Vulvovaginal Symptoms in Women With Bacterial Vaginosis

Abstract

To investigate the symptoms among women with bacterial vaginosis, the authors conducted a longitudinal study comparing symptoms experienced by women with and without a diagnosis of bacterial vaginosis confirmed by Gram stain and Amsel clinical criteria. Subjects were recruited from women making routine healthcare visits to clinics in Birmingham, Alabama. Participating patients were interviewed intensively for information about lower genital tract symptoms, including vaginal wetness, vaginal discharge, vaginal odor, persistent vaginal itch, pain with urination, and abdominal or pelvic pain. All subjects underwent an initial clinical assessment with pelvic examination and lower genital tract microbiologic evaluation, as well as detailed questioning, which included demographic factors, obstetric and gynecologic history, dental symptoms and practices, feminine hygienic and health behaviors, sexual history and practices, history of genital tract infections or sexually transmitted diseases, alcohol and drug use, and psychosocial status. There were 2888 eligible patients who had Gram stain results available. These women were predominantly black, young, parous, unmarried, and of low income. Thirty-seven percent (1063 patients) were positive for bacterial vaginosis by Gram stain. Positivity was more common in black women and women who smoked and increased with decreasing general health status. Women who were married, of higher income, and less than 20 years of age were less likely to have bacterial vaginosis. Few of the total study population reported pelvic or abdominal pain. More women who were positive for bacterial vaginosis reported vaginal wetness and vaginal odor, and more women who were free of bacterial vaginosis reported dysuria and vaginal irritation. The differences were significant, but the numbers of women in either group who had symptoms were small. The most common symptom was vaginal odor, but only 25% of the patients with and 18% of those without bacterial vaginosis noticed vaginal odor. In all, 58% and 57% of the positive and negative patients, respectively, reported experiencing wetness, discharge, and/or vaginal odor. Among sexually active participants, those who were positive for bacterial vaginosis were more likely to have any odor or fishy odor with sexual intercourse, but less than 20% of either group reported these symptoms. When analyses were performed using Amsel criteria to define bacterial vaginosis, the pattern of reported symptoms was largely unchanged. Participants were asked to describe their usual vaginal odor to clarify their reports of symptoms. No one description was more common than another, but all descriptive terms were more frequent among patients with bacterial vaginosis. The characteristic “fishy” odor was reported by only 6% and 4% of the positive and negative patients, respectively. Thirty-seven percent of the women with no reported symptoms, 26.3% of those with vaginal irritation alone, and 19.4% of those with both irritation and discharge or wetness were positive for bacterial vaginosis. Women who reported vaginal irritation were less likely to have bacterial vaginosis no matter what other symptoms or odor they reported. Vaginal discharge did not indicate the presence of bacterial vaginosis when experienced alone or with other symptoms. Vaginal odor was the only symptom with even a moderate association with bacterial vaginosis. At clinical examination, 35% of patients who reported no discharge, and 49% of those who said they had severe discharge, were described by the examining nurse as having a thin, homogeneous discharge. Similarly, 36% of those reporting no vaginal odor, and 48% of those who felt they had severe vaginal odor, were positive for the “whiff” test.