What Are the Symptoms of Bacterial Vaginosis?

Bacterial vaginosis (BV) is one of the most common causes of unusual discharge, but it can easily go unnoticed. 

Around 30% of people with vaginas get bacterial vaginosis each year, making it the most common vaginal infection according to the Centers for Disease Control (CDC). 

Keep reading to learn more about the symptoms of bacterial vaginosis and how to treat them.

What is bacterial vaginosis (BV)?

Bacterial vaginosis is a bacterial infection that happens when there’s an imbalance of vaginal bacteria. 

Healthy bacteria, primarily Lactobacillus, play a crucial role in maintaining the vagina slightly acidic and preventing harmful bacteria from thriving. However, an overgrowth of bad bacteria (namely, Gardnerella and Prevotella) and a decrease in Lactobacillus levels can lead to dysbiosis, also known as an imbalance, and result in bacterial vaginosis.

There are many things that can trigger an episode of bacterial vaginosis. Anything that messes with your vaginal pH can affect bacteria levels and lead to infection.

Some risk factors make you more likely to develop bacterial vaginosis, including: 

• Using vaginal douches or vaginal deodorants
• Smoking cigarettes 
• Taking antibiotics
• Chronic stress
• Hormonal fluctuations (e.g. birth control, pregnancy, and menopause)
• Your period
• Having unprotected sex (but it’s not a sexually transmitted infection)
• Having multiple sex partners or a new sex partner

Symptoms of bacterial vaginosis

The main symptom of bacterial vaginosis is abnormal vaginal discharge. Vaginal discharge in bacterial vaginosis usually has the following characteristics: 

• Odor: a strong fishy smell (particularly after sex)
• Color: gray or white 
• Consistency: thin or watery 

Healthy vaginal discharge is typically clear or white with a creamy or stretchy consistency. It can have a mild odor that ranges from musky to tangy. Knowing how to spot healthy vs. abnormal vaginal discharge can help you recognize when something isn't quite right down there.

Most people don't have noticeable irritation or discomfort. If you experience any pain, burning, or vaginal itching, it may be due to another infection. (FYI, it’s possible to have more than one vaginal infection at the same time!) 

Bacterial vaginosis might not always have noticeable symptoms, and sometimes they come and go so most people might not even realize they have it. The symptoms can be subtle or similar to other vaginal infections, so it can be tricky to pinpoint. Trichomoniasis, for example, can often be mistaken for bacterial vaginosis. A study found that self-diagnosis of bacterial vaginosis was only correct 56% of the time.

If you suspect you have bacterial vaginosis, see your healthcare provider. Although it’s not a serious infection, untreated BV can lead to serious complications, including infertility and pelvic inflammatory disease (PID).

To diagnose bacterial vaginosis, your doctor will perform a pelvic exam to check for symptoms of BV. They will also take a sample of vaginal fluid with a swab, and analyze it to check for BV-causing bacteria.

How to treat BV

The most common and effective treatment for bacterial vaginosis is a course of antibiotic medications prescribed by a healthcare provider. The typical antibiotics used are:

• Metronidazole
• Clindamycin 
• Tinidazole 

Your doctor might prescribe antibiotics in the form of a vaginal gel or suppository, or the form of an oral tablet. It's important to complete the full course of antibiotics prescribed, even if symptoms improve before finishing the medication. 

Follow up with your healthcare provider if your symptoms don’t go away. They may recommend a different treatment approach or further tests to rule out other conditions.

Lifestyle adjustments can also help restore the natural balance of bacteria in the vagina and help prevent bacterial vaginosis:

• Avoid douching, as it upsets the normal balance of bacteria in your vagina
• Change your period products within the proper time frame
• Practice safe sex and use condoms or dental dams
• Cover sex toys with a condom during partnered sex, and wash them after each use
• Quit smoking.

FAQ

How do you know if you have bacterial vaginosis?

Sometimes, symptoms are enough to know if you have bacterial vaginosis. Telltale bacterial vaginosis symptoms are gray, watery vaginal discharge, and a fishy vaginal odor. That said, other infections can cause similar symptoms. And sometimes bacterial vaginosis doesn’t cause any symptoms at all. The best way to know if you have bacterial vaginosis is to see your healthcare provider or take a vaginal microbiome test. 

Can BV go away on its own?

Sometimes, your body can clear up bacterial vaginosis on its own, but waiting it out isn't the best idea. Without treatment, BV increases your risk of serious health issues like STIs, infertility, pregnancy complications, and pelvic inflammatory disease (PID). It's best to see your healthcare provider and treat bacterial vaginosis if you're experiencing symptoms. 

Is bacterial vaginosis an STD?

No, bacterial vaginosis is not classified as a sexually transmitted disease (STD), but it is linked to sexual activity. Bacterial vaginosis happens when there’s an imbalance in the vaginal microbiome, with a decrease in Lactobacillus (good bacteria) and an overgrowth of other types of bacteria. While you can develop BV even if you aren’t sexually active, it’s more common in those who are, especially if they have new or multiple sexual partners. 

What happens if BV goes untreated?

Untreated bacterial vaginosis puts you at an increased risk of serious complications, including infertility, pelvic inflammatory disease (PID), pregnancy complications, and a higher risk of contracting sexually transmitted infections.