Is Bacterial Vaginosis an STI?

The short, TLDR answer here is no… however, because of the nature and location of the infection, it is closely tied to sexual health and may easily be mistaken for an STI – or vice versa. If you’re concerned about your red, itchy and smelly vagina, or you’ve recently been diagnosed with bacterial vaginosis, read on for all the facts!

What is Bacterial Vaginosis?

Bacterial vaginosis is a type of vaginal inflammation caused by the overgrowth of bacteria that is naturally found in the vagina – most commonly Gardnerella vaginalis. While the bacteria aren’t harmful, there is a natural balance that must be maintained in order to keep the vaginal environment healthy. When there is an imbalance between the vagina’s “good” (lactobacilli) and “bad” (anaerobes) bacteria, vaginal inflammation and irritation can occur.

What causes bacterial vaginosis?

A change in the pH of the vagina, causing an overgrowth of one of the kinds of bacteria that live in the vagina, can trigger an onset of bacterial vaginosis. The vaginal flora is mostly made up by lactic acid bacteria which, along with other vaginal bacteria, create a slightly acidic environment that helps to protect against germs and keeps the level of bad bacteria in check. When the number of lactic acid bacteria decreases it allows other vaginal bacteria to quickly reproduce, causing an imbalance that can result in infection.

What are the symptoms of bacterial vaginosis?

Many women who develop bacterial vaginosis have no noticeable symptoms, but some telltale signs and symptoms include:

Discharge: Bacterial vaginosis can cause an unpleasant, thin grey, green or white vaginal discharge, which can irritate the vagina.
Odour: Bacterial vaginosis can cause a strong-smelling, “fishy” odour which is often stronger during menstruation or after sex.
Itching: Bacterial vaginosis can cause itching of the vulva (the area around the vagina) and the vagina. This is because the infection triggers an immune reaction in the body that often causes the vulva and vagina to become irritated and inflamed.
Burning sensation: Bacterial vaginosis can also result in a burning sensation when urinating or having sex, due to the change in pH level of the vagina and the irritation and inflammation of the vulva, the area around the urethra (the hole your pee comes out of), and the vagina.
Vaginal dryness: Bacterial vaginosis can result in vaginal dryness, due to the change in pH level of the vagina and swelling of the mucous lining of the vagina, and this can contribute to the irritation and inflammation of the vulva and vagina.

What kinds of things can increase the risk of bacterial vaginosis?

Several factors that can increase the risk of developing bacterial vaginosis include:

Vaginal douching

Vaginal douching is the practice of rinsing out the vagina with water, soap or some other cleansing product. Sometimes the practice involves rinsing the outer surface of the vagina (immediately inside the vaginal flaps), but sometimes it involves using a tube or applicator to spray or squirt a product up into the vaginal canal. Some women use it to “freshen up” or remove unpleasant odours, to cleanse their vagina of menstrual blood or semen, to lessen their risk of contracting an STI or to prevent a pregnancy after sex. Many women don’t know that their vagina is self-cleaning, or that excessive douching strips away the vagina’s natural flora and actively changes its pH level, and this can actually increase the risk of developing infections like bacterial vaginosis.

Unprotected sex with a new sexual partner

Evidence shows that the incidence of bacterial vaginosis is much higher in women who are very sexually active and have a new partner. This is because having penile-vaginal intercourse with a new partner can change the pH level of the vagina. Research also shows that women who have sex with women are more likely to develop bacterial vaginosis.

Sex with multiple partners

Evidence has also shown that the incidence of developing bacterial vaginosis is higher in women who frequently switch sexual partners, because of the naturally occurring bacteria that can be transmitted via new sexual partners and the changes this can make to the natural flora and pH levels of the vagina.

A naturally occurring lack of “good” bacteria

If your vagina doesn’t produce enough “good” (lactobacilli) bacteria then you may be more prone to developing bacterial vaginosis. This may be a natural lack of the lactobacilli bacteria in the vaginal environment, or it could even be related to something as simple as having taken a course of antibiotics for an unrelated bacterial infection which can strip the body of its naturally occurring lactobacilli stores. Many people know that a course of antibiotics can affect the levels of good bacteria in their gut, but don’t realise the vaginal environment is equally susceptible.

Hormonal changes

Changing hormone levels can affect the pH levels of the vagina, so women may be more prone to developing bacterial vaginosis around menstruation, at conception, during pregnancy, or at the onset of menopause.

Who can get bacterial vaginosis?

Research suggests that bacterial vaginosis affects around 5 in 100 women. It is most likely to occur in women of reproductive age, as hormonal levels fluctuate in these years and actively contribute to changing the pH levels of the vagina.

Can you catch bacterial vaginosis?

