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Bacterial Vaginosis And HIV
Key pointsBacterial vaginosis (BV) is a condition which occurs when the normal balance of bacteria in the vagina becomes disrupted. This can result in an over-growth of certain bacteria, which can be accompanied by unpleasant symptoms.
It is a very common condition and can affect any woman or person with a vagina. It is not a sexually transmitted infection (STI) and is easily treated with antibiotics.
Having bacterial vaginosis increases your risk of acquiring HIV and STIs including herpes, human papillomavirus (HPV), chlamydia and gonorrhoea. For people living with HIV, having bacterial vaginosis increases the risk of passing on HIV during sex and childbirth. However, this is not the case if you are receiving HIV treatment and have an undetectable viral load.
Causes of bacterial vaginosisWhat causes the imbalance of bacteria in the vagina which leads to bacterial vaginosis is not fully understood. Since you can develop bacterial vaginosis without having ever had sex it is not classified as an STI, but sexual activity appears to increase the likelihood of developing it. For reasons that remain unclear, there are higher rates of bacterial vaginosis among lesbian, bisexual and other women who have sex with women than among heterosexual women.
These activities can increase the risk of developing bacterial vaginosis:
Bacterial vaginosis is common during pregnancy.
These activities can reduce the risk of developing bacterial vaginosis:
Studies have also shown a reduced risk of bacterial vaginosis in women whose male sexual partners are circumcised.
SymptomsBacterial vaginosis is often asymptomatic, meaning you experience no symptoms at all. When they do occur, symptoms can include changes to vaginal discharge, including turning grey or whitish, watery or developing a fishy smell. This may be worse after sex.
Bacterial vaginosis is not usually associated with itchiness, irritation, sores, blisters, or vaginal bleeding. If you have any of these symptoms, seek advice from your GP or sexual health clinic.
DiagnosisIf you think you have bacterial vaginosis, you can go to your GP or a sexual health clinic. A doctor or nurse will examine you to look for signs of bacterial vaginosis. They may be able to diagnose bacterial vaginosis straight away because of the distinctive appearance of the discharge.
If not, they will probably use a swab to collect a sample from your vagina. A swab looks like a cotton bud and collecting a sample only takes a minute or two. It shouldn't be painful, but it may feel a little uncomfortable. The sample will then be sent to a lab for testing and you should get your results within a few days.
They may also test you for sexually transmitted infections if the symptoms are similar.
Sexual health screens are freely available from NHS genitourinary medicine (GUM) and sexual health clinics. Many HIV clinics also provide sexual health screens and tests for bacterial vaginosis as part of their routine care.
TreatmentBacterial vaginosis sometimes goes away by itself as the balance of bacteria in the vagina corrects itself. If bacterial vaginosis is not bothering you, it is not always necessary to have it treated. However, it can increase the chance of acquiring HIV or passing it on if you have a detectable viral load. Treatment for bacterial vaginosis is recommended if you have a different HIV status from your partner and one of you has a detectable viral load.
Glossary bacterial vaginosisA condition caused by the overgrowth of certain species of the bacteria that are normally present in the vagina.
symptomAny perceptible, subjective change in the body or its functions that signals the presence of a disease or condition, as reported by the patient.
sexually transmitted infections (STIs)Although HIV can be sexually transmitted, the term is most often used to refer to chlamydia, gonorrhoea, syphilis, herpes, scabies, trichomonas vaginalis, etc.
detectable viral loadWhen viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners.
It is also important to be treated if you are going to have a surgical procedure that involves going through the neck of your womb (the cervix). If bacterial vaginosis is transmitted from the cervix into the womb during a procedure, you can develop a serious condition called pelvic inflammatory disease.
If you are pregnant or thinking about becoming pregnant, you may also want to be treated. There is some evidence that bacterial vaginosis can increase the risk of premature birth, especially if you have had a miscarriage, premature baby or baby with a low birth weight before. There is also a greater risk of passing on HIV to a baby during delivery. You can safely take treatment during pregnancy.
If you have a same-sex partner, your doctor or nurse may also recommend that they are treated.
Treatment is with antibiotics, usually either metronidazole or clindamycin. It can be given as tablets (a single larger dose or doses over seven days) or a vaginal gel over five to seven days. It is important that you take all the treatment prescribed to you. You will need to avoid alcohol during treatment and for 48 hours after you have finished it, as it will make you feel very sick.
There is a lot of information online about complementary therapies to prevent or treat bacterial vaginosis, such as probiotics. However, the evidence of their effectiveness is inconclusive and therefore their use is not recommended by clinicians.
It is common for bacterial vaginosis to recur after treatment, so you may require another course of treatment at a later date. If you have frequent bouts of bacterial vaginosis, your doctor may recommend preventive treatment with antibiotics.
Using condoms can help reduce the risk of bacterial vaginosis recurring. The vaginal gel can weaken latex, so you will need to use non-latex condoms while using this treatment.
Acknowledgements
Thanks to Dr Phillip Hay for his advice.
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Oral Sex Linked To Vaginal Condition Bacterial Vaginosis
BV bacteria covering cells
Oral sex may create an environment for a common vaginal condition called bacterial vaginosis or BV, according to research in the journal PLoS Biology.
BV is not a sexually transmitted infection. It is an imbalance of the usual bacteria found in the vagina.
Women who have it may have no symptoms, but some get a strong-smelling discharge.
Researchers explored what effect mouth bacteria have on microbes that live and grow in the vagina.
About BV
BV is not usually serious, but should be treated because having BV makes women more vulnerable to catching sexually transmitted diseases and getting urinary infections.
If the woman is pregnant, it increases the risk of premature birth.
How can you tell if you have it?
It is quite common and women who have it may notice they have an unusual discharge that has a strong fishy smell.
You may notice a change to the colour and consistency of your discharge, such as becoming greyish-white and thin and watery.
Your GP or sexual health clinic could arrange for a swab test to see if you have BV.
If the result is positive, it can be treated with antibiotic tablets, gels or creams.
What did the new research find?
Women without BV tend to have plenty of "good" bacteria called lactobacilli that keep the vagina more acidic, with a lower pH.
Sometimes this healthy balance can tip and let other vaginal micro-organisms thrive.
What causes this to happen is not fully known, but you're more likely to get BV if:
The study in PLoS Biology showed how a common type of bacteria found in the mouth that is linked with gum disease and dental plaque may support BV.
They did experiments in human vaginal specimens and in mice to look at bacterial behaviour.
The mouth bacterium, Fusobacterium nucleatum, appeared to aid the growth of other bacteria implicated in BV.
The researchers, Dr Amanda Lewis from the University of California and colleagues, say the findings show how oral sex might contribute to some cases of BV.
Experts already know that BV can be triggered by sex, including between women.
Prof Claudia Estcourt, spokesperson for the British Association for Sexual Health and HIV, said research such as this was important to add to the understanding of BV.
"We know BV is a really complex entity with lots of contributing factors."
She said oral sex could pass on sexually transmitted infections and other bacteria that may or may not be important in other health conditions.
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