Bacterial vaginosis (BV) is a common vaginal infection caused by an imbalance of the natural bacteria in the vagina. It occurs when harmful bacteria outnumber healthy Lactobacilli. BV is not a sexually transmitted infection (STI), but it can increase the risk of STIs or complications if untreated.
Common Symptoms
- Fish-like odour, especially after sex (most noticeable symptom).
- Thin, greyish-white vaginal discharge.
- Mild itching or burning (less common than in yeast infections).
- Up to 50% of women have no symptoms.
Causes & Risk Factors
- Imbalance of vaginal bacteria: Overgrowth of harmful bacteria like Gardnerella.
- Triggers:
- Douching or using scented vaginal products.
- New or multiple sexual partners.
- Smoking or hormonal changes (e.g., menstruation).
- BV is not caused by poor hygiene.
Diagnosis
- Test pH: BV often raises vaginal pH (>4.5).
- Microscopic analysis to detect “clue cells” (bacteria-coated cells).
Treatment Options
- Antibiotics:
Metronidazole: Pills (oral) or gel (applied vaginally) for 5–7 days.
Clindamycin cream: Applied vaginally for 3–7 nights. - Avoid alcohol during metronidazole treatment (causes nausea).
- Follow-up: Recurrence is common; retest if symptoms return.
Prevention Tips
- Avoid douching or scented soaps/sprays.
- Wear cotton underwear and loose clothing.
- Practice safe sex: Condoms may reduce risk.
- Consider probiotics (containing Lactobacilli)—evidence is mixed but safe.
eGynaecologist Advice
- BV is treatable with antibiotics and early treatment lowers complications (e.g., STI risk).
- BV is very common (1 in 3 women experience it) and you should openly discuss concerns with your gynaecologist.
- You must seek gynaecological opinion if symptoms persist after treatment, or you notice new or worsening odour/discharge and if you are planning pregnancy or pregnant.
- You must seek urgent gynaecological consultation if you have high temperature, pelvic pain, or unusual bleeding as this may indicate pelvic inflammatory disease.
Frequently Asked Questions
Is BV an STI?
No, but sexual activity can disrupt vaginal bacteria balance.
Can men get BV?
No, but male partners don’t need treatment if you have been diagnosed with BV.
Can BV affect pregnancy?
Yes – untreated BV increases preterm birth risk. You should consider vaginal microbiome testing if you are planning pregnancy. Tell your gynaecologist if you are pregnant and diagnosed with BV.
Why does BV recur?
The vaginal balance is delicate. Recurrence is common; long-term treatment may help.
Is use of probiotics helpful?
Evidence is growing to support the targeted use of specific probiotic strains as a safe and effective strategy to support vaginal health, particularly in prevention of recurrent BV.
