better air circulation, allowing sweat to dry up easily and preventing dampness from building up. As we previously discussed, warm and moist environments create the ideal conditions for BV-related bacteria to thrive, which is exactly what you want to avoid.

Opt for cotton underwear

Underwear made of natural fabric like cotton allows the area to breathe and helps absorb moisture, reducing the risk of dampness where harmful bacteria can thrive.

You should also change your underwear after physical activities. This can prevent bacterial growth and keep the area feeling fresh and balanced.

Keep the vaginal area dry

Keeping the vaginal area dry prevents moisture from building up, which makes an ideal environment for bacteria to grow and multiply. Make sure to pat dry the area gently using a microfibre towel or tissue after showering or using the toilet to maintain a healthy balance.

Wipe from front to back

While it might seem minor, the way that you wipe your private area helps lower the risk of BV infection. Make sure to wash the vaginal area first with running water before continuing to the back part, as this helps prevent bacteria from spreading from the anus to the vagina.

Talk to your doctor about birth control alternatives

If you’re using an IUD and experiencing recurrent BV, it’s worth consulting your doctor about other birth control options. Some women may be more sensitive to the copper IUD, which can trigger changes in vaginal pH or irritation that contributes to BV.

In this case, your doctor can help assess whether the IUD is causing your BV and recommend a better alternative that suits you better.

Take probiotics

Probiotics that contain Lactobacillus can help maintain or restore a healthy vaginal flora. By supplying beneficial bacteria to the body, these supplements may help offset the overgrowth of Gardnerella vaginalis, which is responsible for causing BV. 

Eat a healthy diet

A healthy, balanced diet rich in protein and fibre, promotes a stronger immune system and a more balanced vaginal flora. When your body is well-nourished, it’s better equipped to fight off infections, regulate pH levels, and support the growth of good bacteria that protect against BV.

Avoid smoking

Cigarettes contain harmful compounds that compromise your immune system and disrupt the natural balance of vaginal flora. Smoking has also been linked to a lower level of Lactobacillus, the beneficial bacteria that help protect against BV, making recurring infections more likely.

Getting Tested and Treated for BV

Experiencing unusual vaginal discharge, or one with fishy odour, is thin and watery, and causes constant itching, necessitates a screening for bacterial vaginosis. Getting a proper medical diagnosis early on allows for immediate remedy before the infection causes further concerns.

Ignoring the symptoms can be risky, as BV is associated with an increased risk of exposure to STIs and issues with pregnancy. On the other hand, attempting to self-medicate with over-the-counter medicines is ineffective, often leaving the infection to persist.

Treatments for BV

⚠️ Note: Avoid self-medicating with antibiotics, as there’s no way to confirm if the infection is truly BV without proper diagnosis. Taking the wrong medication increases the risk of mistreatment and contributes to antibiotic resistance, which can make future bacterial infections harder to treat.

Doctors typically prescribe antibiotics as the first-line treatment for BV. In some cases, they may also recommend combining antibiotics with antifungal medication, especially if BV occurs alongside a yeast infection.

Common treatments for BV include:

Metronidazole

Oral metronidazole is an antibiotic used to treat BV. It inhibits the growth of BV-related bacteria, preventing them from multiplying and causing an infection.

Metronidazole tablets for bacterial vaginosis are usually prescribed to finish over the course of 5-7 days. Make sure to follow your doctor’s instructions closely and complete the full course of medication, even if your symptoms improve before you finish the antibiotics.

Stopping antibiotics abruptly or without medical guidance can leave some bacteria alive, increasing the risk of recurrence and contributing to antibiotic resistance, which can make future infections harder to treat.

Anti-fungals

Bacterial vaginosis may overlap with thrush or yeast infection. That’s when doctors may combine antibiotics with antifungal medication like clotrimazole which can help eliminate yeast and relieve symptoms such as itching, unusual discharge, and irritation. 

What are the Risks of Untreated BV?

Beyond causing discomfort and affecting your overall well-being, BV infection that’s left untreated presents several health risks. Here’s what might happen:

• Higher risk of exposure to STIs. BV affects the vaginal microbiome in a way that makes it more susceptible to infections, including STIs like chlamydia, trichomoniasis, and HPV.
• Increased risk of developing urinary tract infections (UTI). While BV doesn’t directly cause UTI, disrupted vaginal microbiome can make it easier for harmful bacteria to travel to the urinary tract and trigger an infection.
• Higher risk of developing pelvic inflammatory disease (PID). Changes in the vaginal flora can create an environment where harmful bacteria grow and potentially affect the upper genital tract that leads to PID.
• Increased risk of pregnancy complications. BV during pregnancy is linked with a higher risk of preterm birth and low birth weight.

Can BV Come Back After Treatments?

Yes, BV can come back even after successful treatment. Recurrence is also common, especially if the underlying cause, such as exposure to the microbiome from multiple sexual partners or hormonal changes, isn’t addressed.

While it’s necessary to complete your prescribed treatment, reducing your risk of recurrence requires more than that. Make sure to follow good hygiene practices, such as using protection during sex, avoiding unnecessary feminine products and douching, and consider regular checkups if you’re more prone to recurrence.

Final Thoughts: Keep Your Reproductive Health in Check

Bacterial vaginosis isn’t a sexually transmitted infection, yet leaving it untreated can increase your risk of exposure to STIs such as chlamydia, trichomoniasis, or HPV. Changes in the vaginal microbiome can also affect the urinary tract, leading to urinary tract infection.

If you notice symptoms of BV, such as a thin, watery discharge with a fishy smell, it’s important to get checked as soon as possible. Doing so helps prevent the infection from worsening or causing other health concerns.

Here at Prologue Clinic, we aim to provide professional and non-judgmental women’s health screening. Whether you come in for vaginal infection checking, UTI test, or cervical cancer screening, we ensure respectful care and clear guidance for your peace of mind and well-being.

Keep your reproductive health in check. Schedule your appointment today.

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