woman suffering from thrush and BV

Bacterial vaginosis (BV) is a common vaginal infection caused by an overgrowth of bacteria disrupting the normal vaginal flora. It results in abnormal greyish discharge, foul odour, and sometimes itching/burning and also increases risks like preterm birth and contracting STDs.

In this ‘Ultimate Guide’ for bacterial vaginosis, we will examine this vaginal infection and provide you with a comprehensive breakdown of the condition and provide essential tips and prevention.  

Our goal at e-Surgery is to inform and empower our readers about vaginal infections such as BV and provide important information about managing this condition.

Understanding What Is Bacterial Vaginosis?

Bacterial vaginosis is a type of vaginal inflammation caused by an overgrowth of naturally occurring vaginal bacteria. It is the most common vaginal infection in women of childbearing age and is estimated to affect one in ten women at some point during their life.

The vagina contains a carefully balanced mix of different bacteria, which help maintain a healthy, slightly acidic environment. In women with bacterial vaginosis, there is an overgrowth of one particular bacteria strain called Gardnerella vaginalis. This disrupts the normal vaginal flora (microbiome) by decreasing the amount of protective lactobacillus bacteria.

While not considered a true sexually transmitted infection in the classic sense, bacterial vaginosis does appear to be linked to sexual activity. It is more common in sexually active women, those with new or multiple partners, and those who douche regularly.

Other risk factors include using an intrauterine device (IUD) for birth control, lack of condom use during sex, and a natural lack of hydrogen peroxide-producing lactobacilli.

Although bacterial vaginosis doesn’t directly cause complications itself, the disruption to the vaginal environment can increase susceptibility to other issues. These include a higher risk of preterm birth, post-surgical infections like after a hysterectomy or abortion, and contracting sexually transmitted diseases like HIV, herpes simplex virus, gonorrhoea or chlamydia.

Bacterial Vaginosis Symptoms

Bacterial vaginosis symptoms can vary from woman to woman. Many women with bacterial vaginosis experience no obvious symptoms, while others report mild to more severe signs of infection. 

Common symptoms include the following:

Abnormal Vaginal Discharge

This is one of the most common and noticeable symptoms of bacterial vaginosis. The vaginal bacterial vaginosis discharge takes on a greyish-white, thin and watery appearance, unlike the normal clear/white and thicker discharge. It may look like a milky, grey liquid that easily coats the vaginal lining.

Fishy Vaginal Odour

Perhaps the most distinctive sign of bacterial vaginosis is an unpleasant, fishy odour coming from the vaginal area. This odour is often more pronounced after sex or during menstruation when the normal vaginal environment is disrupted. Some women describe it as a strong, foul, or rotten fish-like smell.

Vaginal Itching/Irritation

While less common than discharge and odour, bacterial vaginosis can cause feelings of vaginal itchiness, burning, and irritation in some cases. The itching may be internal in the vagina or around the vulva area.

Burning with Urination

When bacterial vaginosis causes inflammation of the vagina and surrounding tissues, it can lead to discomfort and a burning sensation when urinating for some women.

Other Symptoms

Although rare, bacterial vaginosis may cause other symptoms like vaginal pain during sex, vaginal bleeding between periods, or lower abdominal pain and backache if the infection spreads to the uterus or fallopian tubes.

It’s important to note that many women with bacterial vaginosis have no evident symptoms whatsoever. For many, it may only be discovered during a routine pelvic exam and testing by their gynaecologist.

The severity and combination of symptoms can vary, but the trademark signs are typically an abnormal greyish vaginal discharge along with a persistent fishy odour, especially after intimacy or menstruation. Any concerning symptoms should prompt an evaluation for bacterial vaginosis or other conditions such as Thrush.

Diagnosis of Bacterial Vaginosis

There are several clinical tests and techniques that doctors use to diagnose a case of bacterial vaginosis:

Clinical Diagnosis

Looking at a sample of vaginal discharge under a microscope, physicians can detect the presence of “clue cells” – vaginal cells that are coated with BV-associated bacteria like Gardnerella. The vaginal pH is typically elevated to greater than 4.5 as well.

Whiff Test

In this low-tech method, a small amount of potassium hydroxide solution is added to a sample of vaginal discharge. If bacterial vaginosis is present, this can enhance the telltale fishy odour of the infection.

DNA Tests

Newer molecular diagnostic tests look for the genetic presence of Gardnerella vaginalis bacteria as well as other microbes associated with bacterial vaginosis for a more accurate diagnosis.

To rule out other possible vaginal infections like yeast infections or trichomoniasis, your doctor may also test vaginal discharge samples on culture plates to check for the growth of other disease-causing microbes like Candida fungus.

Newly available multiplex tests can detect multiple pathogens at once, helping distinguish between different causes of vaginitis, such as bacterial vaginosis, yeast, and trichomoniasis.

Bacterial Vaginosis Treatment & Medication

There are several ways to start treatment for bacterial vaginosis, from medicines to home remedies.

How to Treat Bacterial Vaginosis?

While some mild cases of bacterial vaginosis may clear up on their own, antibiotics are typically used to help restore the normal balance of vaginal flora.

Common treatment options include:


One of the most frequently prescribed bacterial vaginosis treatments is the antibiotic metronidazole. It comes as a pill taken twice daily for seven days or as a vaginal gel applied internally. Women are advised to avoid alcohol while taking this medication due to potential side effects.


The antibiotic clindamycin is another effective bacterial vaginosis treatment that comes as either a vaginal cream applied for seven days or in an oral pill form also taken for one week.


This is a type of antibiotic similar to metronidazole, but it should be taken as a single dose rather than over the course of a week. Some studies suggest it may cause fewer gastrointestinal side effects.


Taking probiotic vaginal tablets or oral probiotic supplements containing Lactobacillus strains can help replenish levels of protective vaginal bacteria during and after antibiotic treatment for bacterial vaginosis.

Home Remedies

For cases of bacterial vaginosis that are mild or infrequent, some women try home remedies like inserting yoghurt vaginally to restore lactobacilli, using boric acid capsules, or hydrogen peroxide diluted in water for douching. However, these are not considered first-line treatments.

Next Steps

Even after receiving antibiotic treatment, bacterial vaginosis has high rates of recurrence within just 3-6 months, estimated at 30-50% of cases. To help prevent recurrences:

  • Avoid douching as it disrupts the vaginal microbiome
  • Use fragrance-free, gentle feminine personal care products 
  • Abstain from sex or use condoms temporarily
  • Consider switching to a non-spermicidal, microbiome-friendly lubricant  

Women who experience frequent, recurrent episodes of bacterial vaginosis may require more comprehensive testing and treatment. This can include an evaluation by an infectious disease specialist to look for underlying causes or ineffective antibiotic treatment.

To further reduce risk factors:

  • Limit new or multiple sexual partners
  • Practice safe sex and use protection like condoms consistently  
  • Discontinue routine vaginal douching completely  
  • Keep blood sugar well-controlled if diabetic

Pregnant women should seek prompt treatment for bacterial vaginosis due to the risk of complications like preterm premature rupture of membranes and preterm birth associated with bacterial vaginosis.

While bacterial vaginosis is not considered a serious condition, it can be unpleasant and frustrating. However, it is very manageable with proper antibiotic treatment and excellent preventative feminine hygiene habits.

If you believe you may have symptoms of bacterial vaginosis or have any further questions, follow this link to connect with certified pharmacists at e-Surgery.