“The odour was pretty alien, it made me feel quite self-conscious,” Jackson recalls.
Over the course of a year, Jackson tells Mamamia she saw three separate doctors and was put on about eight different courses of antibiotics. The 24-year-old Melbourne woman was told a mix of things – that she had thrush, a UTI, pelvic inflammatory disease – but still, nothing worked.
Early on, in a moment of exasperation, she Googled her symptoms. A disease called bacterial vaginosis (BV) was the first thing that came up. And she, like most women, had never heard of it before then.
“I read an excerpt that said bacterial vaginosis is more common in women than thrush. And I thought if that’s so common and they haven’t picked it, then I probably don’t have it,” she says. “I thought it must be a really easy one to detect.”
So for a while, she dismissed it. But after a year of ping-ponging between antibiotics, she requested a pap smear that would include a check for BV (it is not routinely tested for). And that’s when she finally had an accurate diagnosis.
BV is in fact the most common vaginal infection, affecting about one in three women at some point in their lives. Yet, incredibly, it's one of the lesser known vaginal conditions and it's often mistaken for thrush.
"None of my friends had heard of BV. I had girlfriends who I would speak with about this and they wouldn't understand, they were just stunned. Everyone has heard of thrush but hardly anyone knows about BV. It made me feel completely alone and abnormal," Jackson says.
She says lack of awareness of the disease makes it very isolating, and she wishes there had been more information readily available.
"You get pigeonholed as the girl with the smelly vagina... I wish women were taught more about this really common condition."
And today, in Australia, a group of sexual health experts is working hard to do precisely this.
What is bacterial vaginosis?
Dr Catriona Bradshaw, a Melbourne Sexual Health Clinic physician and Monash University associate professor, says BV occurs when there is a decrease of healthy vaginal bacteria and and overgrowth of the bad ones.
While the exact cause in unknown, it is typically characterised by a thin, watery, milky discharge that has an unpleasant "fishy" odour. This is unlike thrush, which involves a thick, curd-like, usually odourless discharge and causes an irritation that rarely occurs in BV.
"An experienced doctor will instantly see the difference," she says.
Dr Bradshaw says it's crucial that women are helped to differentiate between the two because medications for thrush do not treat BV. Getting the right treatment - which currently is a prescribed course of antibiotics - is important, because BV has been linked to serious health complications, including pelvic inflammatory disease, HIV and other STIs. (In fact, when Ms Jackson was diagnosed with BV, it was also discovered she had chlamydia.)
Dr Bradshaw says BV also has risks associated with pregnancy, including miscarriage, premature delivery and post-partum endometriosis.
"We don't want women to be terrified, but we believe we should be restoring women's healthy vaginal bacteria so they can have a healthy reproductive life as well as be relieved from symptoms than often cause a lot of stress," she says.
Monash University sexual health researcher Dr Jade Bilardi says medical effects aside, BV can often take a huge toll on a woman's confidence. She says it's for this reason she created a new website, named What's Going On Down There, to help women feel less alone and and teach more people about the hidden condition affecting more women than thrush.
"It is a condition that really affects a lot of women and the symptoms can be really quite embarrassing," Dr Bilardi said.
"It affects sexual relations because women don't want to have sex, it can mean limiting social contact because women are worried about the smell. They might sit away from people and not attend functions. The condition has a big impact on people's quality of life and self-esteem."
Ms Jackson's tale of misdiagnosis is one that's shared by many Australian women, and Dr Bilardi urges them to persist in seeing a doctor if their symptoms aren't going away.
"GPs are under an enormous amount of pressure to cover a huge array of medical conditions and sexual health training in medical school is extremely limited, if existent," she says.
"Unless they have a specific interest or training in the area of sexual health, doctors may not have a good understanding of BV and the impact symptoms can have on women’s lives, especially if its recurring. Women may feel embarrassed to undergo examination and GPs may not wish to make them uncomfortable, and so treat complaints as thrush in the first instance."
Is bacterial vaginosis actually an STI?
Sadly, for many women, BV can cause long-term discomfort because the exact cause of the infection is unknown. Dr Bradshaw says more than half of women who get treated will have BV again within 3-6 months.
According to Dr Bradshaw, this is one of several characteristics that make BV behave suspiciously like an STI - and it's a theory that she is on a mission to investigate. She says BV occurs in women for the first time when they are currently sexually active, and it isn't found in women who have never had sexual contact with another person. Inconsistent condom use is also linked to BV recurrence.
Most strikingly, it is women who have an ongoing long-term partner who are more than twice as likely to acquire BV again within a few months, meaning it is possible that men are carrying BV and contributing to reinfection through sexual intercourse.
New technology has found that men can carry BV bacteria under the foreskin and in the urethra, without showing any symptoms.
In order to explore whether BV is indeed an STI, Dr Bradshaw will soon be running a clinical study, named Step Up, to examine whether treating men as well as women will prevent the recurrence of BV in female partners. Dr Bradshaw is currently recruiting couples in Victoria and New South Wales to participate.
For more information on bacterial vaginosis, please visit What's Going On Down Here. If you have symptoms, see your doctor for an examination and testing.
For more information Dr Bradshaw's clinical study, please visit the Step Up website.