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Forum Name: Gynecology

Question: bacterial vaginosis

LKahler - Fri Jan 19, 2007 12:34 pm

Hello, I am a 24-year old female - just found out I had BV on the 5th of this month. For a couple of weeks prior, I thought I had a bad yeast infection and treated it with an at-home monistat kit. It did nothing, and one night while looking at my privates in a little bathroom mirror, a thin, runny, whitish discharge leaked out of me (sorry if TMI). I knew I had to go to the doctor right away, so I went the very next morning. She said I had BV after doing a test under the microscope, and prescribed me a one-dose treatment of Metronidazole (4 pills all at once). The pills had horrible side effects (especially metallic taste in the mouth and Nausea) but no effect on my vagina. I called her again and she prescribed me clindamycin gel. I did not take the gel right away because I was getting my period and figured I would wait to see if my period would make the BV go away. Of course, it didn't, so here I am on my third day of using the clindamycin 2% cream. I have a lot of questions about what causes BV and how I can get rid of it. So much information on the Internet contradicts itself. I would really like to get straight facts on what I can do about this! Here are some of my questions, if anyone would be able to answer, I would really appreciate it so much! 1. I suspect that when my boyfriend ejaculates inside of me (we are both STD free) that it causes something to go wrong inside of my vagina, causing the BV. We had had sex quite often before without him ejaculating (though no condoms) and I never got BV. It was not until he ejaculated in me that it seemed to happen. Could his semen be the cause of this problem? Also, I noticed that his semen made my privates burn and feel irritated. It felt like I was swollen down there for about 30 min after sex. Is this normal? Could I be allergic to his semen? Does his semen cause BV? 2. If that is the case, does he need to be treated for BV as well? I read from various online sources that BV is not sexually transmitted, and that treatment is not necessary for male partners, but some websites say exactly the opposite. What are the facts on this? Does he need to take metronidazole? If we keep having sex and he ejaculates inside of me every time, am I just going to keep getting re-infected? 3. Is this going to cause major pregnancy complications, or even an inability to conceive a child? 4. Once you get BV, does it ever go away? Women in online forums talk about it as if it never goes away, that it is a chronic disease. This really frightens me as this has a huge impact on my sex life. 5. I realize that you cannot use latex condoms while on clindamycin, as the drug will cause them to erode. I would really like to be able to have sex with my boyfriend despite using the vaginal cream. Do I have to wait out the 7 days, or can we have sex? Will the cream hurt him if it gets on his penis? What if we do use condoms? We're not worried about diseases/pregnancy; I was going to suggest using a condom to see if that would protect him from getting the medicine on his privates. Also, I would ask him not to ejaculate inside of me as to not re-infect me (if it is true that he is the cause of it) 6. I work out 4 days a week, intense cardio. My undergarments tend to get very sweaty and damp as a result. Could this also be a cause of BV? I would appreciate any input at all on this. I am at my wit's end! I am so frustrated and scared that I will never get rid of this that I feel like I could cry. PLEASE HELP! PS - Current medications I am taking are Solia (desogen) birth control, have taken this since I was 18 with no problems, and 50 mg of Zoloft. I also take Vitamin C daily.

Dr. Chan Lowe - Sat Jan 20, 2007 12:05 am

Your symptoms that you describe are consistent with BV. If your doctor did a microscopic preparation the diagnosis is almost certainly correct. Generally the single dose of oral metronidazole (2 grams) is sufficient to treat BV, but occasionally this may fail. At this point, it is advisable to use a 7 day treatment course-either an oral route with metronidazole or clindamycin, or a topical route generally with clindamycin gel. As to your questions: 1) Semen does not "cause" BV but increased infection rates have been described in those that are sexually active. BV is not considered a sexually transmitted disease as it can occur in virginal girls as well, however. BV is basically due to an overgrowth of bacteria (generally gardnerella vaginalis) that causes the symptoms. It is possible, though rare, for women to be allergic to semen. If your burning symptoms persist you may consider seeing an allergist. It is more likely, however, that you have some inflammation and mucosal irritation for the infection that was irritated by intercourse. 2) In cases where women are having repeat occurrences of BV, it is possible that the male partner can be colonized with the gardnerella within the urethra. As such, he may be "passing" it back to you. Treating your partner may or may not help. There have not been a lot of studies on this. Treatment is the same oral dose for him. Most commonly, women do not run into this situation but if you are experiencing repeated episodes you may want to discuss this with your doctor. 3) BV is not associated with future pregnancy complications to my knowledge. Infection during pregnancy can occasionally cause increased complications, so talking with your doctor in this situation is important. 4) BV most certainly does go away, although it can reoccur. If it does, retreatment should resolve the infection. 5) Clindamycin cream and ovules are oil based and as such may weaken latex condoms. It is advisable to abstain from sexual contact during treatment or use alternative methods of prevention. Clindamycin is not dangerous to him. 6) Physical activity is generally not considered a risk factor for BV. As always, general good hygiene practices are recommended and changing clothing as soon as possible afterward will help. In addition, this can help prevent yeast infections. To help in prevention of recurrence or help treat your current infection you can try eating yogurt or other foods with active colonies of Lactobacillus in them. Lactobacillus is a normal organism that colonizes the vaginal mucosa. Its presence helps keep the gardnerella from "overgrowing" and causing BV. Keep in mind that gardnerella normally is found in the vaginal area. Only when it becomes too numerous does it cause infection. Anything that changes the environment of the vagina can lead to subsequent BV or a yeast infection, particularly Antibiotic use. Hope this helps.

LKahler - Mon Jan 22, 2007 2:47 am

Dr. Lowe, Thank you so much for this information. This is really a great relief for me. I am on my fifth night of the cream and it seems to be working well. Hopefully it will stay away for good! I wish that more women knew about BV, that it is the most common type of vaginal infection, and that they should avoid all of the misinformation that can be found online. Your post helps to emphasize the importance of getting the facts from a medical professional. Thanks again!

Dr. Chan Lowe - Thu Jan 25, 2007 1:30 am

Glad your feeling better and like our site. Come back any time.

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