Bacterial Vaginosis

Learn the symptoms & how to treat it.

What is bacterial vaginosis?

Bacterial vaginosis (BV) is a common vaginal infection. It is due to an overgrowth of bacteria, which causes a vaginal discharge that usually has a fishy odor. It is treated with either vaginal or oral antibiotics.

It is not a sexually transmitted disease (STD), but condoms may help prevent it.

What is causing your symptoms?

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Most common symptoms

The most common symptoms are fishy-smelling, off-white, watery vaginal discharge. You may notice your underpants feel wet.

It can also cause itching or burning in the vagina and itching around the outside of the vagina. However, many women may not have any symptoms.

Typically, you’ll notice symptoms after sexual activity or when your period ends. BV should not cause fever or abdominal/vaginal pain.

BV is different from a yeast infection, which also causes vaginal discharge. With a yeast infection, the discharge may also be white or gray but may look like cottage cheese.

Dr. Rx

Other diagnoses that may be mistaken for BV include yeast infection or STDs such as Trichomoniasis, Chlamydia, and Gonorrhea. Occasionally, a patient may have BV and a yeast infection at the same time. It needs to be determined by physical exam and culture. Additionally, if there is high suspicion or the patient is at high risk, STD screening should also be performed. —Dr. Jessica White-Videa, DO, FACOG

Is bacterial vaginosis an STD?

Pro Tip

A few years ago I had a patient who was developing BV recurrently, at least twice a month. We tried various treatments and preventative measures with no improvement. Eventually we realized that the BV was due to her boyfriend who was cheating on her. Once she got rid of her boyfriend her symptoms improved. —Dr. White-Videa

While BV is technically not an STD, sexual activity is a risk factor, simply because it can expose the vagina to more bacteria. Women who are sexually active with women are also at risk for developing BV for the same reasons.

Having other STDs, such as herpes or HIV, also put you at a higher risk for developing BV. Vaginal douching and smoking cigarettes may increase the risk of BV.

Bacterial vaginosis causes

The healthy vagina contains mostly Lactobacillus bacteria, which is considered a good bacteria. It creates an acidic environment in the vagina. Anything that disrupts levels of Lactobacillus bacteria (such as douching or infection from herpes or HIV) can cause other bacteria to grow in the vagina instead.

Women who have an overgrowth of other non-Lactobacillus bacteria in the vagina may then develop signs and symptoms of BV.

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Bacterial vaginosis treatment

If you think you may have BV, schedule an appointment with your doctor. While this is not an emergency, you should try to see your doctor as soon as possible.

After doing a pelvic exam, your doctor will probably collect discharge from your vagina to evaluate it for bacteria or yeast. Treatment is typically with a vaginal or oral antibiotic.

Medication

While BV may go away on its own, if you have symptoms you should take an antibiotic to treat BV. Pregnant women who have BV are more likely to have complications, so it’s especially important for them to get treated.

Antibiotics include metronidazole, either orally or vaginally, or clindamycin (oral or vaginal). Vaginal medication usually does not have side effects. Oral antibiotics may cause nausea, upset stomach, or headaches. Avoid alcohol when taking metronidazole.

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Follow up

Pro Tip

Untreated bacterial vaginosis increases your risk of contracting a STD. Though you can develop BV even if you are not sexually active. —Dr. White-Videa

Always finish all the antibiotics you are given. Symptoms may linger even after you are done with your antibiotics—it may take 2 weeks for symptoms to completely go away. If the BV comes back, you will need to take another course of antibiotics. If you get a BV infection several times a year, you may need to take a long-term course of antibiotics.

Prevention

Avoid douching, quit smoking, and use condoms.

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