Bacterial Vaginosis (BV) is a common vaginal infection caused by an imbalance in the normal bacterial flora of the vagina. Typically, the vagina maintains a natural balance between various bacteria, with Lactobacilli playing a key role in keeping harmful bacteria in check. However, when the levels of Lactobacilli decrease and harmful bacteria like Gardnerella vaginalis multiply, BV occurs. Though it is not classified as a sexually transmitted infection (STI), it is more common in sexually active women and is linked to sexual activity.
1. Persistent Symptoms and Discomfort
In many cases, BV is accompanied by noticeable symptoms such as a thin white or gray vaginal discharge, a strong fishy odor (especially after sex), itching, and burning during urination. When left untreated, these symptoms may persist or worsen. While they may not be life-threatening, they can significantly impact a woman’s quality of life. Chronic discomfort can lead to embarrassment, social withdrawal, and sexual distress.
Moreover, the persistence of abnormal vaginal discharge and odor often leads to self-diagnosis and the use of over-the-counter remedies or douching, which can further disrupt the vaginal flora and worsen the condition.
2. Increased Risk of Sexually Transmitted Infections (STIs)
One of the most serious consequences of untreated BV is an increased vulnerability to sexually transmitted infections, including HIV, herpes simplex virus (HSV), gonorrhea, chlamydia, and trichomoniasis. The vaginal flora acts as a natural barrier against pathogens, but when BV disrupts this balance, it compromises the vagina’s natural defense system.
In particular, BV has been shown to increase a woman’s risk of acquiring HIV if exposed. This is due to increased vaginal inflammation and microabrasions that provide entry points for the virus. Furthermore, BV can increase viral shedding in HIV-positive women, making them more likely to transmit the virus to sexual partners.
3. Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease (PID) is a serious infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries. BV itself doesn’t cause PID, but it can contribute to its development when harmful bacteria ascend from the vagina into the upper reproductive tract.
Women with untreated BV who are exposed to other bacteria during unprotected sex or medical procedures such as intrauterine device (IUD) insertion are at a higher risk of developing PID. This can result in chronic pelvic pain, infertility, ectopic pregnancy, and scarring of reproductive organs. The longer BV goes untreated, the higher the risk of these complications.
4. Infertility and Reproductive Health Issues
Infertility is one of the long-term consequences of chronic, untreated BV, especially when it leads to PID. The inflammation and infection associated with PID can cause permanent damage to the fallopian tubes, preventing the egg from traveling to the uterus. This blockage can make natural conception difficult or impossible.
Additionally, BV-related inflammation may negatively affect sperm motility and embryo implantation, even if the fallopian tubes remain open. Women undergoing fertility treatments such as in vitro fertilization (IVF) may have lower success rates if BV is present and untreated.
5. Complications in Pregnancy
BV during pregnancy poses significant risks to both the mother and the fetus. Pregnant women with untreated BV are more likely to experience complications such as:
- Preterm birth: BV is associated with a higher risk of preterm labor, leading to premature birth. This puts the newborn at risk of respiratory issues, developmental delays, and increased susceptibility to infections.
- Low birth weight: Infants born to mothers with untreated BV may weigh less than 2,500 grams, increasing the risk of neonatal complications.
- Late miscarriage: BV may contribute to miscarriage during the second trimester.
- Intra-amniotic infection: Bacteria can infect the amniotic fluid and membranes surrounding the fetus, leading to inflammation (chorioamnionitis) and sepsis.
Given these risks, screening for and treating BV in pregnant women, especially those with a history of preterm birth, is essential to promote healthy pregnancy outcomes.
6. Increased Risk of Post-Surgical Infections
Women undergoing gynecological surgeries such as hysterectomy, cesarean section, or abortion are at a greater risk of post-operative infections if BV is present and untreated. BV-related bacteria can migrate from the vagina into the surgical site, leading to infections of the uterus, abdominal cavity, or bloodstream.
This can result in prolonged hospitalization, antibiotic therapy, and, in severe cases, life-threatening sepsis. Therefore, pre-operative screening and treatment for BV is recommended before major gynecologic procedures.
