From the Guidelines
Bacterial vaginosis (BV) often presents with a thin, grayish-white vaginal discharge that has a distinctive "fishy" odor, particularly noticeable after sexual intercourse or during menstruation, as noted in studies such as 1 and 1. Many women also report vaginal itching or irritation, though approximately 50% of women with BV experience no symptoms at all. The discharge typically coats the vaginal walls and may be accompanied by burning during urination or mild vaginal discomfort. Unlike yeast infections, BV rarely causes significant pain or redness. The fishy odor results from volatile amines produced by the overgrowth of anaerobic bacteria like Gardnerella vaginalis, which disrupt the normal vaginal flora dominated by Lactobacillus species. This bacterial imbalance raises the vaginal pH above the normal range of 3.8-4.5, contributing to the symptoms.
Some key points to consider about the symptoms of BV include:
- The presence of a thin, homogeneous discharge
- A vaginal pH greater than 4.7
- The presence of clue cells on wet mount
- An amine "fishy odor" when potassium hydroxide is added to the discharge, as outlined in the Amsel clinical criteria 1
- Burning during urination or mild vaginal discomfort
If you experience these symptoms, it's essential to seek medical evaluation rather than self-diagnose, as similar symptoms can occur with other vaginal infections. Treatment typically involves antibiotics such as metronidazole (500mg twice daily for 7 days) or clindamycin, which can be prescribed as oral medication or vaginal preparations depending on individual circumstances, as recommended by studies such as 1 and 1.
From the FDA Drug Label
Metronidazole vaginal gel is indicated in the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, or anaerobic vaginosis) NOTE: For purposes of this indication, a clinical diagnosis of bacterial vaginosis is usually defined by the presence of a homogeneous vaginal discharge that (a) has a pH of greater than 4. 5, (b) emits a “fishy” amine odor when mixed with a 10% KOH solution, and (c) contains clue cells on microscopic examination. The symptoms of bacterial vaginosis include:
- A homogeneous vaginal discharge
- A pH of greater than 4.5
- A “fishy” amine odor when mixed with a 10% KOH solution
- The presence of clue cells on microscopic examination 2
From the Research
Symptoms of Bacterial Vaginosis
- Abnormal vaginal discharge 3
- Vaginal odor 3
- Irritation 3
- Itching 3
- Burning 3
- Elevated pH 4
- Clue cells as determined by microscopy 4
Diagnosis of Bacterial Vaginosis
- Traditionally diagnosed with Amsel criteria 3
- Gram stain is the diagnostic standard 3
- Newer laboratory tests that detect Gardnerella vaginalis DNA or vaginal fluid sialidase activity have similar sensitivity and specificity to Gram stain 3
- DNA probe testing [(5,4)]
Treatment of Bacterial Vaginosis
- Oral metronidazole [(3,5,6,7)]
- Intravaginal metronidazole [(3,5)]
- Intravaginal clindamycin [(3,5,6)]
- Oral tinidazole 7
- Patient counseling and education regarding treatment options, including adherence to prescribed treatments, appropriate hygienic practices, and treatment of symptomatic same-sex partners 4