What is bacterial vaginosis?

Bacterial vaginosis (BV) is the most common cause of vaginal discharge that occurs in reproductive age women (women who have not gone through menopause yet). Up to a third of US women have bacterial vaginosis, and the number is somewhat higher amongst African-Americans, where up to one-half of women can have BV. Bacterial vaginosis does not usually cause serious health problems, but is treated more aggressively in pregnant women due to a possible link with preterm delivery.

What causes bacterial vaginosis?

Bacteria are a natural part of the vagina. For some reason, something upsets the normal balance of bacteria. Some of the bacteria can grow too rapidly and cause an imbalance. Also, not having enough of the right type of protective bacteria can contribute to the problem (the protective bacteria keep the BV bacteria from increasing in number).

What are the symptoms of bacterial vaginosis?

Between half to 75% of the women who have BV do not have any symptoms, and typically women who do not have symptoms do not need to be treated.

Common symptoms of BV include:

  • Off-white or grey discharge
  • Discharge that smells "fishy"
  • "Fishy" smell that is strongest after sex or during the menstrual cycle

Symptoms of an itchy or sore vagina are rarely due to bacterial vaginosis. Because BV has symptoms that are similar to other infections, it is important that you visit your health care provider if you think you have an infection in your vagina.

Who can get bacterial vaginosis?

Any woman can get BV. BV is much more common in sexually active women. You may have a higher risk of getting BV if you:

  • Have many sex partners
  • Have a sexually transmitted infection (STI)
  • Are a smoker

How can I know if I have bacterial vaginosis?

Your health care provider can tell you if you have BV. He or she will examine you and will take a sample of fluid from your vagina. The fluid is viewed under a microscope or sent to the lab for analysis.

How is bacterial vaginosis treated?

Bacterial vaginosis resolves on its own without any medications in one third of non-pregnant women, and about half of pregnant women. BV is treated using medicines that kill the infection when symptoms are bothersome. The most common medicines ordered for BV are metronidazole or clindamycin. These may be given as pills that are taken by mouth. They may also be given as vaginal gels or ovules.

In women who are not pregnant, the Centers for Disease Control recommend treating BV only if it is causing bothersome symptoms for the woman. Treatment is also recommended before surgical procedures to avoid risk of infectious complications. Treatment of BV can lead to vaginal yeast infections.

Do the medications have side effects?

Yes. You may have:

  • Upset stomach
  • Metal taste in your mouth
  • Heartburn

Don't drink alcohol while you are taking metronidazole. You can become very sick to your stomach. Call your health care provider if you have these or any other side effects.

Can I treat myself for bacterial vaginosis?

No. Bacterial vaginosis can only be treated with medicines ordered by your health care provider. You cannot purchase over-the-counter products to treat BV. In fact, over-the-counter yeast treatments can make BV worse. Products for douching will not cure BV.

Should I be treated for bacterial vaginosis if I am pregnant?

Yes. In pregnant women, BV is typically treated even if it is not causing bothersome symptoms due to a potential risk of preterm delivery. The Centers for Disease Control has outlined best recommended therapy options for pregnant women, your doctor will discuss these with you.

How can I protect myself from bacterial vaginosis?

Best ways to prevent BV are not yet known. Female hygiene products like douches and deodorants will not cure the infection. These products have actually been linked to a higher risk of getting BV. Smokers are also more likely to have BV. If you use sexual stimulation devices (sex toys), make sure these are cleaned properly. Studies show that the more sexual partners a woman has, the more likely she is to have BV. Therefore, safer sex practices are important, including using condoms and limiting the number of sexual partners.

To maintain your overall good health:

  • Eat a well-balanced diet
  • Exercise
  • Manage stress levels
  • Get a pelvic exam as directed by your provider
  • Stop smoking

When should I call my doctor?

You should call your health care provider any time if:

  • Your vaginal discharge changes color, becomes heavier, or smells different, and this does not resolve within a few days.
  • You notice itching, burning, swelling, or soreness around the vagina.


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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/18/2015...#3963