What to Do for Bacterial Vaginosis
This article explains BV in more detail, including its symptoms, causes, and risk factors. It also discusses BV treatment options and prevention.
Sex and gender exist on spectrums. This article uses the terms “male” and “female” to refer to a person’s sex assigned at birth.
BV is inflammation of the vagina due to atypical overgrowth of bacteria that are already present in the vagina. This can happen when the usual balance of bacteria in the vagina gets disrupted.
BV is most common in females ages 15–44 years. The estimated number of females with BV in the United States is 21.2 million.
Is bacterial vaginosis a sexually transmitted infection?
Although BV is not considered a sexually transmitted infection (STI), it can increase your chance of experiencing an STI, including HIV. In fact, females with HIV who also have BV are more likely to pass HIV to a male sex partner.
If you have a female sex partner, they may also have BV and should seek treatment from their doctor. Male partners do not need to seek treatment. Bacterial overgrowth does not pass between female and male partners.
Antibiotic treatment of BV helps reduce the chance of developing an STI.
The most common symptom of BV is foul smelling vaginal discharge that looks white (milky) or gray. Sometimes, this discharge is most apparent after vaginal sex.
Other symptoms of BV include:
- a burning feeling during urination
- vaginal itching
- foamy or watery vaginal discharge
- vaginal irritation
- painful vaginal intercourse
When to contact a doctor
If you are experiencing vaginal discharge that has a fishy odor or looks different than it usually does, contact your doctor to rule out BV. BV can look similar to a yeast infection or an STI, so it is important to contact your doctor so that they can determine the correct cause of your symptoms.
The exact cause of BV is not clear, but there are factors that increase the chance of it happening. The vagina has a balance of “good” bacteria and “bad” bacteria. BV can occur when the balance of the usual flora in the vagina changes in favor of the bad bacteria, causing them to multiply. This overabundance of bacteria is what causes inflammation and symptoms of BV.
The most common type of bacteria present in typical vaginal flora are Lactobacilli. When BV occurs, there is a decline in the amount of Lactobacilli. BV infections can start with the bacteria Gardnerella vaginalis, but other bacteria are also abundant in females with BV.
Risk factors for bacterial vaginosis
Having a female sex partner increases the chance of developing BV by 60%, but not everyone with a female sex partner will experience BV.
Other factors that increase the chance of BV include:
- vaginal douching
- having new or multiple sex partners
- not using condoms or dental dams
- pregnancy (due to hormonal changes)
- being of African American descent
- having an intrauterine device
- recent antibiotic use
- cigarette smoking
According to March of Dimes, having BV during pregnancy can increase the chance of premature birth and having a baby of low birth weight. BV can also cause pelvic inflammatory disease, which is an infection in the uterus.
Getting treated for BV in pregnancy can help protect the fetus. Treatment for BV is safe for the fetus, and you can take the medication at any time during your pregnancy.
You can help prevent BV by:
- not douching
- not using harsh soaps around your vagina
- not washing inside the vagina
- limiting your number of sexual partners
Although BV is not sexually transmitted, it is more likely to occur if you have multiple sexual partners. When you have sex, make sure to use a form of barrier protection, such as a condom. This can lower your chance of developing BV.
When you wash, use only warm water or a mild, unscented soap to clean the outside of the genitals only. This is your vulva, not your vagina, which is the internal genitalia. Also, when using the bathroom, wipe from front to back.
If your healthcare professional suspects BV, they may take a sample of vaginal discharge and send it to a laboratory to check it for harmful bacteria. Male sex partners do not need testing or treatment, but female sex partners do.
To diagnose BV, your doctor will document your medical history and ask you about your symptoms. Some questions they may ask include:
- What are your current symptoms?
- When did your symptoms start?
- Do you have new or multiple sex partners?
- Do you have sex with males or females?
- Do you douche?
- Have you ever had an STI?
Your doctor will perform a pelvic exam and take a sample of vaginal fluid to look at under a microscope. This will help determine the type of bacteria that are present in your vaginal discharge. This is also done to rule out the presence of yeast.
Your doctor may also take a cervical swab to check for STIs.
Bacterial vaginosis vs. yeast infection
BV and yeast infections look similar in that they both present with white or gray vaginal discharge. However, the vaginal discharge that occurs with yeast infections sometimes has a cottage cheese-like appearance. This is not true of the discharge that occurs with BV.
Yeast infections are caused by an overgrowth of fungus, while BV is caused by an overgrowth of bacteria. Because of this, BV and yeast infections are treated with different types of medications.
BV is treated with a combination of antibiotics and self-care measures.
The antibiotics used to treat BV are clindamycin and metronidazole. Both are safe for pregnant people to use. They come as a form that you take by mouth or a cream that you apply to the vagina.
The infection does not resolve after the first round of antibiotics in about 10–15% of people. They may require additional treatment.
If you are using a vaginal antibiotic cream and you start your period, be sure to use pads instead of tampons. Tampons can absorb the medication.
Self-care and comfort
You may be most comfortable wearing loose cotton clothing that is less likely than other fabrics to trap heat or moisture against the skin.
For vaginal itching, taking a cool or lukewarm bath may help relieve the symptoms. Avoid washing around your vagina more than once per day, and when you wash, only use warm water or a mild, unscented soap.
Can bacterial vaginosis clear up on its own?
BV may resolve without treatment about 30% of the time. However, if you are experiencing symptoms, seek care from a medical professional.
Complications of BV are more likely when the condition is not treated. Some examples of complications that can occur with BV include:
- STIs, including HIV
- pelvic inflammatory disease, which can lead to infertility
- preterm labor and preterm birth
- having a baby of low birth weight
- an increased chance of infection after gynecological surgery
BV is the most common cause of vaginal symptoms in females. The main symptom is milky white, foul smelling vaginal discharge. Without treatment, BV can lead to health complications and, in pregnant people, complications in pregnancy. BV is treatable with antibiotics.
It is important to contact your doctor if you are experiencing symptoms of BV so that they can rule out other possible causes, such as yeast infections and STIs.