Bacterial Vaginosis (BV): Causes, Symptoms, Testing and Treatment

Bacterial Vaginosis - STDTestGuru
Bacterial Vaginosis – STDTestGuru

Bacterial vaginosis or BV is a vaginal infection that is most common among people 15 to 44 years of age. And it is estimated that 7.4 million new cases occur each year. But the rate varies among different subpopulations, it is 5 to 25% in college students and 12 to 61% in patients with STDs. BV can increase the chance of getting other STDs, like chlamydia and gonorrhea. Sometimes, these bacteria can cause pelvic inflammatory disease (PID). In fact, one in three American women will get BV.

What is Bacterial vaginosis?

Bacterial vaginosis or BV is a vaginal infection caused by an overgrowth of bacteria. Naturally, the vagina has an environment containing both good and bad bacteria. In BV, there is an excess of bad bacteria, which leave the vaginal environment out of balance. It may cause fishy odor and vaginal irritation in some women. About 50 to 75% of women with BV don’t experience any symptoms. This infection usually doesn’t cause any other health problems. However, it can lead to issues, especially when you’re pregnant or trying to get pregnant. Women are most likely to get BV in their reproductive years, and it can affect women of any age. Although the cause of this infection is not completely understood, certain activities, like unprotected sex or frequent douching, may increase the risk.

Bacterial vaginosis isn’t a sexually transmitted infection (STI). Still, having sex with a new partner, or multiple partners, may also increase the risk for BV. Sometimes sexual intercourse may cause BV when the partner’s natural genital chemistry changes the balance in the vagina and causes bacteria to grow.

Bacterial vaginosis causes

Bacterial vaginosis occurs when some of the vaginal bacteria grow more quickly than others. When there is too much of one type of bacteria, it can lead to an imbalance. The lactobacilli are the naturally occurring bacteria that fight off infectious bacteria and the infectious bacteria are known as anaerobes. Normally there will be a natural balance between lactobacilli and anaerobes. Lactobacilli is the one that accounts for the majority of bacteria that keep the vagina slightly acidic and control the growth of anaerobes in the vagina. When lactobacilli are decreased in number, anaerobes have the opportunity to grow. BV occurs when there is an overgrowth of anaerobes takes place in the vagina.

Bacterial vaginosis risk factors

Any woman can get bacterial vaginosis, the risk factor includes:

  • Smoking
  • Having sex without condoms or dental dams
  • Have an intrauterine device (IUD)
  • Douching and using a medicated solution to clean the vagina
  • Using perfumed bubble baths, vaginal deodorants, or some scented soaps
  • Washing underwear with strong detergents
  • Having multiple sex partners
  • Having a female sex partner
  • Sharing sex toys
  • Natural lack of lactobacilli bacteria
  • Vitamin D deficiency
  • Presence of other sexually transmitted infections
  • Having prolonged or heavy periods

For some women, BV can be triggered by the hormonal changes of puberty, pregnancy, or menopause.

Can men get BV?

BV infections occur only in women. Men cannot get bacterial vaginosis because the penis doesn’t have the same delicate balance of bacteria. And BV doesn’t spread like a sexually transmitted infection. There is no way for men to get BV. However, experts are not sure about whether men can spread BV to female partners. Women may develop bacterial vaginosis regardless of whether they are sexually active. Still, sexually active women and women who have sex with women do have a higher risk of developing bacterial vaginosis. But some research put forward that, men can spread BV or similar bacterial infections to female partners.

A study in 2015, which involved 165 uncircumcised men concluded that participants who had one or more female sexual partners, apart from their spouse, were more likely to carry bacteria associated with bacterial vaginosis on their penis. In order, this can increase their spouse’s risk of developing BV after having unprotected sex. And another study from 2013, involved 157 heterosexual men. It was identified that men who have a history of nongonococcal urethritis may carry BV-causing bacteria on their penis. The condition which involves inflammation of the urethra, the tube through which urine passes on its way out of the penis is called nongonococcal urethritis.

Bacterial vaginosis: Symptoms and Statistics
Bacterial vaginosis: Symptoms and Statistics

Bacterial vaginosis symptoms

About 84% of people with bacterial vaginosis do not have symptoms. But when symptoms occur the most common include:

  • Off-white, grey, or greenish color vaginal discharge
  • Burning feeling when you pee
  • Discharge that smells
  • Fishy smell that is strongest after sex or even during the menstrual cycle
  • Pain, itching, or burning in the vagina
  • Itching around the outside of the vagina

As these symptoms are similar to other infections, it is important to visit the healthcare to confirm the infection and get treated if necessary.

Bacterial vaginosis diagnosis

To diagnose bacterial vaginosis,

  • The doctor may ask about previous vaginal infections or sexually transmitted infections.
  • Perform a pelvic exam.
  • May take a sample of fluid from the vagina and the healthcare providers will view the fluid under a microscope, test it in the office or send it to the lab for analysis.
  • The pH of the vaginal discharge is measured. The doctors may check the acidity of the vagina by placing a pH test strip in the vagina. When the vaginal pH is greater than 4.5, it is a sign of bacterial vaginosis.