While bacterial vaginosis isn’t a sexually transmitted infection (STI), it is closely linked to sexual activity and the symptoms can mimic those of an STI. Although you can’t catch bacterial vaginosis from a male sexual partner, or pass it on to them, it is possible for bacterial vaginosis to spread between female sexual partners. This is because women share a similar mix of genital bacteria, so it’s easier for the infection to replicate in a female partner.

Is bacterial vaginosis the same as thrush?

Bacterial vaginosis and yeast infections like thrush are both vaginal infections and while the symptoms are often similar, they have different causes and treatments. Bacterial vaginosis, as the name suggests, is a bacterial infection while thrush is a yeast, or fungal, infection caused by an overgrowth of Candida albicans fungus.

Can bacterial vaginosis cause other sexual or reproductive health problems?

Research has shown that bacterial vaginosis will resolve itself in around one third of cases, without any complications. However, because bacterial vaginosis can cause vaginal inflammation and allow the overgrowth of bad bacteria higher up in the vaginal canal, it can lead to infections in the uterus and fallopian tubes (pelvic inflammatory disease, or PID). Developing vaginal infections, like bacterial vaginosis, during pregnancy can result in a slightly increased risk of complications such as miscarriage, early contractions, pre-term deliveries and low-birth weight in babies.

Bacterial vaginosis can also increase your risk of contracting an STI, such as gonorrhea, chlamydia, genital herpes and HIV – and if you already have HIV then bacterial vaginosis can increase your chances of passing HIV on to your sexual partner… so it’s important to ensure you always practice safe sex!

Preventing bacterial vaginosis

There are a few things you can do to help prevent bacterial vaginosis:

Always practice safe sex! The safest way to protect yourself from developing bacterial vaginosis, or contracting an STI, is to abstain from sex – but where’s the fun in that?! You could also consider limiting the number of sexual partners you have – but that’s an entirely personal choice and you should feel free to own your sexuality. The best advice that we can give you is to always use a latex condom or dental dam when having sex and get tested regularly (p.s. Stigma Health can help you with this!)
Don’t douche! Remember, the vagina is self-cleaning and doesn’t need any extra special ‘cleansing’. Excessive douching won’t prevent or treat a vaginal infection and can actually increase your risk of developing one. If you feel like you need extra freshening, use a product that’s specifically made for the vaginal environment and matches the natural pH of the vagina, and only wash the external surfaces of the vulva (don’t wash inside the vaginal flaps!)
Reduce vaginal irritation. Consider using unscented and unbleached feminine hygiene products (pads & tampons), wearing cotton underwear, and using mild, unscented, pH-balanced body soaps and laundry detergents.

Treatment for bacterial vaginosis

Treatment is usually only needed if the infection causes persistent symptoms. If you feel you need to seek treatment from a doctor, they will likely perform a pelvic exam, test your vaginal pH and take a vaginal smear (a sample of fluid and vaginal skin cells). This will allow them to check the pathology of the infection and make sure any treatment is targeted toward the specific bacteria that is causing the infection, which means that treatment will be more effective.

Generally, symptomatic bacterial vaginosis will require treatment with an antibiotic preparation. This will likely be either an oral antibiotic (tablet, capsule or liquid that you drink) or a topical cream or gel that you insert into your vagina (usually with the help of an applicator). It’s important to take (or use) the prescribed medication as directed by your doctor and pharmacist, to make sure it completely clears the infection and to prevent the infection from recurring.

It is best to avoid home remedies such as inserting tampons soaked in yoghurt or tea tree oil as there is not enough research or evidence on the safety, efficacy or benefits of these treatments. It is also not advisable to rely solely on homeopathic treatments, such as inserting capsules or suppositories containing living lactobacilli bacteria, to resolve the infection – although some research seems to suggest that probiotic supplementation may be useful in restoring vaginal flora after a bacterial vaginosis infection, especially after antibiotic treatment, and in helping to prevent recurrent infections.

When should I see a doctor?

You should make an appointment to see your doctor if:

Your symptoms present after you have had multiple sexual partners or have recently had a new sexual partner. This is because the signs and symptoms of bacterial vaginosis can be very similar to those of thrush and some STIs, and it’s important to rule out other infections and properly treat the cause.
You’ve had vaginal infections before, but the colour, consistency or smell of your discharge seems different this time, or you have developed the discharge and a fever. A medical examination can help identify the cause and assist your doctor to more effectively treat the infection.
You have developed a new discharge and it’s associated with persistent pain in your pelvic region that is causing you significant discomfort. Again, a medical examination will help your doctor identify the cause and determine the most effective treatment.
You have tried an over-the-counter treatment, such as a urinary alkalinizer or a cream or tablet for a yeast infection, but your symptoms persist.

References: