Bacterial vaginosis (BV) and human papillomavirus (HPV) are two common vaginal infections that affect women. They have some overlapping symptoms, which can make differentiating between them confusing at times. However, BV and HPV are caused by different pathogens and require different treatment approaches. This article will explore whether BV can present with symptoms similar to an HPV infection, the key differences between these conditions, and how to get an accurate diagnosis.
What is BV?
Bacterial vaginosis is a dysbiosis of the vaginal microbiota, meaning there is an overgrowth of harmful bacteria in the vagina. It is notclassified as a true sexually transmitted infection (STI) but does tend to affect sexually active women. The most common symptom of BV is a gray, white, or yellow vaginal discharge that has a foul, fishy odor, especially after sex or during menstruation. Other BV symptoms can include vaginal itching, burning during urination, and irritation.
BV occurs when there is an imbalance between the good and bad bacteria in the vagina. Normally, beneficial lactobacilli bacteria help keep the vaginal pH in an acidic range to prevent overgrowth of harmful microbes. In BV, anaerobic bacteria like Gardnerella and Bacteroides species rapidly multiply, raising the vaginal pH and outcompeting the good bacteria. The exact cause is unknown but douching, new sexual partners, lack of condom use, and even stress can increase BV risk.
What is HPV?
HPV stands for human papillomavirus, a group of over 150 related viruses. Certain high-risk strains of sexually transmitted HPV can lead to cell dysregulation and cause genital warts or cancer. However, many types of HPV resolve on their own without causing major symptoms. HPV is extremely common – the CDC estimates 80% of sexually active women contract HPV at some point.
When HPV does cause symptoms, the most common ones are genital warts and cervical cell changes that require Pap smears. Warts appear as small, fleshy bumps in the genital area that can be single or clustered. Cervical cell changes do not have outward symptoms but may be detected by Pap tests. HPV can also lead to vaginal discharge in some cases. This is usually a clear, watery discharge without a strong odor.
Key Differences Between BV and HPV
While BV and HPV can both potentially cause abnormal vaginal discharge and irritation, there are some key differences between the two conditions:
Cause
– BV is caused by overgrowth of bacteria like Gardnerella and Bacteroides species in the vagina
– HPV is caused by contracting the human papillomavirus, usually through sexual contact
Discharge Characteristics
– BV discharge is typically gray, white, or yellow with a distinct fishy odor
– HPV discharge is often clear and watery without a strong smell
Other Symptoms
– BV can cause itching, burning with urination, irritation
– HPV can cause genital warts and precancerous cervical cell changes
Testing
– BV is diagnosed by microscopy of vaginal discharge, testing pH, an amine “whiff” test, or nucleic acid amplification tests.
– HPV testing is done by Pap smear, HPV DNA test, or visual inspection of warts.
Transmission
– BV is associated with sexual activity but not considered an STI.
– HPV is a sexually transmitted infection passed through skin and mucous membrane contact.
Complications
– BV can increase susceptibility to STIs and HIV, lead to PID, and cause pregnancy complications.
– Some high-risk HPV types are linked to cervical, anal, throat, and other cancers.
Can BV Mimic HPV?
Because BV and HPV share some general symptoms like discharge and irritation, BV could potentially be mistaken for HPV at first glance. However, the characteristics of the discharge and the presence of other symptoms like warts usually differ.
It is possible that someone could have a co-infection of BV and HPV. In this case, they may have discharge with features of both conditions. A foul-smelling but clear discharge could indicate concurrent BV and HPV. The only way to know for sure is through diagnostic testing.
While BV discharge can be similar to that of an HPV infection in some ways, a skilled healthcare provider can usually distinguish between the two based on medical history and an exam. Diagnostic tests can also pinpoint the exact cause.
Getting an Accurate Diagnosis
To determine whether vaginal discharge and irritation is due to BV or HPV, diagnostic testing is needed. Here is an overview of how doctors diagnose bacterial vaginosis vs. HPV:
BV Testing
BV is often first suspected due to the characteristic discharged noted on physical exam. Diagnostic tests for BV include:
– Microscopic examination of vaginal discharge – this allows identification of clue cells which indicate BV.
– Whiff test – adding potassium hydroxide to a sample results in a fishy odor if BV is present.
– Vaginal pH testing – a pH above 4.5 indicates BV.
– Nucleic acid amplification test (NAAT) – polymerase chain reaction (PCR) can detect bacteria associated with BV.
HPV Testing
HPV can be tested for in various ways, including:
– Visual inspection – warts caused by HPV may be visible on gynecological exam.
– Pap smear – abnormal cervical cell changes caused by high-risk HPV strains can be detected.
– HPV DNA test – samples are taken to identify the presence of HPV genetic material.
– HPV genotyping – determines the exact HPV strain someone is infected with.
Sometimes BV and HPV co-infect the vagina. In this case, a woman would test positive for both infections with the above methods. Treatment would then target both the bacterial overgrowth of BV and the viral HPV infection.
Treatment Options
Since BV and HPV have different causative pathogens, the treatment options differ:
BV Treatment
– Antibiotics – oral or topical metronidazole or clindamycin.
– Probiotics – restoring healthy vaginal lactobacilli.
– Maintaining vaginal pH – avoiding douching and other practices that change pH.
HPV Treatment
– Genital wart removal – cryotherapy, laser therapy, medication, surgery.
– Pap smear surveillance – detecting and treating precancerous cervical lesions.
– HPV vaccines – Gardasil and Cervarix protect against HPV strains that cause warts and cervical cancer. The vaccines work best when given at younger ages before exposure to HPV.
While BV is treatable with a course of antibiotics, HPV infections often clear on their own. If abnormal Pap smears show dysplasia due to high risk HPV types, surgery may be warranted. Stopping smoking, using condoms, and getting screened regularly helps reduce complications.
Preventing BV and HPV
There are some overlapping ways to prevent both bacterial vaginosis and HPV:
– Use condoms correctly every time you have sex
– Limit number of sexual partners
– Don’t douche, as this can upset the natural vaginal microbiome
– Stop smoking cigarettes
Some other BV prevention tips include avoiding fragranced soaps, choosing cotton underwear, and wearing looser fitting pants. The HPV vaccine protects against cancer-causing HPV strains and can be given to boys, girls, and young adults.
While BV and HPV have some general similarities, they represent very distinct vaginal infection processes. Paying attention to the exact nature of discharge and getting laboratory diagnostic tests can help differentiate between the two. Understanding the causes and optimal treatment helps lead to the best outcomes.
Conclusion
In summary, while BV and HPV can both lead to vaginal discharge and irritation, the characteristics of the discharge often differ in color, odor, and other qualities. BV is caused by bacterial overgrowth, while HPV stems from contraction of the human papillomavirus. Diagnostic testing like microscopy, DNA tests, Pap smears, and others can identify the precise infection. BV is treated with antibiotics and HPV with wart removal, Pap smears, and vaccines in some cases. Being aware of the distinguishing features of BV vs. HPV ensures appropriate diagnosis and treatment. Practicing safe sexual habits helps prevent contracting these common vaginal infections.