What Is Bacterial Vaginosis (BV)?

Bacterial vaginosis (BV) is a common vaginal infection. BV occurs when too much of some bacteria grows and causes the normal bacteria levels of the vagina to be out of balance. BV can be a painful and uncomfortable condition.

BV can occur at any age but is more common during the reproductive years. This has to do with the hormonal fluctuations that occur during this period, making it easier for certain types of bacteria to grow. Additionally, you are at a greater risk of developing BV if you are sexually active. Having unprotected sex or douching may also increase your risk of developing BV.

The most common symptom of BV is gray or off-white vaginal discharge that has an unpleasant odor, often described as smelling “fishy.” BV is easily treated with antibiotics and should resolve over time.

Signs and Symptoms

Some people who have BV experience no symptoms. For those who do experience symptoms, symptoms may include:

• Thin or watery gray, off-white, or green vaginal discharge
• Unpleasant or “fishy” smelling discharge, especially after sexual intercourse
• Vaginal pain, itching, or irritation
• Burning sensation during urination

Causes

Bacterial vaginosis develops when the bacteria of the vagina is out of balance. Specifically, when there is more bad bacteria (anaerobes) growth than good bacteria (lactobacilli), there is a risk of developing BV. There are different reasons for vaginal bacteria getting out of balance. Two of the most common causes for an imbalance are unprotected sex and douching.

Risk Factors

There are several risk factors that may put someone at greater risk for developing BV. Risk factors include:

• Unprotected sex
• Douching
• Pregnancy
• Not using condoms or dental dams
• Having an IUD
• Multiple sexual partners
• A new sexual partner
• Antibiotics

Diagnosis

Bacterial vaginosis is diagnosed by a healthcare provider. Typically, a doctor will ask about your medical history and perform a pelvic examination.

Additionally, your doctor may:

• Take a sample of vaginal discharge. The sample will be sent to a lab to assess for “clue cells,” which indicate BV. Clue cells are vaginal cells covered in bacteria.
• Test your vaginal pH. The acidity of the vagina can be assessed by putting a pH strip into the vagina. A vaginal pH level of 4.5 or higher may indicate BV.

Treatment Options

Some cases of BV will resolve without treatment. Typically, antibiotics such as metronidazole or clindamycin are prescribed to treat BV. These can be taken in pill or gel form. It is important to finish the prescribed antibiotics to ensure it fully resolves the issue and keeps it from coming back. In some cases, BV can recur within 3-12 months even with appropriate treatment. Consult with your healthcare provider if you suspect recurrent BV.

Additionally, avoid using douches or products meant to treat yeast infections, which could make BV symptoms worse. If your sexual partner is also female, it may be important for them to be assessed and treated for BV, as it can be transmitted to female partners. Furthermore, BV can impact pregnancy and make it more likely to develop an STI, so it is important to consult with your healthcare provider if you suspect BV.

Preventing BV

There are a few preventative measures to keep from developing BV:

• Stop douching
• Do not use scented products in or around the vagina
• Practice safe sex

Learning more about Bacterial Vaginosis

It is important to understand your BV symptoms and follow a proper treatment plan to prevent any complications from developing. Complications can impact pregnancy, make it more likely to develop an STI, cause pelvic inflammatory disease, or increase the risk of developing an infection after gynecological surgery. Consult with your healthcare provider if you suspect BV.