‍Bacterial vaginosis (BV) is one of the most common causes of abnormal vaginal discharge and vaginal odor, but it’s definitely not the only one. Other conditions, including some sexually transmitted infections, can cause similar symptoms to bacterial vaginosis. So how do you know if you have BV? 

The most accurate way is by taking a BV test, but there are some telltale signs to look out for, too. Keep reading to learn more about how to know if you have bacterial vaginosis, and how to treat it. 

What is bacterial vaginosis? 

Bacterial vaginosis is a common vaginal infection that happens when the healthy balance of bacteria in your vagina is disrupted. Almost 30% of people with vaginas experience bacterial vaginosis each year, making it the most common vaginal condition in women aged 15-44.

The vaginal microbiome is made up of protective bacteria, like Lactobacilli, which keep your vaginal pH acidic and help prevent infections. When these protective bacteria are out of balance (known as vaginal dysbiosis), it gives other, harmful bacteria to overgrow, leading to an infection like bacterial vaginosis.  

Some of the most common BV-associated bacteria include anaerobic species like: 

Having these bacteria present in your vaginal microbiome doesn't necessarily mean you have bacterial vaginosis. It all depends on the amounts present, as well as the amounts of protective bacteria like lactobacilli. In short: it's all about balance!

What causes BV?

Researchers aren’t sure of the exact cause of bacterial vaginosis, so it’s unclear why certain bacteria overgrow. That said, anything that changes the chemistry of your vagina’s pH balance can mess with bacteria levels and lead to infection. 

These risk factors make you more likely to develop bacterial vaginosis: 

Although sex can be a trigger, bacterial vaginosis isn't considered a sexually transmitted infection because you can develop it even if you're not sexually active. That said, using condoms during partnered vaginal sex can drastically reduce your risk of developing bacterial vaginosis.

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BV symptoms 

Bacterial vaginosis doesn't always have symptoms, so many people — up to 84% — don't even know they have it. Sometimes symptoms are so mild that you don't notice them.

The main symptom of BV is increased vaginal discharge that is watery and has a strong fishy smell that is more noticeable after having sex. The discharge may be white, gray, or greenish.

Sometimes, you may have a little itching or burning when you pee, but most people don't have noticeable irritation or discomfort.

Many vaginal infections have similar symptoms, so although they can sound the alarm and let you know that something’s not quite right, symptoms alone aren’t always enough for a diagnosis. Most of us aren’t very good at diagnosing ourselves. One study found that self-diagnoses of BV were right only 56% of the time.

BV diagnosis 

Diagnosing bacterial vaginosis involves a simple vaginal exam and a lab test. During the exam, your healthcare provider will check for signs of BV, like unusual vaginal discharge, a fishy odor (aptly named "whiff test"), and an elevated vaginal pH. 

They'll collect a small sample of vaginal fluid with a swab, which will be tested in the lab. Getting an accurate diagnosis is important because it helps your provider exclude any other infection, such as a sexually transmitted infection like trichomoniasis. 

You can also opt for an at-home vaginal microbiome test like Evvy's. The Evvy Vaginal Health Test screens for all bacteria and fungi that have been found in the vaginal microbiome — including BV-associated bacteria. Your results come with a custom plan of clear next steps, science-backed education, and 1:1 coaching. For eligible tests, Evvy also offers prescription vaginal treatment programs.

Although they’re often marketed as a BV test, at-home vaginal pH tests aren’t comprehensive enough to diagnose an infection. They can tell you if your pH is higher than it should be, but can’t give you an insight into which bacteria are present in your vagina, and at what levels.  

Bacterial vaginosis treatment 

You can treat bacterial vaginosis with antibiotics. Common options include clindamycin, metronidazole, tinidazole, or secnidazole.

Unfortunately, these antibiotics might not provide a long-term solution to treat BV. While they clear up to 85% of cases within a month, the infection can return within six months for over half of the patients. In some cases, the recurrence rate can be as high as 50% just three months after treatment.

It's also important to know that not all antibiotics are created equal. Some may be more effective against certain bacteria. Understanding the specific bacteria in your microbiome — and which one is responsible for causing bacterial vaginosis — could help choose the right antibiotic, especially if you're dealing with recurrent BV.

FAQ

How do I check if I have BV?

There are a few ways to check if you have bacterial vaginosis. Symptoms such as watery, gray vaginal discharge with a fishy odor are the telltale signs of bacterial vaginosis. That said, BV isn’t always symptomatic, and the symptoms can often be mistaken for another infection. The only way to know for sure if you have BV is to do a vaginal swab test and have the sample analyzed in a lab. You can test for bacterial vaginosis with your healthcare provider, or take an at-home vaginal microbiome test like Evvy’s. 

What does the start of BV feel like?

The most common sign of bacterial vaginosis is abnormal vaginal discharge that has a strong fishy smell (that gets worse after sex). It might go unnoticed at the start and gradually get more intense as the infection progresses. 

Will BV go away on its own? 

Rarely, bacterial vaginosis will go away on its own without any treatment. However, it’s not worth the wait. It could take weeks for bacterial vaginosis to clear, and untreated BV can put you at higher risk of long-term health problems, including STIs, infertility, pregnancy complications, and pelvic inflammatory disease (PID). If you have symptoms, you should see your healthcare provider.

What can be mistaken as BV? 

Several infections can cause abnormal discharge and vaginal odor. Aerobic vaginitis, trichomoniasis, chlamydia, and pelvic inflammatory disease can all be easily mistaken for bacterial vaginosis. If you’re experiencing any unusual symptoms, see your healthcare provider.