February 18, 2017 Liza Colimon, MD Honoring Health Vow #4: I Promise to Be an Active Participant in the Patient-Doctor Relationship Let us admit… this is a challenging topic. And embarrassing for many of you . But it shouldn’t be. Bacterial Vaginosis, known as BV, is the most common cause of abnormal vaginal discharge in about 50% of women of childbearing age. A large study published by the National Health and Nutrition Examination Survey (NHANES), reported findings from over 3700 women. BV was found in 29 percent in the general population of women aged 14 to 49 years. Now, when you show up in my office complaining that your vagina is “wet” there is not much I can do. It is supposed to be. In fact, once menopause becomes us and vaginal dryness and discomfort sets in, you will find yourself reminiscing about the vagina of your youth. So be grateful. However, if you are noticing an increase in vaginal discharge and a strong, unpleasant or “fishy” odor, call your gynecologist and schedule and appointment to receive an actual diagnosis. Resist the urge to self- treat. And if your doctor refuses to fax a cream or pill to relieve your symptoms over the phone without examining you, then congratulate yourself for having found a responsible clinician. Changes in your vaginal odor, increased discharge, and any symptoms of irritation need to be evaluated. Not everything your vagina experiences outside her “norm” is a yeast infection and Monistat is not the cure all miracle drug. Here are a few important things to know about BV: BV occurs when there is an imbalance in the normal bacteria that live in your vagina. Bacteria live in different parts of our bodies in general. Lactobacilli are the most predominant bacteria that live in your vagina. When there is a change in the normal bacteria, the amount of lactobacilli decreases, your vaginal ph increases and the amount of Gardnerella Vaginalis and other types of bacteria increase, causing BV. A large amount of a thin white discharge is the most common symptom coupled with a strong, unpleasant odor that most women describe as “fishy.” Some women notice more obvious symptoms around their menstrual period or just after sex. BV does not typically cause pain with sex, vaginal redness, itching, abnormal bleeding, or burning with urination. These symptoms suggest there may be other diagnoses to consider. BV is not considered a sexually transmitted disease, but it is mostly found in women who are sexually active. It is rarely diagnosed in women who have never had vaginal sex. It is more commonly found in women who have multiple male or female sexual partners. Your male partner does not have to be treated if you are diagnosed as it has not been found to be helpful. However women who have sex with women should alert their partner to be aware of symptoms suggestive of BV. Studies have shown both female partners have a 25-50% risk of being infected at the same time. Condom use has been found to decrease the risk of BV infections. Bacteria commonly associated with BV has been found in semen, in the male urethra and on penile skin. Some women may find chronic infections with certain partners. I recommend a trial of condom use when this occurs. BV infection is associated with an increased risk of acquiring trichomonas, chlamydia, gonorrhea, human immunodeficiency virus (HIV) , and herpes simplex virus type 2 (HSV -2). Chronic BV infections have been associated with use of Levonorgestrel containing Intrauterine Devices (IUDs) such as the Mirena, Skyla, and Liletta. A vaginal culture is not required to make the diagnosis. Your doctor can make the diagnosis based on your symptoms such as your physical exam findings, a vaginal ph greater than 4.5, and by looking at your vaginal skin cells under a microscope. An overgrowth of the bacteria Gardnerella Vaginalis will be present and visible. Your doctor may also mix your vaginal discharge with a basic solution that results in a fishy odor, which also helps make the diagnosis. BV is easily treated with an antibiotic called metronidazole. One would take a pill twice a day for seven days or use the gel form of this medication for five nights. The gel would be placed inside your vagina at night before bedtime, using an applicator. Both the oral and the vaginal forms of the medication have been known to cause yeast infections during or after treatment. You cannot drink alcohol while using this medication as it will cause vomiting. If you experience more than three BV infections in one year, talk with your gynecologist about prescribing antibiotics to decrease your risk of recurrence. This is typically accomplished with the use of vaginal metronidazole gel, twice a week, for four to six months after you have taken the 7-day oral treatment. Communication with your internist or gynecologist is key. If you are having bothersome symptoms or odor make a log or mental note of when your symptoms began and when they are at their worst. Don’t be embarrassed. Changes in bacterial flora are common and BV is a familiar diagnosis to many women. A good history is very important if a straightforward diagnosis cannot be made. Avoid douching or using feminine washes inside your vagina. And please, do not place any gels or creams in your vagina before your appointment. This makes it very difficult for us to properly diagnose the cause of your symptoms.