Editing Bacterial vaginosis (section)

==Signs and symptoms==
Although about 50% of women with BV are asymptomatic,<ref name="Tidbury Langhart Weidlinger Stute 2021 pp. 37–45">{{cite journal | vauthors = Tidbury FD, Langhart A, Weidlinger S, Stute P | title = Non-antibiotic treatment of bacterial vaginosis-a systematic review | journal = Archives of Gynecology and Obstetrics | volume = 303 | issue = 1 | pages = 37–45 | date = January 2021 | pmid = 33025086 | doi = 10.1007/s00404-020-05821-x | s2cid = 222149236 }}</ref> common symptoms include increased [[vaginal discharge]] that usually smells like fish.<!-- <ref name=NIH2013S/> --> The discharge is often white or gray in color.<!-- <ref name=NIH2013S/> --> There may be [[Dysuria|burning with urination]].<!-- <ref name=NIH2013S/> -->

The discharge coats the walls of the vagina, and is usually without significant irritation, pain, or [[erythema]] (redness), although mild [[Pruritus|itching]] can sometimes occur. By contrast, the normal vaginal discharge will vary in consistency and amount throughout the [[menstrual cycle]] and is at its clearest at [[ovulation]]—about two weeks before the [[menstruation|period]] starts. Some practitioners claim that BV can be asymptomatic in almost half of affected women,<ref name="pmid11120507">{{cite journal | vauthors = Schwebke JR | title = Asymptomatic bacterial vaginosis: response to therapy | journal = American Journal of Obstetrics and Gynecology | volume = 183 | issue = 6 | pages = 1434–9 | date = December 2000 | pmid = 11120507 | doi = 10.1067/mob.2000.107735 }}</ref> though others argue that this is often a misdiagnosis.<ref>{{cite journal | vauthors = Forney LJ, Foster JA, Ledger W | title = The vaginal flora of healthy women is not always dominated by Lactobacillus species | journal = The Journal of Infectious Diseases | volume = 194 | issue = 10 | pages = 1468–9; author reply 1469–70 | date = November 2006 | pmid = 17054080 | doi = 10.1086/508497 | doi-access = free }}</ref>

===Complications===
Although previously considered a mere nuisance infection, untreated bacterial vaginosis may cause increased susceptibility to sexually transmitted infections, including HIV, and [[pregnancy complication]]s.<ref name=Amaya2015/><ref name=CDC>{{cite web|url=https://www.cdc.gov/std/bv/STDFact-Bacterial-Vaginosis.htm#Complications |title=STD Facts — Bacterial Vaginosis (BV) |access-date=4 December 2007 |work=CDC| archive-url= https://web.archive.org/web/20071203214825/http://www.cdc.gov/std/bv/STDFact-Bacterial-Vaginosis.htm| archive-date= 3 December 2007 | url-status= live}}</ref>

It has been shown that HIV-infected women with bacterial vaginosis (BV) are more likely to transmit HIV to their sexual partners than those without BV.<ref name=Bradshaw2015/>
There is evidence of an association between BV and increased rates of sexually transmitted infections such as HIV/AIDS.<ref name=Amaya2015/> BV is associated with up to a six-fold increase in HIV shedding. BV is a risk factor for viral shedding and [[herpes simplex virus]] type 2 infection. BV may increase the risk of infection with or reactivation of [[human papillomavirus]] (HPV).<ref name=Amaya2015/><ref name="SenokVerstraelen2009"/>

In addition, bacterial vaginosis as either [[pre-existing disease in pregnancy|pre-existing]], or acquired, may increase the risk of pregnancy complications, most notably [[premature birth]] or [[miscarriage]].<ref>{{cite web | url = http://www.nhs.uk/conditions/bacterialvaginosis/Pages/Introduction.aspx | title = Bacterial vaginosis | archive-url = https://web.archive.org/web/20140209032557/http://www.nhs.uk/conditions/bacterialvaginosis/Pages/Introduction.aspx | archive-date=9 February 2014 | work = [[National Health Service]], UK. | access-date =  3 October 2013 }}</ref><ref name="HillierNugent1995">{{cite journal | vauthors = Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, Cotch MF, Edelman R, Pastorek JG, Rao AV | display-authors = 6 | title = Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group | journal = The New England Journal of Medicine | volume = 333 | issue = 26 | pages = 1737–42 | date = December 1995 | pmid = 7491137 | doi = 10.1056/NEJM199512283332604 | doi-access = free }}</ref>
Pregnant women with BV have a higher risk of [[chorioamnionitis]], miscarriage, preterm birth, [[premature rupture of membranes]], and postpartum [[endometritis]].<ref name="Nugent1991" /> Women with BV who are treated with [[in vitro fertilization]] have a lower implantation rate and higher rates of early pregnancy loss.<ref name=Amaya2015/><ref name="SenokVerstraelen2009"/>