STD Awareness: Is Bacterial Vaginosis a Sexually Transmitted Disease?

Pictured above: Gardnerella vaginalis under a microscope. Image: K.K. Jefferson/Virginia Commonwealth University. From http://www.nist.gov/mml/bmd/membrane-012914.cfm

Bacterial vaginosis, or BV, is the most common vaginal infection among people 15 to 44 years of age. It’s caused by an overgrowth of harmful bacteria, such as Gardnerella vaginalis. A healthy vagina hosts thriving populations of Lactobacillus bacteria species, but when these “good” bacteria are crowded out by certain types of “bad” bacteria, the vaginal ecosystem can be shifted, causing BV.

There is a lot of confusion about BV. Is it a sexually transmitted disease (STD)? What are the symptoms? How can you avoid it?

All good questions. Let’s examine them one by one.

Is BV an STD?

The consensus seems to be that BV isn’t officially an STD, but even reliable sources have somewhat contradictory information. Planned Parenthood doesn’t list BV as an STD on their informational webpages. The Centers for Disease Control and Prevention (CDC) does include BV on their STD website, but also says that “BV is not considered an STD.”

On the other hand, the Office on Women’s Health says that “BV can … be caused by vaginal, oral, or anal sex” and that “you can get BV from male or female partners.” And there’s an entire chapter devoted to BV in the premier medical textbook on STDs, and its authors say that, while sexually inexperienced females can get BV, “the weight of evidence supports sexual transmission” of G. vaginalis, the bacteria species most famously implicated in BV infections.

The same webpage on which the CDC declared BV not to be an STD also says that it can be transferred between female sexual partners. Indeed, women who have sex with women have higher rates of BV. Since vaginal fluid could spread BV, partners can change condoms when a sex toy is passed from one to another, and use barriers like dental dams when engaging in cunnilingus (oral contact with the female genitalia) or rimming (oral contact with the anus).

What about heterosexual transmission? Bacteria from a penis can be introduced into a vagina, possibly disrupting its ecosystem. The Lactobacillus population can usually keep these invaders in check, but sometimes the vaginal flora can go haywire. Men have been found to host G. vaginalis in their penises, and because BV can be caused by numerous other bacteria — not all of which are known to scientists at this point — it is certainly possible that men could transmit BV-associated microbes to their partners during sex. Oddly, antibiotics for male partners are not recommended, as they are not found to be effective in reducing BV recurrence in female partners. However, better-designed studies might change these recommendations in the future.

The upshot? BV can be transmitted sexually, but because it can strike people who have had zero sex whatsoever, it’s not officially an STD. Many of the machinations of BV are shrouded in mystery for now, but here’s what we seem to know for sure: Virgins can get BV, but risk is increased when someone has a new sexual partner or multiple sexual partners. In fact, the more sexual partners someone has over their lifetime, the greater their risk for BV — a pattern that is consistent with STDs.

BV isn’t the only not-technically-an-STD that can descend upon a female reproductive or urinary tract in the wake of sexual activity. You might have heard of “honeymoon cystitis” — a bladder infection preceded by frequent sex. You don’t have to have sex to get a bladder infection, but some doctors believe that the friction from vaginal intercourse can push preexisting bacteria into the urethra, where it can start its journey to the bladder. Yeast infections are another non-STD that can be transmitted from one partner to another by sexual activity.

Bacterial vaginosis does increase risk for acquiring other STDs, such as HIV, herpes, chlamydia, and gonorrhea. So, while you can get it even without being sexually active, a BV infection can make you more vulnerable to STDs if you do become sexually active.

What Are the Symptoms of BV?

More than 80 percent of people with BV have no symptoms at all. But, for those of us unlucky enough to get symptoms, here are some afflictions we might experience:

• thin white or gray vaginal discharge, which can be watery or foamy
• vaginal odor, which might smell “fishy”
• burning in the vagina
• itching around the vaginal opening
• burning sensation while urinating

These symptoms can be easily confused for trichomoniasis (trich) or a yeast infection. To get a proper diagnosis, you’ll need to see a health care provider, who can take a vaginal sample and look at it under a microscope or perform a lab test.

Can BV Cause Sores?

A lot of people might find sores in their vaginal region and hope they are symptoms of something like BV — rather than evidence of an STD. None of the sources consulted for this article listed sores as symptoms of bacterial vaginosis, but they can be symptoms of other infections, including:

• genital herpes: symptoms can include blisters and open sores
• molluscum contagiosum: symptoms can include round growths that may itch or feel tender
• scabies: symptoms can include small bumps or rashes arranged in small curling lines
• syphilis: symptoms can include a painless sore or open, wet ulcer

A health care provider will be able to give you proper diagnosis and treatment. Some infections can be dangerous when untreated — or improperly treated.

How Can I Prevent BV?

The CDC and Office on Women’s Health have some recommendations for reducing BV risk:

• abstain from sex
• limit sexual partners
• refrain from douching
• use condoms and dental dams during sexual contact
• use condoms on shared sex toys

Alternative remedies, including probiotic supplements, are not adequately studied at this point.

You can seek diagnosis and treatment for bacterial vaginosis at a Planned Parenthood health center. Remember, if something is amiss below the belt, an accurate diagnosis from a qualified health care provider is your best chance for successful treatment!