Bacterial vaginosis treatment

In almost one-third of cases, BV resolves on its own without any medications. But treatment is required when a person has symptoms. The doctor will prescribe antibiotics, typically metronidazole, clindamycin, tinidazole to treat the infection.

  • Metronidazole (Flagyl, Metrogel-Vaginal) – This is taken as a pill by mouth. And it is also available as a topical gel that you insert into your vagina. It is important to avoid alcohol during treatment and for at least one day after completing treatment to reduce the risk of nausea, stomach upset, or abdominal pain while using this medication.
  • Clindamycin (Cleocin, Clindesse) – This is available as a cream that you insert into your vagina.
  • Tinidazole (Tindamax) – This is taken as a pill by mouth. Tinidazole may cause stomach upset and nausea as the oral metronidazole, it’s a good idea to avoid alcohol during treatment and for at least three days after completing treatment.

An infected person needs to take most treatments for 5 to 7 days. As BV can be spread through sex, abstaining from sexual activity until the infection is completely cured is important. If the partner is another woman, they may want to see their doctor to find out if they need treatment. BV often returns even after treatment, in this case, the infected person probably needs to take antibiotics again for a longer time.

Home Remedies

Home remedies can also be used to treat & prevent BV. However, these treatments will not be as effective as prescription medications. But the home remedy for BV may not cause side effects like prescription medications does. Home remedies may include:

  • Consuming yogurt may help introduce healthy bacteria back into the body.
  • As garlic has strong antibacterial properties, it is used as a home remedy for bacterial vaginosis.
  • Tea tree oil contains powerful antibacterial and antifungal properties that can help treat bacterial vaginosis (Don’t use tea tree oil without mixing it with a carrier oil, as it can burn tender skin). As many people are allergic to tea tree oil it is important to test a small amount of the diluted oil on the skin before using it on the tender vaginal tissue. It is safe to use if there is no reaction in 24 to 48 hours.


  • Pelvic inflammatory disease (PID), is an infection of the uterus and the fallopian tubes that can increase the risk of infertility.
  • Having BV may also increase the risk of developing a post-surgical infection after procedures such as hysterectomy or dilation and curettage.
  • Among pregnant women, bacterial vaginosis is linked to premature deliveries and low birth weight babies.
  • Having BV makes women more susceptible to sexually transmitted infections, like herpes, chlamydia, or gonorrhea, or passing HIV to others.
  • Success is fewer infertility treatments like in vitro fertilization (IVF).


  • Don’t push water into your vagina to clean it (douching)
  • Clean sex toys after every use
  • Wash the genital area using water and plain soap
  • Getting tested for sexually transmitted diseases, and make sure your sex partners are tested
  • Limit your number of sex partners
  • Having protected sex
  • Avoid using strong detergents to wash underwear
  • Avoid tight nylon tights and thongs
  • By practicing good hygiene, one can help treat and prevent cases of bacterial vaginosis

Bacterial vaginosis recurrent

Almost 80% of women will get bacterial vaginosis again. It’s common to get BV within three to twelve months, despite treatment. This is treated with a 7-day course of oral or vaginal metronidazole or clindamycin. If treatment was by mouth previously, then vaginal treatment might work better the second time, and if the first treatment was vaginal, the follow-up treatment should be by mouth. If more than three episodes take place within 12 months, the doctor may prescribe a vaginal metronidazole gel to use twice a week for 3 to 6 months. According to a study in 2019, astodrimer sodium significantly reduced BV recurrence rates. And a clinical trial in 2020 found that consuming oral lactobacillus after antibiotic treatment for BV may prevent reinfection.

Bacterial vaginosis and pregnancy

A pregnant woman can get BV. And are more likely to have babies born premature or with low birth weight than pregnant women without BV. Treatment for pregnant women is recommended to decrease the risk of pregnancy-associated complications related to infection. And treatment before total abdominal hysterectomy, cesarean delivery, and insertion of an IUD is also recommended by most experts.

Bacterial vaginosis vs yeast infection

BV is bacterial in nature and it is an overgrowth of one of the kinds of bacteria in the vagina. And a yeast infection is fungal in nature and it is an overgrowth of the candida fungus. Both cause unusual vaginal discharge. The discharge from BV is thin, yellow or gray, and carries a strong unpleasant odor, whereas the discharge from a yeast infection is usually a thick, white consistency and doesn’t have a scent. It’s also possible to have both yeast infection and BV at the same time.

Facts about Bacterial vaginosis

  • Bacterial vaginosis is a common vaginal problem for women ages 15 to 44.
  • The prevalence in the US is 21.2 million (29.2%) among women ages 14-49.
  • About 84% of people with BV don’t have symptoms.
  • Nearly, 30% of women whose symptoms disappear with treatment will have a recurrence within 3 months and 50% will have a recurrence within 6 months.
  • Antibiotics are effective in up to 90% of cases.
  • BV is found in about 25% of pregnant women in the US and about 60% of women who have an STD.

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