Bacterial Vaginosis

The most common symptom of bacterial vaginosis is a change in vaginal discharge. It may become thin, watery, and appear white or grey, often with a characteristic fishy odour that can be more noticeable after sex or during menstruation.

Unlike conditions such as thrush, it does not usually cause itching or soreness. Some people have no symptoms.

Yes, bacterial vaginosis is often asymptomatic. Around 50% of people may not notice any symptoms.

It may be identified during testing for other concerns or remain undetected. As it reflects a change in the vaginal microbiome, symptoms are not always present.

Bacterial vaginosis is usually mild, but in some cases it is associated with increased health risks.

It can increase susceptibility to sexually transmitted infections such as HIV, chlamydia, and gonorrhoea. It has also been associated with pelvic inflammatory disease (PID), particularly following procedures.

In pregnancy, BV has been linked to an increased risk of preterm birth and low birth weight. It may also increase the risk of infection after certain gynaecological procedures.

Bacterial vaginosis does not have a defined onset, as it is not a directly transmitted infection.

Symptoms develop when the normal balance of vaginal bacteria is disrupted. This may be influenced by factors such as menstruation, sexual activity, or use of irritant products.

Some people notice symptoms quickly, while others remain asymptomatic.

Bacterial vaginosis is caused by a disruption in the normal vaginal microbiome, where protective lactobacilli are reduced and other bacteria overgrow.

This imbalance can be influenced by factors such as douching, use of scented products, and sexual activity.

It is not classified as a sexually transmitted infection, although it is associated with sexual activity.

Several factors are associated with an increased likelihood of bacterial vaginosis, including:

• Use of scented or perfumed products
• Douching
• Having a new or multiple sexual partners
• Smoking
• Hormonal changes (e.g. during the menstrual cycle)
• Use of intrauterine devices (particularly copper coils, in some individuals)

These factors can disrupt the normal vaginal environment.

Bacterial vaginosis cannot always be prevented, but the risk may be reduced by:

• Avoiding douching or washing inside the vagina
• Avoiding scented products in the genital area
• Using gentle, non-perfumed hygiene products externally
• Considering condom use if symptoms are triggered after sex
• Avoiding smoking

Yes, it is still possible to develop bacterial vaginosis even if you use condoms.

BV is not a sexually transmitted infection, but it is associated with sexual activity and changes in the vaginal environment.

No, bacterial vaginosis is not transmitted through kissing or casual contact.

No, bacterial vaginosis is not spread through sharing items such as towels, clothing, or bedding.

It develops due to changes within the vaginal environment.

No, bacterial vaginosis cannot be transmitted through blood transfusions.

It is a local condition affecting the vaginal microbiome and is not present in the bloodstream.

Bacterial vaginosis is diagnosed based on symptoms and vaginal testing.

A swab sample is used to assess vaginal pH (typically >4.5 in BV) and to examine the discharge either under a microscope or in a laboratory. This helps confirm the diagnosis and exclude other causes.

Diagnosis is usually based on a combination of clinical features and simple tests, including:

• Vaginal pH testing (elevated in BV)
• Microscopy to identify clue cells
• “Whiff test” (fishy odour when potassium hydroxide is added)

In laboratory settings, additional methods (such as Gram stain scoring systems) may be used to confirm the diagnosis. Molecular tests are not routinely required.

Accurate diagnosis relies on combining symptoms with test findings.

Typical features include a thin, greyish-white discharge with a fishy odour, usually without itching or soreness. These are supported by findings such as elevated pH or clue cells.

This approach helps distinguish BV from conditions such as thrush or sexually transmitted infections.

Yes, several conditions can present similarly and may be mistaken for BV.

These include:

• Vaginal thrush (typically thick discharge with itching)
• Trichomoniasis (often frothy discharge with odour)
• Other infections such as chlamydia or gonorrhoea

Testing is important, as these conditions require different treatments.

Diagnosis is usually confirmed using clinical criteria and standard testing rather than symptoms alone.

Laboratory methods (such as Gram stain scoring) may be used in some settings, particularly if the diagnosis is uncertain.

No, a physical examination alone is usually not sufficient to confirm bacterial vaginosis.

While certain features may suggest BV, testing is required to confirm the diagnosis and exclude other causes.

It can be difficult to diagnose bacterial vaginosis accurately at home.

Symptoms such as a change in discharge or odour may suggest BV, but other conditions can appear similar. Some home tests measure vaginal pH, but these are not definitive.

Clinical assessment and testing are usually needed to confirm the diagnosis and guide appropriate treatment.

The long-term outlook for bacterial vaginosis is generally very good.

It does not usually cause lasting harm to overall health or fertility in most people, and symptoms typically respond well to treatment.

However, recurrence is common, with many individuals experiencing repeat episodes. Ongoing management may be needed in some cases.

No, treatment does not provide immunity.

Bacterial vaginosis can recur because it results from changes in the vaginal microbiome. Recurrence within a few months is common.

Recurrence cannot always be prevented, but certain measures may help reduce risk:

• Avoid douching or washing inside the vagina
• Avoid scented or perfumed products
• Use gentle, non-perfumed products externally
• Consider condom use if symptoms are associated with sex
• Avoid smoking

If symptoms are recurrent, further assessment or longer-term management strategies may be considered.

There is no medical requirement to inform a partner.

Bacterial vaginosis is not classified as a sexually transmitted infection, and treatment of male partners is not recommended.

In female partners, BV may be associated with shared vaginal microbiota, so discussion may be helpful in cases of recurrent symptoms.

Bacterial vaginosis is not considered a sexually transmitted infection, but it can be associated with sexual activity.

It is not thought to be transmitted to male partners. However, in female partners, there is evidence that BV-associated bacteria may be shared.

To reduce recurrence and potential imbalance:

• Avoid douching and scented products
• Use gentle hygiene practices
• Consider condom use if symptoms are linked to sexual activity
• Avoid smoking

Bacterial vaginosis is not considered an infection that is directly passed to the baby.

However, if present during pregnancy, it has been associated with certain complications, including preterm birth and low birth weight. If you are pregnant and have symptoms, medical assessment is recommended.

Many people with bacterial vaginosis have healthy pregnancies. However, untreated BV has been associated with:

• Preterm birth (before 37 weeks)
• Low birth weight
• A possible increased risk of late miscarriage
• Postpartum uterine infection (endometritis)

Assessment and treatment are recommended if symptoms are present.

Bacterial vaginosis is relatively common during pregnancy, affecting around 10–20% of pregnant individuals.

Hormonal changes can influence the vaginal microbiome, and many people remain asymptomatic.

Yes, bacterial vaginosis can be treated during pregnancy.

Antibiotics such as Metronidazole (oral or vaginal) or Clindamycin are commonly used and considered safe when prescribed appropriately.

Completing the full course of treatment is important.

To help reduce risk during pregnancy:

• Avoid scented or perfumed products
• Do not douche or wash inside the vagina
• Use gentle, non-perfumed hygiene products externally
• Wear breathable underwear

If you notice symptoms such as unusual discharge or odour, early assessment is recommended.

Bacterial vaginosis has been associated with a slightly increased risk of postpartum uterine infection, which may affect recovery if untreated.

It does not affect breast milk or milk supply. Treatments used for BV are generally compatible with breastfeeding.