Bacterial Vaginosis

What is bacterial vaginosis (BV)?

Bacterial vaginosis (BV) is a vaginal infection caused by an overgrowth of bacteria. Every healthy vagina contains bacteria. Typically, these bacteria balance each other. Sometimes, the “bad” bacteria grow too much and overpower the “good” bacteria. This throws off the balance of bacteria in your vagina and leads to bacterial vaginosis.

Bacterial vaginosis may cause your vaginal discharge to have a “fishy” odor. It can also cause vaginal irritation in some people. Others may not have any symptoms of BV.

How common is bacterial vaginosis?

Bacterial vaginosis is the most common vaginal problem for women and people assigned female at birth (AFAB) ages 15 to 44. In fact, about 35% of people with a vagina will get BV. The rate is higher if you’re Black.

Who can get BV?

Anyone with a vagina can get bacterial vaginosis. It usually occurs in people who are sexually active. It’s rare for it to occur in people who’ve never had sex. Some people may naturally produce too much of the bacteria that causes BV.

You may have a higher risk of getting BV if you:

• Are pregnant.
• Don’t use condoms or dental dams.
• Have an intrauterine device (IUD).
• Have multiple sex partners.
• Have a new sex partner.
• Have a sex partner who’s AFAB.
• Use douches.
• Are taking antibiotics.

What are the symptoms of bacterial vaginosis?

Up to 84% of people with bacterial vaginosis don’t have symptoms. If you do, you may have:

• Off-white, gray or greenish-colored vaginal discharge.
• Fishy-smelling vaginal discharge, especially after sex.
• Vaginal itching or irritation.
• A burning feeling when you pee.

BV symptoms are similar to other infections. It’s important to visit a healthcare provider to determine if what you have is BV or another vaginal infection.

How do you get bacterial vaginosis (BV)?

Your vagina is home to multiple types of bacteria (called a microbiome). A change in the balance of the bacteria causes BV.

Specifically, bacterial vaginosis happens when “bad” bacteria (anaerobes) grow more quickly than “good” bacteria (lactobacilli). Too much of one type of bacteria leads to an imbalance.

Researchers know that anything that changes the natural chemistry of your vagina can affect the bacteria in your vagina. That’s why certain activities like douching or unprotected sex can lead to BV. You can’t get BV from hot tubs, swimming pools or toilet seats. You also can’t get BV from touching a surface that a person with BV has touched.

Is bacterial vaginosis contagious?

Bacterial vaginosis doesn’t spread from person to person, but sexual activity can increase your risk of getting the infection.

Is bacterial vaginosis an STD or STI?

Bacterial vaginosis isn’t sexually transmitted, but it’s linked to sexual activity. Researchers think that sex may change the bacterial environment in your vagina. This makes bacterial overgrowth more likely.

What’s the difference between bacterial vaginosis and a yeast infection?

Both bacterial vaginosis and yeast infections are vaginal infections that increase amounts of discharge. Here’s how you can tell the difference:

• Discharge: The hallmark sign of BV is discharge with a “fishy” smell. Discharge from yeast infections doesn’t usually have a strong smell but may look like cottage cheese.
• Vaginal irritation: Typically, BV doesn’t cause vaginal irritation or itchiness. Yeast infections do.
• Over-the-counter treatment: You can treat yeast infections with over-the-counter (OTC) medications. You’ll need to see a healthcare provider to get antibiotics for BV.

How do you know if you have BV?

Only a healthcare provider can diagnose bacterial vaginosis. Contact a provider for an appointment if you have signs of BV. At your appointment, your provider will ask you about your medical history, including vaginal infections or sexually transmitted infections (STIs). They may also:

• Perform a pelvic exam: Your provider will place gloved fingers inside your vagina to look for signs of infection, like an increase in discharge or foul-smelling discharge that has a white or gray color.
• Take a sample of vaginal discharge: Your provider will insert a speculum into your vagina. Then, they’ll use a swab to get a sample of fluid from your vagina. The fluid is sent to a lab to see what types of bacteria are present.

