Bacterial vaginosis

Overview

Bacterial vaginosis (BV) is a common condition where the normal balance of bacteria in the vagina is upset, leading to an overgrowth of certain bacteria. It is not a sexually transmitted infection, but it can increase your risk of getting one.

Yes, bacterial vaginosis is very common. It affects about 1 in 3 women at some point in their lives.

BV most often affects women between the ages of 15 and 44, especially those who are sexually active. It is less common in women after menopause.

Symptoms

Common symptoms

• Thin, white or gray vaginal discharge
• A strong fishy odor, especially after sex or during your period
• Mild vaginal itching or irritation (less common)
• Some women have no symptoms at all

Symptoms in children

• Bacterial vaginosis is very rare in children. If a child has unusual discharge, odor, or itching, it is important to see a doctor to rule out other causes.

Symptoms in older adults

• After menopause, BV is less common because of hormonal changes. Symptoms are similar: unusual discharge or odor. Older women should see a doctor for any new vaginal symptoms.

Causes

Main causes

• An imbalance in the normal bacteria of the vagina – usually a decrease in 'good' bacteria (lactobacilli) and an overgrowth of other bacteria like Gardnerella vaginalis.

Risk factors

• Douching (rinsing the vagina with water or other fluids)
• Having a new sex partner or multiple sex partners
• Smoking
• Using an intrauterine device (IUD) for contraception
• Hormonal changes, such as during pregnancy or the menstrual cycle

When to see a doctor

See a doctor urgently if:

• You have severe pain in your lower belly or fever with vaginal symptoms.
• You are pregnant and have symptoms of BV.

Book a routine appointment if:

• You notice a new or unusual vaginal discharge or odor.
• You have mild itching or irritation that doesn't go away.

Diagnosis

A doctor or nurse can diagnose BV by asking about your symptoms, examining your vagina, and taking a sample of the discharge for testing.

Tests that may be done

• Pelvic exam: The doctor looks at your vagina and cervix for signs of infection.
• pH test: A simple swab to check the acidity of your vagina. A higher pH can suggest BV.
• Wet mount: A sample of discharge is looked at under a microscope.
• Sometimes a lab test (PCR) is done to confirm the bacteria.

What to expect at your appointment

The exam is quick and usually not painful. You may feel some pressure from the speculum. The swab feels like a brief pinch. Results are often available right away or within a few days.

Treatment

Bacterial vaginosis is usually treated with antibiotics that kill the overgrown bacteria. Treatment is safe and effective, even during pregnancy. You may get pills or a cream/gel to use inside your vagina.

Self-care at home

• Avoid douching – it can make the problem worse and increase your risk of getting BV again.
• Use mild, unscented soap and water to clean your genital area.
• Wear cotton underwear and avoid tight pants to keep the area dry.
• Do not use scented products like feminine sprays or perfumed pads.

Medical treatments

Doctors prescribe antibiotics such as metronidazole or clindamycin. These can be taken by mouth or applied as a cream or gel inside the vagina. It is important to finish the entire course, even if symptoms go away. Do not drink alcohol while taking some oral antibiotics (your doctor will advise). Treatment usually lasts 5 to 7 days.

When is surgery considered?

Surgery is not used to treat bacterial vaginosis.

Living with this condition

If you have BV, it can be managed with treatment. Most symptoms improve within a few days. If it comes back (recurrent BV), your doctor might recommend a longer treatment or preventive measures.

Lifestyle tips

• Practice good hygiene but do not douche.
• Use condoms during sex to lower your risk of getting BV again.
• If you smoke, consider quitting – smoking increases your risk of BV.

Diet and exercise

There is no special diet for BV, but eating a balanced diet supports your immune system. Regular exercise is good for overall health.

Mental health and emotional wellbeing

BV can be distressing because of the odor and discharge, but it is a common and treatable condition. It is not a sign of being unclean. Talking to your partner or a healthcare provider can help ease worries.

Prevention

You cannot always prevent BV, but you can lower your risk by not douching, limiting your number of sex partners, using condoms, and not smoking.

Vaccines

There is no vaccine for bacterial vaginosis.

Screening programmes

Routine screening is not recommended for women without symptoms. Testing is only done if you have symptoms or certain risk factors (like being pregnant).

Complications

If left untreated

• Untreated BV can increase your risk of getting sexually transmitted infections (STIs) like HIV, chlamydia, or gonorrhea.
• During pregnancy, BV may raise the risk of early labor or having a low-birth-weight baby.
• It can also lead to pelvic inflammatory disease (PID), an infection of the uterus and fallopian tubes.

Long-term outlook

With treatment, BV usually clears up within a week. However, it comes back in about half of women within a few months. If it recurs, your doctor can help you manage it. Overall, BV is not dangerous, and with proper care, you can stay healthy.

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