What to Do for Bacterial Vaginosis

Medically Reviewed By Wendy A. Satmary, MD
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Bacterial vaginosis (BV) is a common gynecological condition in females. It occurs when there is an imbalance in the typical vaginal flora. Douching, not using condoms, and having multiple sex partners can increase the chance of BV. The most common symptom of BV is foul smelling discharge that is thin and white or gray.

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.

What is bacterial vaginosis?

clothed butt of unidentifiable female lying face down on blanket outside in the sun
Wendy Laurel/Stocksy United

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.

What are the symptoms of bacterial vaginosis?

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

BV symptoms can last as long as there is an overgrowth of bacteria. Treatment with antibiotics clears the infection and any symptoms in 5–7 days, though there is a chance of recurrence.

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.

Although BV is typically not a medical emergency, you should alert your doctor if you have a fever or pelvic pain, which could be symptoms of a more serious condition, such as gonorrhea.

How do you get bacterial vaginosis?

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

Can bacterial vaginosis affect pregnancy?

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.

How do you prevent bacterial vaginosis?

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.

How do doctors diagnose bacterial vaginosis?

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.

How do you get rid of bacterial vaginosis?

BV is treated with a combination of antibiotics and self-care measures.

Medication

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.

What are the potential complications of bacterial vaginosis?

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

Summary

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.

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Medical Reviewer: Wendy A. Satmary, MD
Last Review Date: 2022 May 25
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.