Bacterial vaginosis (BV) is a common vaginal infection. Research suggests it is a polymicrobial syndrome, a condition caused by the presence of multiple microorganisms. In the case of BV, the composition of the vagina microbiome shifts from one that is optimal, abundant in protective Lactobacillii, to one that is non-optimal, or a reduction in the beneficial microbes and an increase in less favourable strict anaerobes, such as Gardnerella vaginalis[i], Atopobium vaginae and Prevotella spp[ii]. Although preventable, many women are prone to recurrent infection, with approximately 80%[iii] experiencing BV just three months after effective treatment[iv]. In this article, we take a closer look at what BV is and what you can do to stop it coming back.
What is bacterial vaginosis?
The vaginal microbiome is predominantly made up of lactic acid bacteria. Alongside other resident vaginal species, these bacteria help to promote an acidic environment which protects the area against pathogens.
However, bacterial vaginosis occurs when there is an imbalance in the acidic environment, caused by a reduction in the abundance of lactic acid bacteria and a rise in less favourable microbes.
Bacterial vaginosis symptoms include:
· Abnormal, thin grey-white vaginal discharge,
· Discharge that has a strong fish-like smell, especially after sex or during menstruation[i]
· Pain, itching, or burning sensation in the vagina
· Itching around the outside of the vagina
· Burning sensation when peeing[ii]
However, some women may not experience any symptoms.
Why do I keep getting bacterial vaginosis?
Let’s take a look at some of the factors that can contribute to recurring BV.
Bacterial vaginosis is not a sexually transmitted infection (STI), but it can increase your risk of catching an STI, like chlamydia. Sex is a common risk factor[iii] for BV infection, although doctors do not fully understand the link. However, the infection commonly occurs in women who have multiple sexual partners or who have a new sexual partner. One study published in 2011 found that semen exposure was associated with BV[iv].
Some women find that recurrent episodes of BV occur around menstruation. According to the National Institute for Health and Care Excellence (NICE) and studies of Prof. J. Sobel[v], [vi], menstruation is a contributing factor for BV infection[vii].
That’s because your menstrual cycle can affect the balance of vaginal bacteria. During menstruation, the abundance of Lactobacilli naturally falls, enabling pathogens, like Gardnerella to overgrow. That’s because Gardnerella gain iron, an essential factor for the growth of many bacteria, from menstrual discharge, promoting a comfortable environment to thrive[viii]. In women who have a healthy immune system, the balance recovers after menstruation. However, there are some confounding factors that can mean the balance doesn’t recover, including:
· Hormonal contraception
· Hormonal therapy
· Weak immune system
· Menstrual or sanitary products.
Recurrence of BV happened within the first 10 days after a period in 83% of cases[ix]. Interestingly, hormonal contraception reduces the recurrence of BV, which is thought to be because women using this contraception have lighter periods.
Some women believe their sanitary products may also be a contributory factor to recurrent infection.
Even though any woman can get bacterial vaginosis, those who use an intrauterine device (IUD) are at greater risk[x]. A 2012 study demonstrated two strong factors for the development of the infection:
1. Intermediate flora at the time the IUD was fitted
2. Irregular bleeding during the first 6 months of contraceptive use
The researchers found that women fitted with an IUD who experienced irregular bleeding were twice as likely to develop bacterial vaginosis, and that irregular vaginal bleeding could be a cause of BV in women who use an IUD as their preferred method of contraception[xi]. More recent studies have concluded that copper IUD use increased the risk of bacterial vaginosis infection but more research is needed to define the cause[xii][xiii].
As well as other adverse health effects, smoking is also strongly associated with BV and other vaginal infections[xiv]. That’s because the immune system will become less effective at fighting infections and it’s possible that smoking can change the composition of the vaginal microbiome.
3 ways to stop BV coming back
If you’ve been diagnosed with BV in the past or more recently, it’s likely your doctor will have prescribed antibiotics, but for many women BV will come back.
Here are three things you can do to prevent its recurrence.
1. Use condoms
Vaginal exposure to semen can disrupt the balance in your vaginal microbiome[xv] and having multiple sexual partners can also be a high-risk factor. So, using condoms every time you have sex could prevent BV from coming back. Don’t forget condoms are the best way to prevent the transmission of STIs.
2. Maintain good vaginal hygiene
Keeping the area around your vagina clean and fresh, doesn’t require much effort, and it certainly doesn’t require any perfumed soaps or cleansers. Instead, gently rinsing the area around your vagina with clean, warm water will usually suffice.
You should also:
· Avoid douching
· Change sanitary products regularly (try to keep shorter periods between changing)
· Always wipe from front to back to stop the spread of germs to your vagina
3. Sign up for Avodes' subscription service and be among the first to receive news and updates about Avodes launch dates.
Avodes is a new antibiotic-free treatment for both bacterial vaginosis and candidiasis. It is a unique medical device that inhibits pathogens that contribute to the development of infection. Avodes is impregnated with a biotechnological solution and will be used for infection treatment. It will also be used for your next 2-3 periods to restore the healthy balance of your vaginal microbiome during menstruation. This will prevent the infection coming back and help you to live your life without discomfort. Avodes usage during the menstruation, will free you from the use of messy and inconvenient suppository based treatment.
Be one of the first to try it, and sign up today.
