Bacterial vaginosis

Bacterial vaginosis (BV) is a common vaginal condition caused by an imbalance of the naturally occurring bacteria in the vagina. In BV, the normal "good" bacteria (lactobacilli) are outnumbered by an overgrowth of other bacteria, leading to a change in the vaginal environment. BV is not considered a sexually transmitted infection (STI), but it is more common in sexually active people. 

Signs and symptoms

Many women with BV have no symptoms at all, or their symptoms may be very mild. When symptoms do occur, the most common ones are: 

  • Abnormal vaginal discharge: A thin, grayish-white, or greenish discharge that often coats the vaginal walls.

  • Strong, fishy odor: The odor is often more noticeable after sexual intercourse or during menstruation.

  • Burning during urination: A stinging or burning feeling when you urinate.

  • Vaginal itching or irritation: This can occur but is less common with BV than with a yeast infection. 

Diagnosis

A doctor can diagnose BV by reviewing your symptoms and conducting a pelvic exam. They may also perform some simple tests to confirm the diagnosis. 

  • Vaginal fluid sample: Your doctor will take a sample of your vaginal discharge with a swab to examine under a microscope. The sample is checked for "clue cells," which are vaginal cells covered in bacteria.

  • Whiff test: A chemical is added to the vaginal fluid to see if a strong, fishy odor is produced.

  • Vaginal pH test: A pH greater than 4.5 can be an indicator of BV. 

Treatment

BV can sometimes clear up on its own, but seeking medical treatment can reduce symptoms and prevent complications like a higher risk of getting or transmitting STIs. The standard treatment is a course of prescription antibiotics. 

  • Antibiotics: A doctor can prescribe antibiotics such as metronidazole or clindamycin, which can be taken as an oral pill or as a gel or cream that is inserted into the vagina.

  • Finish the full course: It is important to take all of the medication as prescribed, even if your symptoms clear up before you are done. This helps ensure the infection is fully treated and reduces the chance of recurrence.

  • Consider a longer-term treatment: Since BV can often recur, your doctor may recommend a longer treatment plan for frequent infections.

  • Partner treatment: Male partners do not need to be treated for BV. However, if you have a female sexual partner, they may also need to be treated. 

Important considerations

  • Avoid home remedies: Over-the-counter products for yeast infections will not work for BV and can make it worse. Home remedies like boric acid or douching are not recommended and can be harmful.

  • Practice good hygiene: To help prevent BV, avoid douching and using scented soaps or feminine hygiene products, as these can upset the natural balance of bacteria in the vagina

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