Dr Lauren talks bacterial vaginosis!

Hi everyone — it’s Dr Lauren Healy here. I want to share some important and up-to-date information about bacterial vaginosis (BV) — what it is, how to recognise it, how we treat it here in Australia, and what you can do to reduce the chances of it coming back.

What is BV?
Bacterial vaginosis is a condition in which the usual balance of bacteria in the vagina is disturbed. Normally, “good” bacteria (especially lactobacilli) dominate, helping to keep the environment acidic and safe. In BV, there’s an overgrowth of other bacteria — often anaerobes (those that thrive without oxygen). You can think of it like a garden: when the usual helpful plants are outnumbered, weeds can take over. In some people, this “weed takeover” causes symptoms; in others, it doesn’t, but it still can have implications.

Causes and Risk Factors
We don’t yet have a single clear cause. But research shows several associated factors:

• Sexual activity: new or multiple partners, or lack of condom use.
• Having a partner with a vagina is also associated with higher concordance rates.
• Not using barrier protection.
• Disturbances to the vaginal environment: for example, vaginal douching or use of perfumed or harsh products.
• Possibly use of contraceptives or menstrual hygiene practices. Some hormonal contraceptives may reduce risk; others less so.

Importantly, BV isn’t always sexually transmitted in the classic sense, but sexual behaviour is strongly associated with acquiring it or having it recur.

Symptoms
BV may cause:

• A thin, white or greyish vaginal discharge that may seem more watery or more than usual.
• A strong or unusual odour, often described as “fishy”. It can become more noticeable after sex or around the time of your period.
• Sometimes mild irritation or discomfort; itching is less common.

However, up to half of people with BV may have no symptoms at all.

Why it matters
If BV is mild or with no symptoms, it may not require treatment immediately. But there are situations where BV can lead to more serious issues:

• During pregnancy, it is associated with risks such as premature labour, low birth weight, miscarriage.
• After gynaecological surgery, insertions (e.g. IUD, termination of pregnancy), there is a higher risk of infections.
• It also correlates with a higher risk of acquiring other STIs.

Diagnosis
As a clinician, here’s what we look for:

• Clinical evaluation (history + symptoms).
• Examination of the discharge.
• Lab tests: microscopy of a high vaginal swab (looking for “clue cells”), checking vaginal pH (often > 4.5), possibly using Gram stain / Nugent scoring in certain settings.

We also rule out other causes of discharge/odour (e.g. STIs) because treatment differs.

Treatment
If you have symptoms, or if there are risks (e.g. pregnancy, plans for an IUD insertion, etc.), then treatment is usually recommended. Some key points:

• First‐line antibiotic options in Australia include metronidazole (oral, or vaginal gel), or clindamycin vaginal cream. Treatment durations vary depending on formulation.
• It’s important to finish the full course. Partial treatment may reduce symptoms temporarily, but recurrence risk remains.
• Avoid douching or intravaginal cleansing or perfumed products. These can disturb the bacterial balance further.

Recurrence & Partner Treatment
Here’s where practice and recent research are evolving — something I find particularly interesting as both a clinician and someone interested in public health.

More than 50% of people treated for BV will experience a recurrence within 6 to 12 months.

Recent studies suggest that treating partners (especially male partners) might help reduce recurrence rates. Partner treatment is not yet the standard everywhere but is an active area of research.

What YOU can do (“self care” & prevention)
From the clinic, and from what the evidence we have tells us, here are practical tips I often share:

• Use condoms or barrier protection, especially if you have new or multiple partners.
• Avoid vaginal douching, internal washing, or use of perfumed/deodorant/scented feminine hygiene products inside the vagina or around the vulva.
• Maintain good menstrual hygiene. Some people find that changing protection regularly helps, choosing unscented products.
• Discuss contraception options with your GP: some hormonal methods may help reduce risk in certain individuals.
• If you get symptoms that trouble you (discharge you don’t like, odour, discomfort), see your GP early rather than waiting.

What’s new & what we as clinicians are thinking about
There’s growing evidence that BV might better be considered (in at least some cases) like an STI, or something close, in terms of transmission dynamics — not in the sense of stigma, but in understanding how reinfection and partner carriage contribute.

Guidelines are beginning to include discussion of partner treatment, although it’s not yet standard in all settings. Deciding whether to use partner treatment should be done in consultation with patient, considering risks, benefits, and patient preference.

Research into preventing recurrence is ongoing, including what role probiotics, lactic acid treatments, or long‐acting maintenance regimens might have. At present, evidence is not strong enough to make firm national recommendations.

Bottom line
If you suspect BV — whether yourself, or a patient — the good news is: we have effective treatments, and with careful management recurrences can be reduced. But because recurrence is common, and because individual situations vary (pregnancy, partner situation, tolerance of medications, etc.), care needs to be tailored.

If you have symptoms affecting your life: reach out to your doctor. If you’re treating BV and it keeps coming back, bring up the possibility of partner treatment or review of prevention strategies.

Stay curious, look after yourself, and don’t hesitate to ask questions. If there’s one thing I want people to remember — you deserve to be comfortable and confident in your body.

Best wishes,
Dr Lauren Healy ‍

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