A quarter of women are diagnosed with bacterial vaginosis every year, and 80% of them experience recurrence. But there are things women can do to help prevent the infection coming back, like maintaining good feminine hygiene, using condoms during sex, and of course, signing up to Avodes.
[i] Kairys N, Garg M. Bacterial Vaginosis. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459216/ [ii]STD facts - bacterial vaginosis (2022) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm (Accessed: April 9, 2023). [iii] Mayo Clinic. Bacterial Vaginosis https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/symptoms-causes/syc-20352279 [v] Jack D Sobel et al. Conventional oral and secondary high dose vaginal metronidazole therapy for recurrent bacterial vaginosis: clinical outcomes, impacts of sex and menses. Infect Drug Resist. 2019; 12: 2297–2307. Published online 2019 Jul 24. doi: 10.2147/IDR.S213853 [vi] J. Sobel et al. Prognostic Indicators of Recurrence of Bacterial Vaginosis. J Clin Microbiol. 2019 May; 57(5): e00227-19.Published online 2019 Apr 26. Prepublished online 2019 Mar 6. doi: 10.1128/JCM.00227-19 [vii] What factors contribute to the development of bacterial vaginosis? (2018) NICE. Available at: https://cks.nice.org.uk/topics/bacterial-vaginosis/background-information/contributing-factors/ (Accessed: April 9, 2023). [viii] Srinivasan, S., Liu, C., Mitchell, C. M., Fiedler, T. L., Thomas, K. K., Agnew, K. J., Marrazzo, J. M., & Fredricks, D. N. (2010). Temporal variability of human vaginal bacteria and relationship with bacterial vaginosis. PloS one, 5(4), e10197. https://doi.org/10.1371/journal.pone.0010197 [ix] Sobel, J. D., Kaur, N., Woznicki, N. A., Boikov, D., Aguin, T., Gill, G., & Akins, R. A. (2019). Conventional oral and secondary high dose vaginal metronidazole therapy for recurrent bacterial vaginosis: clinical outcomes, impacts of sex and menses. Infection and drug resistance, 12, 2297–2307. https://doi.org/10.2147/IDR.S213853 [x] The facts - bacterial vaginosis (BV) (2015) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/std/bv/the-facts/default.htm (Accessed: April 11, 2023). [xi] Madden T, Grentzer JM, Secura GM, Allsworth JE, Peipert JF. Risk of bacterial vaginosis in users of the intrauterine device: a longitudinal study. Sex Transm Dis. 2012 Mar;39(3):217-22. doi: 10.1097/OLQ.0b013e31823e68fe. PMID: 22337109; PMCID: PMC3285477. [xii] Peebles, K., Kiweewa, F. M., Palanee-Phillips, T., Chappell, C., Singh, D., Bunge, K. E., Naidoo, L., Makanani, B., Jeenarain, N., Reynolds, D., Hillier, S. L., Brown, E. R., Baeten, J. M., Balkus, J. E., & MTN-020/ASPIRE study team (2021). Elevated Risk of Bacterial Vaginosis Among Users of the Copper Intrauterine Device: A Prospective Longitudinal Cohort Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 73(3), 513–520. https://doi.org/10.1093/cid/ciaa703 [xiii] Achilles, S. L., Austin, M. N., Meyn, L. A., Mhlanga, F., Chirenje, Z. M., & Hillier, S. L. (2018). Impact of contraceptive initiation on vaginal microbiota. American journal of obstetrics and gynecology, 218(6), 622.e1–622.e10. https://doi.org/10.1016/j.ajog.2018.02.017 [xiv] Nelson, T.M. et al. (2018) “Cigarette smoking is associated with an altered vaginal tract metabolomic profile,” Scientific Reports, 8(1). Available at: https://doi.org/10.1038/s41598-017-14943-3. [xv] Gallo, M.F. et al. (2011) “Association between semen exposure and incident bacterial vaginosis,” Infectious Diseases in Obstetrics and Gynecology, 2011, pp. 1–10. Available at: https://doi.org/10.1155/2011/842652. [i] InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Bacterial vaginosis: Overview. 2015 Apr 22 [Updated 2018 Aug 9]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK298829/ [ii] Vodstrcil, L. A., Muzny, C. A., Plummer, E. L., Sobel, J. D., & Bradshaw, C. S. (2021). Bacterial vaginosis: drivers of recurrence and challenges and opportunities in partner treatment. BMC medicine, 19(1), 194. https://doi.org/10.1186/s12916-021-02077-3 [iii] Makella S Coudray, Purnima Madhivanan Bacterial Vaginosis – A Brief Synopsis of the Literature. Eur J Obstet Gynecol Reprod Biol. 2020 Feb; 245: 143–148. Published online 2019 Dec 24. doi: 10.1016/j.ejogrb.2019.12.035 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989391/ [iv] Coudray, M. S., & Madhivanan, P. (2020). Bacterial vaginosis-A brief synopsis of the literature. European journal of obstetrics, gynecology, and reproductive biology, 245, 143–148. https://doi.org/10.1016/j.ejogrb.2019.12.035
 Makella S Coudray, Purnima Madhivanan Bacterial Vaginosis – A Brief Synopsis of the Literature. Eur J Obstet Gynecol Reprod Biol. 2020 Feb; 245: 143–148. Published online 2019 Dec 24. doi: 10.1016/j.ejogrb.2019.12.035 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989391/