The vagina operates at an optimal environment established by the balance of different bacteria. In a healthy vagina, “good” bacteria create an acidic environment that prevents the overgrowth of “bad” or “pathogenic” (disease-causing) bacteria. In some cases, various pathogenic bacterial species may proliferate in excess, resulting in deviation from an optimal environment. This is referred to as bacterial vaginosis. The factors that may cause bacterial vaginosis include the use of antibiotics, excessive personal hygiene (douching), foreign bodies, hormonal changes, an increased number and frequency of sexual partners, smoking, other infections such as HIV, and low socioeconomic status. About 50 percent of women with bacterial vaginosis are asymptomatic; those who do have symptoms report unpleasant vaginal odor, discharge, and itching. 

Several complications are associated with bacterial vaginosis. For example, women with bacterial vaginosis are at an increased risk of developing pelvic inflammatory disease (PID) and cervical cancer/dysplasia. Additionally, these women are at higher risk of transmission of infections such as HIV, chlamydia, trichomoniasis, gonorrhea, and herpes. Obstetric complications have also been reported in pregnant women; spontaneous abortion, preterm delivery, low birth weight, and postpartum endometriosis are examples of poor birth outcomes associated with bacterial vaginosis.

Bacterial Vaginosis Treatment and Alternatives

Treatments of bacterial vaginosis vary widely. Antibiotics can be used to treat bacterial vaginosis successfully by inhibiting pathogenic bacteria; however, there are alternative non-antibiotic related strategies that have shown some success. Dietary modifications to achieve optimal nutrition, acidifying agents to facilitate the acidic environment of a healthy vagina, and probiotics to maintain and reestablish the microbiome are examples of these alternative strategies. However, the most successful treatment has been shown to be a combination of antibiotics alongside these alternatives. 

The take-home message: bacterial vaginosis is characterized by a fluctuation in the microbiome of the vagina. While many factors may contribute to this variation, it is effectively treated by antibiotics in combination with alternative strategies.