Bacterial Vaginosis (BV): An Overview and More

Bacterial vaginosis (BV) is a common but uncomfortable condition in which the normal balance of vaginal flora is disturbed, resulting in an overgrowth of anaerobic bacteria. Symptoms include itching, vaginal discharge, and a bad odor. Although BV is easily treated with antibiotics, recurrence of the infection is common, usually within 12 months of treatment. BV generally affects women of childbearing age and is often associated with douching, unprotected sex, having multiple sexual partners, and other risks. factors.

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Symptoms of bacterial vaginosis

Of the 21 million American women who are believed to have bacterial vaginosis each year, only about three million experience symptoms. When they do occur, the symptoms of bacterial vaginosis are usually mild but persistent and can include:

  • A grayish-white or yellow vaginal discharge.
  • "Fishy" odor, which may increase after intercourse.
  • Burning sensation when urinating.
  • Vaginal itching, redness, and swelling
  • Vaginal bleeding after intercourse.

Less commonly, bacterial vaginosis infection can lead to urinary problems, pain during intercourse, and the development of pelvic inflammatory disease (PID) .

Although BV symptoms are rarely severe, they can erode the integrity of vaginal tissues and increase your vulnerability to sexually transmitted diseases (STDs) such as gonorrhea , chlamydia , trichomoniasis , and HIV.

Also, if an infection occurs during pregnancy, you may face an increased risk of preterm labor, low birth weight, and in rare cases, a miscarriage in the second trimester.


Bacterial vaginosis occurs when healthy bacteria in the vagina are depleted, allowing unhealthy bacteria to prevail and cause an infection. Gardnerella vaginalis is one of the most common "bad" bacteria, but others can also cause infections.

This imbalance can be caused by changes in vaginal acidity or problems with the immune response that reduce the body's ability to control the overgrowth of bacteria. Sex can often trigger an infection by introducing new or excessive germs into the vagina.

Some of the more common causes of BV include:

  • Unprotected oral, vaginal, or anal sex
  • Multiple sexual partners
  • New sexual partners
  • General Sex Toys
  • Showers
  • Of smoking
  • Intrauterine devices (IUD)

Genetics are also believed to play a role in promoting inflammation or causing lower than expected levels of protective lactobacilli in the vagina.


Since bacterial vaginosis is caused by more than one pathogen, a diagnosis will be made based on an evaluation of your symptoms and the results of various laboratory tests. This generally includes:

  • Medical history review
  • Gynecological examination
  • PH test to check the acidity of the vagina.
  • Microscopic evaluation of your vaginal discharge

The microscopic exam will look for "key cells" (vaginal cells filled with bacteria) or use a Gram stain to help differentiate the types of bacteria and measure the ratio of "good" to "bad" bacteria. Based on a review of the criteria, the doctor can confirm the diagnosis or perform other tests to make sure it is not another medical condition (such as yeast infection or genital herpes ).

Home tests are also available, but they are much less accurate.

Watch out

The standard treatment for bacterial vaginosis is a short course of antibiotics . The methods used in first-line therapy, called metronidazole and clindamycin, are very effective in treating BV and have relatively mild side effects.

Preferred first-line regimens include:

  • Metronidazole 500 milligrams by mouth twice a day for seven days.
  • Metronidazole 0.75% vaginal gel is applied once a day for five days.
  • Clindamycin 2.0% vaginal cream applied at bedtime for seven days

Bacterial Vaginosis Discussion Guide

Get our printable guide to your next doctor's appointment to help you ask the right questions.

Alternatives include vaginal clindamycin suppositories or tinidazole tablets. Despite the effectiveness of treatment, relapses are common and may require additional or even multiple treatments to achieve control.

Common side effects include nausea, abdominal pain, cough, sore throat, runny nose, and a metallic taste in the mouth.

In addition to prescription antibiotics, there are several home and maintenance remedies that can help. These include probiotics (found in supplements and foods like yogurt), which can help prevent relapses, and boric acid , an old drug that's making a comeback in medicine.


Despite how common bacterial vaginosis is, there are some things you can do to lower your risk. These include safer sex to avoid contact with harmful bacteria and good vaginal hygiene to reduce the chances of infection.

To prevent bacterial vaginosis:

  • Limit the number of sexual partners.
  • Wear protective gear during oral, vaginal, or anal sex, including condoms and tooth pads .
  • Don't take a shower .
  • Wipe from front to back after urinating.
  • Avoid the IUD if you have recurrent BV or a previous severe infection.

Verywell's Word

Even with the most effective preventive measures, bacterial vaginosis can sometimes occur. Try not to get nervous. Instead, seek treatment and do your best not to make the condition worse.

If symptoms distract you, make your life easier by avoiding tight pants and wearing looser clothing or a skirt. To treat itching, apply a cool washcloth directly to your vagina or wash it off with cold water in the shower. Scratching will only make the situation worse.

Lastly, if you are on antibiotics, don't stop in the middle, even if the symptoms go away. This can increase the risk of antibiotic resistance and make treatment even more difficult if the infection returns.

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