According to the Centers for Disease Control and Prevention, bacterial vaginosis (BV) is the most common vaginal condition in women of reproductive age in the United States, affecting approximately 21 million women. BV has also been shown to disproportionately affect Black women.
"In addition to the physical symptoms, BV can also impact a woman’s emotional well-being. A 2017 survey among 304 women diagnosed with BV2 found that 79 percent avoided intimacy with their partner and 68 percent felt self-conscious because of their condition," according to a press release from global healthcare company Organon announcing XACIATO™, a vaginal gel available by prescription to treat bacterial BV in females 12 and older.
BlackDoctor.org sat down with Board-Certified Obstetrician/Gynecologist Kameelah Phillips, MD to discuss what BV is, how it differs from other vaginal infections, and its specific impact on Black women as well as the treatment options available to women living with this condition.
What is bacterial vaginosis and how does it differ from other vaginal infections?
Bacterial vaginosis is one of the most common infections of reproductive age women. It is an overgrowth of bacteria in the vagina. Different things can offset the sort of delicate microbiome of the vagina. When that happens a certain group of bacteria get to overgrow and that's bacterial vaginosis. In my practice, women come complaining of an increase in their vaginal discharge – that it might be a little more runny. The hallmark really is a complaint of a fishy odor or vulvar discharge and I find that often people get bacterial vaginosis confused with yeast infections.
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Can you describe the difference between BV and yeast infections, and how to distinguish between them?
Bacterial vaginosis tends to be a more copious watery discharge. Yeast infections tend to be a little thicker. We describe [it] as cottage cheese-like discharge. That's the way we distinguish them. Some people just have a vulvar irritation because there's just so much moisture there. Whereas, with yeast, it's red [and] it can feel swollen. With BV, [you] typically don't get complaints about discomfort in that sense but the yeast infections can cause a ton of itch and urinary tract infection. BV, in particular, can be really embarrassing for people and because it's so common, it can cause discomfort – it can cause embarrassment. Come to the doctor so we can help discuss treatment options for you.
What advice do you have for women dealing with the embarrassment of BV?
I think one thing is to normalize bodies and what happens with bodies and reduce the stigma in terms of bodies that may have imbalance or odor and that kind of thing because it's such a common infection. We should talk about it with each other – with our healthcare providers especially. I think that starts to destigmatize some of what's going on with our bodies. It helps us feel more comfortable addressing it with our healthcare providers. It also helps us talk about the options for management and treatment. With upwards of 58 percent of women having a recurrence of bacterial vaginosis, talking about it and understanding what to do to helps minimize BV as something that we should all know and be familiar with and feel comfortable talking to our doctors about.
How does BV specifically affect Black women?
We do see a disproportionate amount of BV in the Black and Hispanic community and it's a little unclear as to why. But what we do know is that the microbiome in our population and Hispanic women can be a little different and I'm not saying that's bad or good, but it's just different and everyone's microbiome for the vaginal environment is different and so that's one reason we need more research so we can learn how to manage that. Culturally, I do see women who still practice douching or different internal vaginal cleaning and I do try and discourage that.
Are there any preventive measures or lifestyle changes that women can make to reduce the risk of BV?
I don't frame it as preventing BV because it can create a sense of blame. Instead, we focus on risk factors and awareness. For example, avoiding douching, which disrupts the vaginal microbiome, is important. Smoking is another risk factor, as smokers have higher rates of BV. Regarding sexual activity, whether or not it includes condoms, having multiple partners can be a risk factor. I don't intend to shame anyone but rather to provide information for consideration. BV can still occur despite these precautions, so seeking timely treatment is crucial.
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What are the next steps for women who suspect they have BV, and what are the treatment options available?
We do this: itching? Yes. Copious discharge? Yes. Fishy odor? Yes. We often follow this algorithm, especially since it can be recurrent in the reproductive age domain. Sometimes, we use swabs, but primarily, it's a clinical diagnosis based on examination. Healthcare providers can diagnose BV using the patient's history as well. Patients should talk to their healthcare provider to see if they're a candidate for treatment.
The antibiotic, clindamycin, which has been a staple in medicine for a long time, is effective against bacterial vaginosis, making it a tried and true medication to treat BV. XACIATO™, a treatment option for BV, is a single-dose vaginal gel formulated with clindamycin in a thermosetting gel, allowing the medication to stay in the vagina longer, limiting leakage. This prolonged exposure is important because we know that 2/3 of people with BV need treatment, and 58 percent of them have recurrent BV. Having a single-dose vaginal gel with these properties, containing an antibiotic that is tried and true against this type of infection, is something patients and doctors can consider when treating the 21 million or more people affected annually.
Are there any complications associated with untreated BV?
Recurring BV can cause physical discomfort, emotional stress, and side effects from the infection. For pregnant women, there's ongoing research, but BV has been associated with preterm labor, which is concerning. Some studies suggest that vaginal infections can make women more susceptible to other infections. There's also an economic aspect, as trying various treatments can be costly. Overall, not addressing BV can have significant emotional, economic, and reproductive health implications.
Is there anything else you'd like to share about BV and its management?
I believe it's crucial to normalize conversations about bacterial vaginosis because one in three women experience it. At some point, whether it's you, your friends, or people you know, someone is likely to have BV. Therefore, discussing the signs and symptoms is important, as well as feeling comfortable enough to articulate them to your OB or internal medicine doctor for a proper diagnosis. This way, you can avoid confusion between BV and yeast infections. It's important to discuss treatment options, and I believe this article will be very helpful in informing people about BV and XACIATO as a treatment option. By expanding the conversation and treatment options for BV, we can help eliminate some of the embarrassment and provide more solutions for those affected.
This conversation has been edited and condensed for clarity.
