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What Is Bacterial Vaginosis? The Surprising Difference That Delays Treatment

What Is Bacterial Vaginosis? The Surprising Difference That Delays Treatment

For most any chronic problem in the vaginal area, women are often told it’s “just a yeast infection.” After a few such experiences, many women don’t even bother to go to the gynecologist since they assume that this is a recurrence of the yeast infections.  


Instead of seeking medical advice, they try for the easy fix. They think that’s found at the local drugstore.


So, they buy an over-the-counter slimy cream, or a powder that gets all over clothes and linens. But it’s cheaper than a prescription drug and quick to obtain, so it makes sense at the time.


Then there are the hand-me-down yeast infection remedies - hot baths, cold baths, ice (ugh?) or drinking gallons of cranberry juice. No wonder women are frustrated by this problem.


What they don’t know is that they may be treating THE WRONG PROBLEM. The persistent yeast infection is actually Bacterial Vaginosis (also called BV).


While certain aspects of BV may feel similar to a yeast infection, these conditions are not the same. Think of it this way: If you get sick and assume that it’s only a head cold, you will under-treat the cold.


You might feel better for a week, but the bug isn’t gone. What you really had was the flu and it’s not finished with you yet. The milder medications that you took might slow down the flu bug, but it wasn’t a knock-out punch - so the flu comes back with a vengeance, bringing more symptoms that hang on longer.


If only you had known it was the flu and taken the right medication to kill instead of merely stun the flu bug, you’d feel a whole lot better - faster.


That’s similar to what happens when you attempt to treat BV as if it’s a yeast infection. You’re merely prolonging the agony. BV is both physically and emotionally uncomfortable.


The physical symptoms are painful itching and burning that doesn’t get relief even with the creams, powders or douches.  No matter how hard you try to keep clean and fresh, that disgusting fish odor lingers.


The emotional impact of BV is stressful - even in a committed relationship. After all, how can you feel sexy when your finest perfume is mixed with vaginal body odor?


Bacterial Vaginosis occurs when the normal bacteria found in the vagina is overtaken by unfriendly bacteria. You might say it’s an imbalance of bacteria. This isn’t even an unusual condition.


Before getting embarrassed by something that is a medical issue, keep this in mind: having BV does not imply that a woman engages in any unusual sexual practices.


Any woman of childbearing age is potentially at risk for BV.  Even women who are not sexually active can get BV.


What does BV feel like? How can you recognize the symptoms?  Here are the basic ways to recognize BV:


·         Vaginal discharge that is thicker and lasts longer than normal

·         Vaginal discharge smells sour or fishy, particularly after intercourse

·         The color of the discharge is white or gray

·         Painful burning sensation when urinating with no other indications of a urinary tract infection

·         Itching or burning sensation in the vaginal area


One or more of these symptoms would certainly tell you that treatment is needed. But here’s an oddity about BV that differs from yeast infection: Some women who have chronic BV have NONE OF THOSE SYMPTOMS. 


For them, the infection has months to years to build up in the body without challenge. The long-term consequences are devastating as well as the ongoing discomfort.


Where Do You Get BV?


BV is not floating around the air like the flu. Here are some of the myths about how women get BV:


·         A toilet seat used by an infected person

·         Sitting in wet sand at the beach

·         Lingering in public or private swimming pools

·         In a hot tub or sauna

·         Touching objects used by an infected person

·         Sleeping on bedding not properly sanitized

·         Wearing wet swim suit too long

·         Failure to dry completely after shower or swimming

·         Wearing undergarments washed in harsh detergents

·         Lingering too long in a hot bubble bath

·         Excess use of perfumed lotions in the vaginal area

·         Sharing clothing with other women


These so called “bacterial transmission” methods are the stuff of urban legends and scary stories but they are not factual. 


Bacterial Vaginosis is generally transmitted with sexual contact - whether between male and female or two females. While medical research has not pinpointed all the details on transmission of BV, one factor does stand out: women who have never been sexually active and remain abstinent rarely get BV.


How Many Women Have BV?


Since Bacterial Vaginosis is often misdiagnosed or not diagnosed at all, it’s difficult to get an accurate count on how many women have BV. From the available medical data at the Centers for Disease Control and Prevention, about 1 in every 424 women is reported to have BV.


As for the incidents among various ethnic groups, BV is most prevalent among African Americans (23%) and Hispanics (16%).  Fewer incidents of BV are found among Caucasians (9%) and Asians (6%).


Normal Versus Abnormal


Obviously Bacterial Vaginosis is an abnormal condition in the vagina that is both uncomfortable and needs treatment to restore the normal vaginal environment. Before going farther in describing BV as an abnormality, this is the time to discuss what is normal in the vagina.


A healthy vagina has bacteria. Does that shock you to think that bacteria are casually floating along inside your private place?


Not to worry, the normal bacteria are good for the vaginal area because it acts like a resident clean-up crew.


Women only notice discharge when it’s thick or odorous. Whether or not you realize it, there are varying amounts of vaginal discharge that regularly occur.


The amount is small and the odor is not offensive, so most women hardly notice.


Contrary to old viewpoints, a small amount of vaginal discharge is not a signal to douche. The opposite is true. Excessive douching damages the normal balance of good bacteria in the vagina, which makes it easier for BV and other harmful bacteria to thrive.


While many women cringe at the thought of a yeast infection, the normal vagina has some level of yeast, just not enough to cause painful symptoms. This area is warm, secluded and moist, so as with any such environment, these are the conditions for bacteria to grow and multiply.


