Symptoms and signs
Many women (about 85% of those affected) with bacterial vaginosis actually have no symptoms. When symptoms do occur, vaginal discharge and odor are the predominant symptoms. Usually, there are no other symptoms. The amount of vaginal discharge that is considered normal varies from woman to woman. Therefore, any degree of vaginal discharge that is abnormal for a particular woman should be evaluated.
Some women may experience an unpleasant fishy odor with vaginal discharge. The discharge is usually thin and grayish white. The discharge is often more noticeable after sexual intercourse.
A healthy vagina normally contains many microorganisms; some of the common ones are Lactobacillus crispatus and Lactobacillus jensenii. Lactobacilli, particularly hydrogen peroxide-producing species, appear to help prevent other vaginal microorganisms from multiplying to a level where they cause symptoms. The microorganisms involved in BV are very diverse, but include Gardnerella vaginalis, Mobiluncus, Bacteroides, and Mycoplasma. A change in normal bacterial flora including the reduction of Lactobacilli, which may be due to the use of antibiotics or pH imbalance, allows more resistant bacteria to gain a foothold and multiply.
Although BV can be associated with sexual activity, there is no clear evidence of sexual transmission.[non-primary source needed] It is possible for sexually inactive persons to get infected with bacterial vaginosis. Rather, BV is a disordering of the chemical and biological balance of the normal flora. Recent research is exploring the link between sexual partner treatment and eradication of recurrent cases of BV. Pregnant women and women with sexually transmitted infections are especially at risk for getting this infection. Bacterial vaginosis may sometimes affect women after menopause. A 2005 study by researchers at Ghent University in Belgium showed that subclinical iron deficiency (anemia) was a strong predictor of bacterial vaginosis in pregnant women. A longitudinal study published in February 2006 in the American Journal of Obstetrics and Gynecology showed a link between psychosocial stress and bacterial vaginosis independent of other risk factors.
When a woman reports an unusual vaginal discharge, the doctor will ask her a series of routine questions to help distinguish mild from more serious conditions. Additional issues that might indicate the presence of a more serious condition include fever, pelvic pain, new or multiple sexual partners (especially with unprotected intercourse), and a history of sexually-transmitted infections (STDs).
In addition to these questions, the doctor will perform a pelvic exam. During the exam, the doctor notes the appearance of the vaginal lining and cervix. The doctor will also perform a manual exam of the ovaries and uterus. The cervix is examined for tenderness, which might indicate a more serious infection. The doctor may collect samples to check for chlamydia or gonorrhea infection.
Examining the vaginal discharge under the microscope can help distinguish bacterial vaginosis from yeast vaginitis (vaginal yeast infection, Candidiasis) and trichomoniasis (a type of sexually-transmitted infection). A sign of bacterial vaginosis under the microscope is a vaginal cell called a clue cell. Clue cells are vaginal cells covered with bacteria and are believed to be the most reliable diagnostic sign of bacterial vaginosis. In addition to clue cells, women with bacterial vaginosis have fewer of the normal vaginal bacteria, called lactobacilli. A vaginal pH greater than 4.5 is also suggestive of bacterial vaginosis. Cultures of bacteria are generally not useful in establishing the diagnosis of bacterial vaginosis.
Finally, the doctor may perform a 'whiff test' with potassium hydroxide (KOH) liquid. When a drop of KOH testing liquid used in the 'whiff test' contacts a drop of the discharge from a woman with bacterial vaginosis, a certain fishy odor can result.
Metronidazole or clindamycin either orally or vaginally are effective treatment. However, there is a high rate of recurrence. In contrast to some other infectious diseases affecting the female genitals, according to some sources, treatment of the sexual partners is not necessarily recommended.
SIPO ( State Intellectual Property Office of China) has published a herbal remedy named Fuyan Pill which is used to treat multiple infections and inflammations of women's reproductive system. Recurrent BV can be treated by Fuyan Pill after three months treatment. Fuyan pill preserves the body as well as treats the disease, as a result, the recurrence rate of the patients after treatment is much more lower than those who's disease is cured by antibiotics.