Bacterial Vaginosis: What It Is and How to Treat It
Medically Reviewed by Alvaro Lucioni, MD
Virginia Mason Medical Center
By Sheryl Kraft
If you've ever experienced thin, milky vaginal discharge, possibly with a mild to strong fishy odor, you may have had bacterial vaginosis (BV). Have more questions? We have the answers.
What is bacterial vaginosis?
Bacterial vaginosis is the most common vaginal infection in women.
Although a woman of any age can get it, it's predominantly found among women of childbearing age. It is very common, affecting more than 21 million U.S. women each year. The infection occurs when the normal balance of bacteria in the vagina is upset, resulting in a higher pH and the overgrowth of more "harmful" than "good" bacteria.
Who is most likely to get BV?
Risk factors for bacterial vaginosis include:
Race: Non-white women have higher rates of BV than white women. About half (51 percent) of BV cases occur in African American women, 32 percent in Mexican Americans, and 23 percent in white women.
Having multiple sex partners or a new sex partner. Despite this risk factor, in a recent survey of 1,969 women, conducted by HealthyWomen in partnership with Symbiomix Therapeutics, the majority (71 percent) of women who had received a BV diagnosis (457 women) said they only had one sexual partner at the time of their diagnosis. So while multiple sexual partners may increase your risk, it is very possible to get BV if you only have one sexual partner. It's also possible to develop BV without ever having sex.
Douching. This can upset the natural balance of your vagina, which may lead to an overgrowth of anaerobic bacteria and cause bacterial vaginosis. Since the vagina is self-cleaning, douching isn't necessary.
Natural lack of lactobacilli bacteria. If your natural vaginal environment doesn't produce enough of the good lactobacilli bacteria, you're more likely to develop bacterial vaginosis.
What are the symptoms of BV?
Some women may not have symptoms or may not recognize that what they're experiencing is BV. Many women wait an extended time for symptoms to go away without seeking health care provider advice or treatment.
When symptoms are present, most women notice a thin white or gray discharge often with a mild to strong fishy odor, which may be more noticeable after sex.
A woman may also experience other symptoms like itching, pain or burning in or around vagina, that may be associated with another infection.
Who seeks treatment?
Survey respondents were almost equally split between women who waited for the symptoms to subside and women who sought evaluation by a health care professional (usually their OB/GYN).
Twenty-two percent tried an over-the-counter remedy and 12 percent used an at-home or natural remedy to treat their symptoms.
What are the risks of BV?
Untreated BV can lead to serious health risks, such as an increased likelihood of contracting a sexually transmitted infection such as chlamydia or gonorrhea; an increased chance of getting HIV (if you have sex with a person who is infected); and pelvic inflammatory disease, which may lead to infertility.
Pregnant women with BV that is left untreated are at risk for premature birth or having a low–birth-weight baby weighing less than 5.5 pounds. Pregnant women can be safely treated, at any stage of pregnancy, with the same antibiotic given to women who are not pregnant.
How is BV diagnosed?
The only way to be sure you have BV is to visit your health care provider. Your health care provider may be able to visually spot the signs of BV during a vaginal exam. In addition, your provider may take a sample of the vaginal discharge or perform an in-office pH strip test for examination.
It's recommended that women not douche or use vaginal deodorant sprays before their appointment because these can mask odors and irritate the vagina. Women should also try not to be evaluated for vaginal discharge during the menstrual period because it can make diagnosis more difficult.
How is BV treated?
It's important to consult your health care provider and seek treatment because untreated BV can lead to complications and health risks.
BV is easily treatable with prescription antibiotics in the forms of oral medications, such as pills, or with topical creams or gels inserted into the vagina. Because some oral antibiotics can cause stomach upset, nausea or abdominal pain, women should avoid drinking alcohol to reduce the risk of stomach upset, increased heart rate, shortness of breath, vomiting and headache. It's also important to note that some of the prescription creams that contain clindamycin can weaken latex condoms. It's advisable to abstain from sexual contact until the treatment is completed.
Even if all symptoms disappear, it's important that women take the full course of treatment and alert their health care professional of any symptoms that persist after finishing the antibiotic, because BV can recur within three to 12 months, despite treatment.
Does my partner need to be treated?
Men can't be treated for BV. The female partner of a woman with BV may also have it and should be tested and treated, if needed. BV is not a sexually transmitted infection, but sexual activity can increase the risk of BV by changing pH levels in the vagina.
How can BV be prevented?
Practicing smart vaginal care is important:
- Clean the outside of your vagina with warm water only; even mild soap can be irritating or cause infection.
- Make sure to wipe from front to back (from the vagina back to the anus).
- Wear cotton or cotton-lined panties to keep the area cool.
- Avoid douching, which can upset the balance of protective bacteria in the vagina.
- Practice safe sex.
- Limit your number of sex partners.
- Some research points to the benefit of consuming foods containing lactobacilli, like certain yogurts and other foods, to help balance the level of bacteria in the vagina.
When is it safe to resume sex if you've had BV?
It's best to wait about seven days after treatment ends to resume sexual relations. Check with your health care provider to confirm you're cleared to have sex.
This resource was developed with the support of Symbiomix Therapeutics, LLC.
- Survey results from “Do You Really Know What’s Causing Your Discharge?” (online survey conducted by HealthyWomen and Symbiomix Therapeutics, LLC in the first quarter of 2017). Results on file with HealthyWomen and Symbiomix Therapeutics, LLC. 2017.