Bacterial vaginosis (BV)

Overview

The vagina normally has a balance of bacteria. In bacterial vaginosis (BV), helpful bacteria drop and other bacteria grow too much. It is the most common cause of unusual vaginal discharge.

BV is not dangerous for most people, but it can raise the risk of getting STIs and of problems during pregnancy. It's easy to test for and treat.

Symptoms

Many people with BV have no symptoms.

• Thin white or gray vaginal discharge
• Fishy odor, often stronger after sex
• Unusual vaginal discharge

Less common

• Itching or burning in the vagina
• Burning when urinating
• Itching around the outside of the vagina

How it usually goes

• Days of treatment: Symptoms usually improve within a few days.
• 5 to 7 days: Treatment is finished.
• Later: BV often comes back within months.

When to get medical care

Causes

The exact cause isn't known. BV happens when the normal balance of vaginal bacteria changes. It's more common in people who are sexually active, but it can happen to anyone with a vagina.

Does it spread or run in families?

• It isn't caught from someone else. It's caused by germs that already live on or in the body.

Who is more likely to get it

• A new partner or more than one partner
• Douching
• Not using condoms
• Having had BV before

Possible complications

• Pelvic inflammatory disease: BV is often found with PID
• STIs: BV raises the risk of getting chlamydia and other STIs

Diagnosis

A healthcare professional can test a sample of the discharge.

Questions you may be asked

• What the discharge looks and smells like
• Itching, burning, or pain
• Douching, new partners, or new products
• Whether you could be pregnant

The exam

A pelvic exam to look at the discharge.

Tests

Testing is quick:

• Discharge test: A sample is checked under a microscope and for pH, or with a lab test.
• STI tests: To check for trichomoniasis and other infections that can look similar.

Treatment

BV is treated with antibiotics, as pills or a gel or cream put in the vagina.

Self-care

• Take all of your medicine, even if you feel better
• Don't drink alcohol while taking metronidazole and for at least a day after
• Don't douche. It upsets the vagina's balance
• Avoid sex, or use condoms, until treatment is done
• Wash with plain water and avoid scented products

Medicines

BV medicines need a prescription.

Male partners usually don't need treatment.

BV often comes back. Your healthcare professional may try a different medicine or a longer, preventive treatment if it keeps returning.

How it compares

Prevention

You can lower the risk:

• Don't douche
• Use condoms
• Limit your number of partners
• Avoid scented soaps and sprays in the genital area

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a gynecologist (OB-GYN).

Children, pregnancy, and older adults

• Pregnancy: BV can raise the risk of early birth. Pregnant women with symptoms should be tested and treated.
• Teens: BV can happen even in people who haven't had sex.
• Breastfeeding: Ask which treatment is best.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Some infections can pass to the baby during pregnancy or birth. Tell your provider if you've been exposed.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

BV usually clears with treatment, but it comes back often. Treat again if symptoms return.

Getting ready for your visit

Don't douche or use vaginal products for a day or two before.

What to bring

• What your symptoms are and when they started
• Products you use, like soaps or douches
• Whether you could be pregnant

Questions to ask

• Is this BV, a yeast infection, or an STI?
• Pills or gel: which is better for me?
• Does my partner need treatment?
• What if it comes back?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Bacterial vaginosis (BV)