Symptoms of bacterial vaginosis – confirming BV with tests

Bacterial vaginosis is a kind of vaginitis (i.e. inflammation of the vagina). Other common types of vaginitis include yeast infection, trichomoniasis and chlamydia. The common symptoms of vaginitis include abnormal discharge, itching and pain, and are often accompanied by foul vaginal odor, irritation or infection of the vulva. The typical symptoms of bacterial vaginosis are milky white vaginal discharge that has a fishy smell and, occasionally, vagina itchiness and pain during urination. The vaginal discharge and odor usually get worse after a sexual intercourse or during the menses.

If you are experiencing abnormal vaginal discharge or other symptoms indicative of a vaginal infection (e.g. pain or irritation of the vagina), then it is recommended that you go for a test to find out if it is bacterial vaginosis or other types of vaginitis.

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Distinguishing bacterial vaginosis from other vaginal infections

A series of physical examinations and laboratory tests can be performed to confirm if the symptoms if they are indeed a result of bacterial vaginosis infection. Generally, this is how it goes:

Your gynecologist will first take a medical history from you by asking a routine of questions, such as if you have had experienced symptoms of bacterial vaginosis before, the nature of your discharge, are there symptoms of vaginal irritation, have you recently got a new sexual partner, did you have a history of sexually transmitted infection, etc.

After that, your gynecologist will perform a pelvic exam on you, during which she will observe the appearance of your vaginal lining and cervix, and examine the ovaries and uterus. During the pelvic exam, your gynecologist may also gather tissue samples from those areas to be checked under a microscope. This step is to exclude the possibility of any sexually transmitted disease, such as gonorrhea and chlamydia.

A sample of the vaginal discharge may also be collected to be examined under the microscope. The purpose is to differentiate bacterial vaginosis from yeast infection (e.g. candidiasis) and an STD (e.g. trichomonas). Bacterial vaginosis is indicated by the presence of an unusual cell (known as ‘clue cell’) observed under the microscope.

If you have bacterial vaginosis, the microscopic examination of vaginal discharge will also detect a lower number of the normal ‘good’ vaginal bacteria lactobacilli. The vaginal pH may also be tested since one of the symptoms of bacterial vaginosis is a vaginal pH greater than 4.5.

To test for foul vaginal odor, a test called ‘whiff test’ is performed by mixing a drop of potassium hydroxide testing liquid with a drop of vaginal discharge on a microscope slide. A fishy odor is produced if bacterial vaginosis is present.

Bacterial vaginosis during pregnancy puts women at a higher risk for complications such as preterm delivery, miscarriage and infection after delivery. Pregnant women who have symptoms of bacterial vaginosis should be tested for the infection so that they can be treated early.

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