7. Recurrence and Antibiotic Resistance
BV is known for its high recurrence rate, even after treatment. If left untreated initially, the bacterial imbalance can become chronic, leading to repeated episodes. This can cause a cycle of infection, partial treatment, temporary relief, and relapse.
Repeated or inadequate treatment with antibiotics may also contribute to antibiotic resistance, making the condition more difficult to manage over time. It also increases the risk of side effects from repeated antibiotic use, including gastrointestinal disturbances and secondary infections like yeast infections.
8. Impact on Mental and Emotional Well-Being
The symptoms of BV—especially chronic odor and discharge—can be distressing and affect a woman’s self-esteem and intimate relationships. Many women report embarrassment, anxiety, and even depression related to their condition.
In relationships, BV can lead to misunderstandings, sexual avoidance, and emotional tension, especially if the symptoms are misinterpreted as signs of infidelity or poor hygiene. The chronic nature of untreated BV can lead to feelings of hopelessness and frustration.
9. Challenges in Diagnosis and Mismanagement
BV can be misdiagnosed or confused with other conditions such as yeast infections or trichomoniasis. This is particularly true when women self-diagnose or rely on over-the-counter treatments. Yeast infections, for example, are commonly treated with antifungal medications, which are ineffective against BV and may even worsen symptoms.
Delays in accurate diagnosis and treatment can lead to progression of the infection and more serious complications. Proper evaluation by a healthcare professional, including vaginal swabs and pH testing, is essential for correct diagnosis.
10. Effects on the Vaginal Microbiome
The vaginal microbiome is an intricate and dynamic ecosystem. Chronic, untreated BV can cause long-term disruption to this delicate balance. Over time, the reduction of protective Lactobacillus species and overgrowth of anaerobic bacteria can lead to a persistent dysbiotic state.
This may make the vagina more susceptible to other infections and impair the mucosal immune response. In some women, especially those who experience recurrent BV, restoring a healthy vaginal microbiome may require long-term probiotic therapy or advanced treatments such as vaginal microbiota transplants (an emerging area of research).
11. BV in Immunocompromised Women
For women with compromised immune systems, such as those with HIV/AIDS or undergoing chemotherapy, untreated BV can be more dangerous. It may lead to more aggressive infections and worsen existing health conditions. Furthermore, these women may have a reduced ability to fight off BV-related pathogens, increasing the likelihood of systemic infection.
Prompt and aggressive management of BV is crucial in these populations to prevent complications and maintain overall health.
12. Impact on Sexual Health and Pleasure
BV symptoms like odor and discomfort can negatively affect sexual desire and satisfaction. Women may feel self-conscious during intimacy, leading to reduced sexual activity. The vaginal inflammation and dryness that can occur with chronic BV may also cause painful intercourse (dyspareunia).
In long-term relationships, this can create a strain on emotional intimacy, while in casual relationships, it may affect confidence and social engagement. Thus, untreated BV can have broader implications on a woman’s sexual and emotional well-being.
13. Public Health Implications
BV is a common condition with wide-reaching public health implications. Because it often goes undiagnosed and untreated, it contributes to increased rates of STIs, reproductive health complications, and adverse pregnancy outcomes. Public health initiatives aimed at education, early screening, and treatment are essential to reduce these risks.
Addressing BV also means improving access to healthcare, particularly for women in low-resource settings where routine gynecological care may be lacking. Culturally sensitive education about vaginal health and hygiene practices can help reduce stigma and encourage women to seek timely care.
Conclusion
While Bacterial Vaginosis may seem like a minor infection at first glance, untreated BV can lead to a cascade of complications affecting not only vaginal health but also overall reproductive, sexual, and emotional well-being. From increased susceptibility to STIs and infertility to pregnancy complications and pelvic inflammatory disease, the consequences can be severe.
Early diagnosis and appropriate treatment—typically involving antibiotics like metronidazole or clindamycin—are key to managing BV effectively. Women should also be educated on prevention strategies, such as avoiding douching, practicing safe sex, and recognizing symptoms early.
Healthcare providers must play an active role in identifying and managing BV, especially in at-risk populations. Routine gynecologic check-ups, comprehensive sexual health education, and greater awareness can all contribute to reducing the prevalence and long-term impact of this common yet often underestimated condition.