Bacterial vaginosis and HIV

Bacterial vaginosis (BV) is a condition which occurs when the normal balance of bacteria in the vagina changes. This can cause an overgrowth of certain bacteria, which can cause unpleasant symptoms.

BV is a very common condition and can affect anyone with a vagina. It is easily treated with antibiotics.

BV is not a sexually transmitted infection (STI). However, having BV increases your risk of STIs such as herpes, human papillomavirus (HPV), chlamydia, and gonorrhoea. It also increases your risk of acquiring HIV.

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.

What causes bacterial vaginosis?

It’s not fully understood what causes the imbalance of bacteria in the vagina which leads to BV.

You can develop bacterial vaginosis without having ever had sex, so it is not classified as an STI. But sexual activity increases the likelihood of getting it. Other things that increase your risk are:

• having a new sexual partner or several sexual partners
• washing your vagina (douching) and using soap or vaginal deodorant
• using strong detergents to wash your underwear
• smoking
• using bubble bath, shower gel, scented soaps or antiseptic washes
• receiving oral sex
• having an intrauterine device (IUD) fitted.

We also know that there are higher rates of bacterial vaginosis among lesbian, bisexual, and other women who have sex with women compared to heterosexual women.

Can you prevent bacterial vaginosis?

The following things can reduce the risk of developing bacterial vaginosis:

• using condoms and dental dams during sex
• cleaning, or changing condoms on, sex toys before sharing them with sexual partners
• using an oral contraceptive pill
• having showers rather than baths.

Studies have also shown a reduced risk of bacterial vaginosis in women whose male sexual partners are circumcised.

Symptoms of bacterial vaginosis

Bacterial vaginosis often doesn’t cause any symptoms at all.

If you do get symptoms, they can include changes to vaginal discharge. This includes your discharge turning grey or whitish, turning watery, or developing a fishy smell. These symptoms 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.

Testing for bacterial vaginosis

If 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 from the way your discharge looks.

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 STIs 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.

Do I need treatment for bacterial vaginosis?

Bacterial vaginosis sometimes goes away by itself as the balance of bacteria in the vagina corrects itself. If BV is not bothering you, it is not always necessary to have it treated.

However, 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. This is because BV can increase the chance of acquiring HIV or passing it on if you have a detectable viral load.

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 (PID).

If you have a partner, your doctor or nurse may also recommend that they are also treated. This is because your partner may have bacteria linked to BV on their penis or in their vagina. Recent research found that giving male partners antibiotic tablets and cream to put on their penis reduced their partner’s risk of BV coming back.

Treating bacterial vaginosis

Treatment for BV is antibiotics. The medication is usually called metronidazole or clindamycin.

You will either take your medication as tablets (a single larger dose or doses over seven days) or as a vaginal gel over five to seven days. It is important that you take all the treatment prescribed to you.

If your treatment is metronidazole vaginal gel, you should avoid having sex until you finish the course of treatment.

You don’t need to avoid sex while taking oral metronidazole or clindamycin vaginal gel, but you might find your symptoms clear up more quickly if you avoid sex during this time. If you do have sex, use a condom.

Clindamycin vaginal gel used to treat BV can weaken latex, so you will need to use non-latex condoms while using the treatment, and for 5 days afterwards.

There is a lot of information online about complementary therapies to prevent or treat bacterial vaginosis, such as probiotics. However, there’s not enough evidence that they work, so they are not recommended.

It is common for bacterial vaginosis to come back after treatment, so you may need another course of treatment at a later date. If you frequently have bacterial vaginosis, your doctor may recommend preventive treatment with antibiotics.

Pregnancy and breastfeeding

Bacterial vaginosis is common during pregnancy.

If you are thinking about becoming pregnant, you may want to be treated for BV even if you don’t have symptoms.

There is some evidence that BV can increase the risk of premature birth, especially if you have had a miscarriage, premature baby, or a baby with a low birth weight before.

If you are living with HIV, there is also a greater risk of passing it on to a baby during delivery if you have BV.

You can safely take treatment for BV during pregnancy and while you're breastfeeding.