Tests for bacterial vaginosis use samples of fluid from your vagina. That sample can undergo several types of tests for bacterial vaginosis. The most common are:

• Wet mount: This involves looking at your vaginal discharge on a glass slide under a microscope.
• Whiff test: Your provider smells your vaginal discharge for a fish-like smell.
• Vaginal pH: This test measures how acidic your discharge is. A higher pH may indicate BV.

How do I get BV to go away?

Your healthcare provider will prescribe antibiotics, typically metronidazole or clindamycin. These medications come in a gel or cream you insert into your vagina. Some antibiotics are pills you can take orally (by swallowing them).

It’s important to finish the antibiotic and take it as your provider prescribes. Stopping early because your symptoms go away increases your risk of getting BV again.

Can bacterial vaginosis go away on its own?

Some cases of bacterial vaginosis resolve on their own without any medications. However, if you have symptoms, you should seek medical care. Having BV makes you prone to sexually transmitted infections and can affect pregnancy.

Is there a home treatment for bacterial vaginosis?

There are no over-the-counter products to treat bacterial vaginosis (BV). Avoid using douches or products meant for yeast infections, which could make BV worse. See a healthcare provider for treatment.

How long does bacterial vaginosis last?

Most of the time, one round of antibiotics — taken for up to seven days — eliminates the infection. About 10% to 15% of people need another round of treatment.

How can I lower my risk of BV?

You can’t prevent bacterial vaginosis. However, taking these precautions could reduce your risk:

• Avoid douching. It changes the natural balance of bacteria in your vagina. Instead, practice healthy vaginal and vulvar care.
• Avoid vaginal contact with anything that has touched your anus. Things like toilet paper and sex toys could transfer bacteria found in your poop to your vagina. Make sure sexual toys are properly cleaned after every use.
• Limit your number of sex partners. Research shows you’re more likely to get BV if you have multiple sex partners.
• Use latex condoms or dental dams. Although it’s unclear why, research indicates that sexual activity is associated with BV.
• Wear cotton or cotton-lined underwear. Bacteria thrive in moist environments. Cotton helps wick away moisture.

Can you get bacterial vaginosis multiple times?

Yes. Up to 80% of people get bacterial vaginosis again in their lifetime.

What are complications of BV?

Bacterial vaginosis doesn’t typically cause serious complications. But if left untreated it could lead to:

• Complications during pregnancy: If you’re pregnant and have BV, it may lead to premature birth.
• Sexually transmitted infections (STIs): BV increases your risk for STIs like chlamydia and gonorrhea. If you have HIV and develop BV, you’re at higher risk for passing HIV to your partner.
• Pelvic inflammatory disease (PID): BV can cause PID, an infection of your reproductive organs. Untreated, PID can lead to difficulties getting pregnant.

Should I be treated for bacterial vaginosis (BV) if I’m pregnant?

If you have bacterial vaginosis (BV), your provider can prescribe medication that’s safe to use during pregnancy. You should get treated for the infection whether or not you have symptoms. BV can cause pregnancy complications, such as premature birth or having a baby that weighs less than average (low birth weight).

When should I tell my partner?

Men and partners assigned male at birth (AMAB) don’t need to be treated for bacterial vaginosis (BV). If you have a partner who’s AFAB, they may have BV, too. It’s important to let them know so they can get treatment.

When should I call my healthcare provider?

Call your provider if you have:

• Vaginal discharge that changes color or consistency.
• Vaginal discharge that smells different than usual.
• Vaginal itching, burning, swelling or soreness.

Can men and people AMAB get bacterial vaginosis?

No. But they can spread the bacteria that causes BV. So, this means a person with a penis can get BV from one partner who’s AFAB and spread it to another partner AFAB.

Can a woman and person AFAB give another woman and person AFAB BV?

Yes. If both you and your partner have a vagina and one of you has BV, there are steps you can take to protect yourself.

• Cover sex toys with a condom. Replace the condom each time you share the toy with your partner.
• Use a dental dam during oral sex.

Are people who are pregnant more likely to get BV?

Yes. About 25% of people who are pregnant will get BV. This is due to all the hormonal changes that occur in pregnancy.

A note from Cleveland Clinic

Although bacterial vaginosis (BV) is a mild infection, it can make you vulnerable to more serious conditions. Don’t put off seeing a healthcare provider if you notice anything unusual about your vaginal discharge. Your provider can treat BV with antibiotics.