Treatments for BV and yeast infections dramatically alter the balance of this internal ecosystem, which helps one problem but usually leads to another or a reoccurrence of the original problem.


A healthy vagina has an environment in which the good bacteria are more prominent than the harmful bacteria.  A woman’s body is constantly monitoring and regulating good bacteria in various areas so the balance tips toward health.


Often, conditions outside the body lead to an imbalance, which results in BV or other vaginal infections that require treatment to restore the healthy balance.


Is BV an Infection or an STD?


Medical researchers disagree widely on this question. In some articles, you read that Bacterial Vaginosis is classified as a sexually transmitted disease - then in other articles, it’s considered an infection.


Even respected medical experts have differing opinions, which is the reason that articles you read may seem contradictory.  For example, the information from the Centers for Disease Control lists BV among the STDs and incorporates BV treatment guideline with those for STDs.


The reason that these seem so close is that BV is usually found in women who are sexually active or have been sexually active. So, the connection between this and STD makes sense. Doctors also know that women with multiple sex partners have a higher risk for BV – just like any of the STDs you know about.


Here’s the situation: the pain, frustration and irritation are the same, whether it’s BV or an STD, so attention is better focused on solving the problem rather than how to classify it. Never avoid going to the doctor or health clinic out of fear that the problem may be an STD.


If the idea of BV being viewed by some physicians as an STD is embarrassing, then keep in mind that women who are not sexually active can get BV too, whereas sexual activity is a firm prerequisite for getting an STD. 


Please don’t hide behind “it’s just a yeast infection” because it’s more socially acceptable in some circles rather than seek needed treatment for BV. This is not the time to pretend, this is time to get the facts and act on the facts.


Is There a Test for BV?


A basic test used by the physician to make a diagnosis is the pH level. This is a chemical measurement that determines the level of acid or alkaline which is an important factor in knowing whether the conditions are right to sustain BV.


As part of the pelvic examination, the doctor removes a small sample of fluid from the vagina to use for this test. The procedure is quick and painless.


Even a healthy woman has bacteria in the vaginal fluid, which cause no problems. If Bacterial Vaginosis is present, the fluid sample will show an increase in certain microorganisms such as Gardnerella, Bacteriodes, Mycoplasma and Mobiluncus. Over time these harmful bacteria destroy the useful bacteria.


A woman has no idea that this war between good bacteria and harmful bacteria is happening unless she experiences obvious symptoms. As irritating as the discharge and order can be, it’s an ideal early warning system telling her to get a checkup.


The pH is a healthy vagina ranges from 3.8 to 4.5 (WebMD). When BV is present, the pH count rises about 4.5.  A fluid sample may also be viewed under a microscope with a bold dye added.


The testing for BV involves both chemistry and a good nose for bacteria. The gram-positive (harmful) bacteria turn bright purple while the gram-negative (healthy) bacteria look pale to pink. Gardnerella, gram negative bacteria, is often found with BV.


The good nose aspect of BV testing is that when vaginal fluid is exposed to the test fluid, the trademark strong fish odor is released. The test technician literally sniffs the test sample to identify that odor which has become all too familiar to a woman who has BV. Granted this does not sound like a pleasant job, but fortunately some people have the training to apply this process needed in making the diagnosis.


Another way that BV is detected by a physician is as part of a routine Pap Test.


While this is not the most efficient way to identify BV, it can be a help particularly for women who show no other symptoms that would cause them concern about an infection.


Relying on a Pap Test to identify BV is not the best idea because the sensitivity to BV is very low, thus if it is detected by this test, then the infection is rampant.


Because BV symptoms are similar to those of Sexually Transmitted Diseases (STDs), the physician may order additional tests for STDs. The strong odor that is characteristic of BV is also found in two particularly dangerous STDs, gonorrhea and Chlamydia. 


Knowing whether the problem is BV only or BV and possibly and STD is critical in guiding the physician toward the right treatment option.


To get a valid test, women need to follow these precautions before having a medical test for BV:


·         No sex for 24 hours prior to the test

·         No douching for 24 hours prior to the test

·         Eliminate all vaginal medicines for 3 days prior to the test, regardless of whether the medicines are prescription of over-the-counter treatments

·         Reduce acidic intake in foods and drink prior to the test

·         Reschedule the appointment if menstrual period starts


Any of these conditions could alter the results of the test. When that happens, you waste time going to the appointment and leave with a false sense of security. In a week or so, that feeling will be shattered as the BV returns even more ferocious than before and you have to start the testing process over again.


How Do You Know When It’s Time to Get Treatment?


The simple answer is, go for treatment when you first see signs of an infection – not when you can’t stand it any longer. In fact, there is no such thing as “too soon” for seeking help.  It’s also not wise to continue to tough it out in the hope that the infection will go away as suddenly as it appeared.


The most important first step is to get the proper medical testing to know the difference between BV and yeast infection or other types of sexually transmitted diseases since many of them have similar initial symptoms.


Many physicians don’t wait for the test results to prescribe some level of treatment. Some suggest the “benign” approach, sending the woman home to have warm baths, drink cranberry juice and reduce sexual contact for a week.


This is not to suggest that the physician fails to take the problem seriously, but rather that it’s a way to stimulate the body to repel the invading harmful bacteria. The idea is that the body’s immune system can take care of things so the treatment is more inclined toward giving her something to focus on besides the BV.


Other physicians are quick to prescribe general antibiotics, taking the “fire full approach” at the bacteria and hope to blast it away. The obvious concern is that if BV is prone to come back several times, and then are antibiotics are most common method of medical treatment.


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