STD Awareness: Is Bacterial Vaginosis a Sexually Transmitted Disease?

Not to scale: Gardnerella vaginalis under a microscope. Image: K.K. Jefferson/Virginia Commonwealth University

Gardnerella vaginalis under a microscope. Image: K.K. Jefferson/Virginia Commonwealth University

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? Continue reading

Is Douching Safe?

This vintage douche ad claims that its product is “safe to delicate tissues” and “non-poisonous.”

Douching is the practice of squirting a liquid, called a douche, into the vagina. Many people believe it helps keep the vagina clean and odor-free, and some are under the impression that it helps prevent pregnancy and sexually transmitted diseases. An estimated 25 percent of American women 15 to 44 years old douche regularly. But just because douching is widespread doesn’t mean it’s safe; indeed, there are two possible mechanisms by which douching might be harmful.

First, douching might alter the pH of the vagina, changing its ecosystem. You might not think of a vagina as an “ecosystem,” but the bacteria and other microscopic organisms that live there sure do — and altering their habitat can harm the beneficial microbes that live there, opening the door for disease-causing microbes to take over the territory. Frequent douching can result in the vagina’s normal microbial population having difficulty reestablishing its population.


Douching increases risk for infections and fertility problems, and has no proven medical benefits.


Second, a douche’s upward flow might give pathogens a “free ride” into the depths of the reproductive tract, granting them access to areas that might have been difficult for them to reach otherwise. In this manner, an infection might spread from the lower reproductive tract to the upper reproductive tract. Douching might be an even bigger risk for female adolescents, whose reproductive anatomy is not fully formed, leaving them more vulnerable to pathogens.

While douching is not guaranteed to harm you, there is no evidence that it is beneficial in any way. Establishing causation between douching and the problems that are associated with it is trickier — does douching cause these problems, or do people who douche also tend to engage in other behaviors that increase risk? So far, the best evidence indicates that douching is correlated with a number of diseases and other problems, including sexually transmitted diseases (STDs), bacterial vaginosis, pelvic inflammatory disease, fertility and pregnancy complications, and more. Continue reading

STD Awareness: Drug-Resistant Trichomoniasis

Two trophozoites of Trichomonas vaginalis, the causative agent of trichomoniasis. Image from the CDC’s Parasite Image Library.

Trichomonas vaginalis organisms, which cause trichomoniasis. Image: Parasite Image Library, CDC

You’ve probably heard of MRSA, which is a strain of Staphylococcus aureus that evolved resistance to all kinds of antibiotics. You also might have heard of other “superbugs,” like Clostridium difficile, aka “C. diff,” or the emerging strains of bacteria that cause antibiotic-resistant gonorrhea. However, other infectious diseases are slowly evolving drug resistance too, but they’re not grabbing headlines. One such disease is trichomoniasis.


We are only starting to learn about drug-resistant trich — and what it means for those who have it.


Trichomonas vaginalis is the single-celled parasite that causes trichomoniasis, or trich (pronounced “trick”). Symptoms can include vaginal discharge (which might have a bad odor), penile burning or discharge, spotting, and itching or swelling in the genital area — but around 70 percent of trich infections are asymptomatic.

Despite its appearance on our list of 10 STDs you’ve probably never heard of, trich is actually the most common curable sexually transmitted disease out there — around 3.7 million Americans are currently infected with trich. When you consider that trich rarely has symptoms, its ubiquity might not even seem all that surprising — there are millions of infections, right under our noses, but mostly unknown and not being aggressively screened for. STD testing doesn’t always include screening for trich, especially in males, who usually don’t have symptoms and can transmit it to others unknowingly. This might not be so bad if trich didn’t cause complications with pregnancy or make it easier to be infected with HIV. Continue reading

Over 90 Percent of What Planned Parenthood Does, Part 12: Colposcopy

Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl doesn’t know about.

When talking about Pap tests — particularly when discussing abnormal Pap results — one procedure that comes up a lot is the colposcopy.

It can sound intimidating and clinical on its own. And if you’re anything like me, you may have — ahem — occasionally confused it with the significantly more internal colonoscopy. For the sake of everyone’s anxiety levels, it may be best to set the record straight.


What is a colposcopy, and what should you expect from the procedure?


Why am I getting a colposcopy?

