VAGINAL DISCHARGE - BACTERIAL VAGINOSIS

Vaginal discharge is a very common problem which teenagers often suffer from when sexual activity starts. This happens to ten to seventy percent of women between the ages of 14 to 60.  They must be made aware of what it means, what causes it and what can be done about it, and can it be protected or is it a serious infection. 

A small amount of vaginal discharge starts with the menstrual cycle; however it is different in the different phases of the cycle. In the mid cycle, there is stretchy discharge, this is indicative of ovulation. If a woman or a teenager has a discharge at odd times or all the time, it can indicate trouble. A child can have a discharge, if she has inserted a foreign body or is being abused. I have removed safety pins from the vaginas of children. When teenagers start a constant discharge, it is often an infection; such as a forgotten tampon. This is very smelly.

Vaginal infections in women are protected by vaginal microbiota, one of these is lactobacillus.  This keeps the vagina acidic, produces hydrogen peroxide and Bacteriocins. These protect the vagina from infections. Normally there are certain bacteria which live in the vagina, and when the vagina is changed such as by using a douche, sex or chemicals; infection happens.  One such infection is called Bacterial Vaginosis.

         

Bacterial Vaginosis causes, watery whitish grey thin discharge, with a very typical fishy odour. This cannot be missed, and can be smelt as soon as a woman enters the room. It is not considered a sexually transmitted infection, however the research on this, is still going on. This almost always happens when a woman has sex with a new partner, male or female, especially if there are pre-existing changes in the vagina, such as increased pH levels, such as using a douche, commercial chemicals, menstrual cycle and menopausal state.  This infection is caused by excessive growth of many bacteria together which are anaerobic, meaning bacteria that can survive without oxygen, which are a part of vaginal microbiota.    The most common of these is Gardnerella. The symptoms of excessive watery smelly discharge, itching and often pain on passing urine are felt by women. Only 50% of the women are symptomatic. The diagnosis is made by a women’s story, examination of the vagina and a vaginal pH of more than 4.5. A drop of fluid from the vagina can be examined in any medical practice under a microscope, for special cells, called the clue cells. These are vaginal epithelial cells covered by bacteria. There should be more than 6 on each epithelial cell. 

A drop of potassium hydroxide on the slide produces a strong smell; this is called a whiff test. This is produced by the amines which the bacteria produce.  All these tests can be done at the medical practice without delay. A swab can also be sent to the lab for culture, but this  delays the diagnosis which is not required. Women who have bacterial Vaginosis can catch STI’s more easily such as HIV, Herpes, and Gonococcus, so if you suspect this is a possibility, do the test for STI”s as well. Bacterial Vaginosis during pregnancy can be problem, as this can cause miscarriage, low birth weight babies and premature birth.  The current research does not confirm if there is great benefit in testing pregnant women routinely for Bacterial Vaginosis or treating them. It may help with premature birth and small in weight babies, if treated before 20 weeks.

Normally the treatment of Bacterial Vaginosis is by antibiotics called Metroniadizol, Clindamycin and Tinidiazole. Both Metroniadizole and Clindamycin can be used orally or as vaginal creams.  Different schedules are used by different medical practitioners. Allergy to Metronidiazole is very rare, it is not Teratogenic (causing harm to the foetus) if used in early pregnancy and above all, it is not expensive. This does not harm the Lactobaccilus which women need to preserve to keep the vagina healthy. Clindamycin can be used if a woman is allergic to Metroniadizole.  Clindamycin is more effective against many bacteria which make the complex structure of Bacterial Vaginosis.  Vaginal Clindamycin can deteriorate condoms. It is not useful to treat the male partner in management of Bacterial Vaginosis. In recurrent cases the same drugs are used over a prolonged period at different intervals.

To prevent Bacterial Vaginosis, take the following precautions:

Always have safe sex

Use cotton underwear, and not very tight pants.

Do not use a douche, or chemical products such as bubble bath or perfumes.

Do not smoke, avoid alcohol.

Avoid IUD’s as contraceptives.

One can use local oestrogens especially if you are post menopausal

   2 tablespoon of vinegar in bath water is also useful in post menopausal women.

In summary, Bacterial Vaginosis is a very common infection caused in women following changes in the vagina, usually following, menstrual cycle unsafe sex, operations, childbirth and IUD’s. Do not ignore it as it can lead to more serious problems such as Pelvic Inflammatory Disease.