Bacterial vaginosis

Douches and soap remove exactly the lactic acid bacteria that keep the environment acid — and are thus one of the commonest causes. Clear water on the outside is enough.

Thin, grey and fishy-smelling is the bacterial shift; crumbly, white and odourless with strong itching is thrush. An antifungal does not help here, and the other way round just as little.

Outside pregnancy it is mainly a nuisance. In pregnancy it is treated even without strong complaints, because it can be linked with a premature birth.

Relapses are common. Then it is worth looking at using condoms for a while, at smoking, at douching and at a longer, tapering treatment — not at ever new short courses.

Both smell alike and are easily confused. In one case the partner is treated too, in the other not — which is why the swab before treatment is worth it.

Metronidazole and clindamycin lower the number of anaerobes — they do not bring the lactic acid bacteria back, and that is exactly why it returns in about half of women within six to twelve months. An antifungal does not work here; the mix-up is common, because both itch. What lowers recurrence: no vaginal douching, gentle washing on the outside only, and with frequent return a longer, less frequent application over months.

It is the most common cause of changed discharge in women of childbearing age; about one in three is affected at times. The pH rises above 4.5 — the simplest point of difference from thrush, where it stays normal. After treatment it returns in about half within six to twelve months, because the lactic acid bacteria do not come back with it. In pregnancy it is treated, because it is linked with premature birth.

A fishy smell that becomes more noticeable after intercourse or during the period. That is the most characteristic feature and the most common reason people come.

Increased, uniform, thin discharge that coats the walls evenly — usually without redness, without itching and without pain.

With thrush the itching is in the foreground, the discharge is white and crumbly, the skin is red, a smell is absent. Here it is the other way round — and the treatment is a different one.

Douching and soap inside, frequent change of partner, smoking, a coil, antibiotics. It is not a sexually transmitted illness, but the link with the flora is close — and relapses are common.

A low vitamin D level is seen more often with recurring vaginosis.

With frequent relapses the long-term sugar is measured as well.

Fever, sweating and faster breathing clearly raise the need. Drinking enough keeps the mucus thin and the circulation steady — in children and older people it is the most important point of all.

With low levels airway infections occur somewhat more often; correcting a deficiency makes sense, a high single dose during the infection does not act on it.

Needed by the defence cells. For lozenges at the start of a cold there are hints of a slightly shortened duration; at a high dose over months zinc lowers copper.

Antibodies and defence cells are protein. After several days with little appetite it is worth at least keeping the protein up — soup with egg, quark, yoghurt, lentils.

Studied to restore flora — mixed evidence.

Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.

Oestrogen maintains the acidic vaginal flora. When it falls — after birth, in the weeks afterwards, after menopause — the pH rises and the bacteria shift. The timing says more here than any swab.

Many notice the complaints regularly just before or during the period: blood raises the pH. A cycle diary over three months shows the pattern more clearly than a single snapshot.

Treatment is with antibiotics. For dietary measures there is little data; individual studies found more frequent recurrence with low vitamin D. Smoking is the better-established factor.

Studied for preventing recurrence after antibiotic treatment, with inconsistent results. The recurrence rate is high — which is why so much is tried here.