The most common reason for undergoing a colposcopy is having an abnormal Pap test result, particularly one that, when tested for DNA of human papillomavirus, yielded a positive result. Effectively, there are some abnormal cervical cells with HPV present. Because this could potentially progress to cervical cancer down the line, this combination makes health care providers want to get a closer look at what’s going on.

That said, colposcopies are sometimes performed for other reasons, such as genital warts on the cervix, cervicitis (inflamed cervix), or benign cervical polyps. Continue reading

STD Awareness: Trichomoniasis

Editor’s note: To find out if trichomoniasis can go away on its own, please see our April 2016 post Will STDs Go Away on Their Own?

Trichomonas vaginalis, normally pear-shaped, flattens itself out after attaching to vaginal cells, maximizing surface area between parasite and host. The purple organisms are bacteria. Image: Antonio Pereira-Neves and Marlene Benchimol, Santa Ursula University, Rio de Janeiro, Brazil

Most sexually transmitted diseases are caused by viruses or bacteria. STDs caused by viruses include herpes and genital warts, and the viruses that cause them aren’t even technically living organisms — they are pieces of genetic information that are able to infect a host cell. STDs caused by bacteria include gonorrhea and syphilis; bacteria are microscopic, single-celled organisms with relatively simple cell structures.

But some STDs are caused by other types of living organisms. Protozoan organisms are microscopic and unicellular, like bacteria; unlike bacteria, their cell structures more closely resemble that of the so-called “higher” life forms such as animals and plants. While protozoa are considered to be “animal-like,” they are not animals at all — they are single-celled organisms that reproduce asexually. When certain types of protozoans get into your body, they can cause infections — such as trichomoniasis, the most common curable STD among young females (as well as more females over 40 than previously thought). It is estimated that 7.4 million new cases of trichomoniasis occur annually in the United States; worldwide, there are about 170 million cases each year.

Trichomoniasis, colloquially known as trich, is spread by vaginal or anal intercourse, direct vulva-to-vulva contact, and other activities that involve passing secretions from one partner to another (e.g., sharing sex toys or mutual masturbation). Sexually active people can reduce the risk of contracting trichomoniasis by using latex barriers, such as condoms. Continue reading

STD Awareness: Bacterial Vaginosis and Chancroid

Editor’s Note: Please see our post of November 2, 2015 to learn if bacterial vaginosis (BV) can cause sores, and to get the scoop on whether or not it’s actually an STD.

Sexually transmitted diseases can be caused by viruses, bacteria, protozoans, and even animals. Bacterial vaginosis and chancroid are both infections caused by bacteria, which means that they can be treated with antibiotics. While bacterial vaginosis only affects people with vaginas, chancroid disproportionately affects people with penises. You can seek diagnosis and treatment for bacterial vaginosis and chancroid at a Planned Parenthood health center, as well as health clinics, private health-care providers, and health departments.

Bacterial vaginosis is caused by an imbalance of bacteria species in the vagina. Image: renjith krishnan / FreeDigitalPhotos.net

Bacterial vaginosis is caused by an imbalance of bacteria species in the vagina. Image: renjith krishnan / FreeDigitalPhotos.net

Bacterial Vaginosis
Bacterial vaginosis seems to be most commonly caused by the bacteria species Gardnerella vaginalis. Scientists aren’t quite sure how this infection is caused, but risk seems to correlate with a change in sexual partners, having multiple sexual partners, douching, or using an intrauterine device; it can also occur in females who have never been sexually active. It is more common in pregnant women. There is no counterpart to this infection in males, although G. vaginalis can be found in their urethras; this raises the possibility that bacterial vaginosis can be sexually transmitted, in which case it could be directly transmitted between two females or indirectly transmitted from one female to another via a male.

Bacterial vaginosis seems to result from an imbalance in the vaginal flora (“flora” is a somewhat fanciful term for the bacteria that live in your body; under normal circumstances they are harmless and even beneficial). Vaginas usually are habitat to a population of bacteria called Lactobacillus, which produce hydrogen peroxide as a byproduct. When the number of Lactobacillus declines, G. vaginalis is able to move in on Lactobacillus’ old territory. The decrease in Lactobacillus and increase in G. vaginalis leads to a rise in the vagina’s pH. The new vaginal environment is less acidic and more alkaline; a vaginal pH of more than 4.5 is one criterion for the diagnosis of bacterial vaginosis. Another symptom includes a vaginal discharge that may smell somewhat fishy. There might also be genital itching or pain during urination. It is also possible not to have symptoms. Continue reading