Bacterial Vaginosis (BV) is an overgrowth of the normal anaerobic bacteria that live in the vagina. It produces a fishy vaginal odor and a thin grey vaginal discharge that may itch, burn or be asymptomatic. The odor may be more noticeable after sex, when the basic semen comes into contact with the bacteria and releases volatile amines that smell like fish. BV can be caused by an alteration of the vaginal pH as can be seen with intercourse, menstruation and menopause.
Bacterial Vaginosis is diagnosed by looking under the microscope and seeing "clue cells" which are normal vaginal epithelial cells that are covered with bacteria and their normally well defined margins are smudged. It can also be diagnosed by sending a sample to the laboratory.
Bacterial Vaginosis is treated by metro gel (metronidazole gel) intravaginally or with clindamycin vaginal cream. It can also be treated by giving oral metronidazole or tindamax, but both of these medications will give an antabuse type reaction if taken with alcohol, so it is better to treat vaginally if possible.
With recurrent infections, consideration of more prolonged regimens or in addition giving prophylactic vaginal probiotic pH balancers like Rephresh® or Luvena® can work well. In menopausal women with pH issues, estrogenizing the vaginal with topical tablets, rings or creams can help to prevent recurrent infection by re-establishing the vaginal pH and making the vagina more resistant to infection.
