Table of ContentsView AllTable of ContentsSymptomsCausesComplicationsTreatmentPreventionFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Complications
Treatment
Prevention
Frequently Asked Questions
About 25% of pregnant women are diagnosed withbacterial vaginosis(BV). BV is a vaginal infection that occurs when there is an imbalance in the normal, healthy vaginal flora (microorganisms). When this happens, the “bad” bacteria outweigh the “good” bacteria that normally live in the vagina.
The most common symptoms of bacterial vaginosis are a strong “fishy” smelling discharge and an increased amount of vaginal discharge.
This article reviews the symptoms, causes, risk factors, complications, prevention, and treatment of bacterial vaginosis during pregnancy.
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What Are the Symptoms of Bacterial Vaginosis?
Sometimes BV does not causesymptoms. For some women, symptoms are intermittent, meaning they come and go. When symptoms are present, the most common are:
Less common symptoms of BV include:
How BV Is DiagnosedTodiagnose BV, your healthcare provider will take a medical history and perform a physical exam and a vaginal exam. This is similar to apelvic examandPap smear(the exams you get during routine gynecological wellness checks).Three of the following four criteria must be met to diagnose bacterial vaginosis:A pH above 4.5Thin, increased vaginal dischargeFishy odor when 10% potassium solution is added to the discharge sample20% or greater clue cells (fuzzy-looking cells that indicate bacteria) when the discharge is examined under a microscopeYour healthcare provider will also likely test for sexually transmitted infections (STIs) during this appointment.
How BV Is Diagnosed
Todiagnose BV, your healthcare provider will take a medical history and perform a physical exam and a vaginal exam. This is similar to apelvic examandPap smear(the exams you get during routine gynecological wellness checks).Three of the following four criteria must be met to diagnose bacterial vaginosis:A pH above 4.5Thin, increased vaginal dischargeFishy odor when 10% potassium solution is added to the discharge sample20% or greater clue cells (fuzzy-looking cells that indicate bacteria) when the discharge is examined under a microscopeYour healthcare provider will also likely test for sexually transmitted infections (STIs) during this appointment.
Todiagnose BV, your healthcare provider will take a medical history and perform a physical exam and a vaginal exam. This is similar to apelvic examandPap smear(the exams you get during routine gynecological wellness checks).
Three of the following four criteria must be met to diagnose bacterial vaginosis:
Your healthcare provider will also likely test for sexually transmitted infections (STIs) during this appointment.
What Causes Bacterial Vaginosis?
Healthy vaginas have naturally occurring bacteria called normalflora. The healthy bacteria and vaginal discharge keep the vagina clean and free from infection.
Bacterial vaginosis occurs when the healthy balance of bacteria in the vagina is disrupted. The “bad” bacteria take over the “good” bacteria.
While BV is not an STI, it can result from sexual activity.
Risk Factors For Bacterial VaginosisThe following factors increase your risk of BV:Douching regularlyUsing fragranced feminine hygiene productsHaving multiple sex partnersNot using condomsSmokingHaving sex with women (typically, both women get the infection)Pregnancy (due to hormone changes)Having an intrauterine device (IUD) (this is a small risk with limited evidence)Due to various reasons, there are more recorded cases of BV in Black and Hispanic populations than in other groups in the United States.
Risk Factors For Bacterial Vaginosis
The following factors increase your risk of BV:Douching regularlyUsing fragranced feminine hygiene productsHaving multiple sex partnersNot using condomsSmokingHaving sex with women (typically, both women get the infection)Pregnancy (due to hormone changes)Having an intrauterine device (IUD) (this is a small risk with limited evidence)Due to various reasons, there are more recorded cases of BV in Black and Hispanic populations than in other groups in the United States.
The following factors increase your risk of BV:
Due to various reasons, there are more recorded cases of BV in Black and Hispanic populations than in other groups in the United States.
Causes and Risk Factors of Bacterial Vaginosis
What Are the Possible Complications of Bacterial Vaginosis?
While BV is typically mild, it’s essential to treat it, especially during pregnancy. When left untreated, there are rare but serious complications associated with BV, including:
How Is Bacterial Vaginosis Treated During Pregnancy?
Even if BV symptoms are mild, it’s essential to seek treatment to prevent complications. During pregnancy, BV is typically treated with one of the following antibiotics:
Are Metronidazole and Clindamycin Safe While Pregnant or Breastfeeding?Research studies have not found concerns with taking metronidazole or clindamycin while pregnant or breastfeeding. This includes in the first trimester of pregnancy.Tinidazole is an antibiotic prescribed for nonpregnant people. It has not been studied in pregnancy. Pregnant people should avoid tinidazole.Healthcare providers often prefer vaginal cream over pills for people who are breastfeeding whenever possible. This is because the medication does not get distributed throughout the body and breast milk as much as oral medication.
Are Metronidazole and Clindamycin Safe While Pregnant or Breastfeeding?
Research studies have not found concerns with taking metronidazole or clindamycin while pregnant or breastfeeding. This includes in the first trimester of pregnancy.Tinidazole is an antibiotic prescribed for nonpregnant people. It has not been studied in pregnancy. Pregnant people should avoid tinidazole.Healthcare providers often prefer vaginal cream over pills for people who are breastfeeding whenever possible. This is because the medication does not get distributed throughout the body and breast milk as much as oral medication.
Research studies have not found concerns with taking metronidazole or clindamycin while pregnant or breastfeeding. This includes in the first trimester of pregnancy.
Tinidazole is an antibiotic prescribed for nonpregnant people. It has not been studied in pregnancy. Pregnant people should avoid tinidazole.
Healthcare providers often prefer vaginal cream over pills for people who are breastfeeding whenever possible. This is because the medication does not get distributed throughout the body and breast milk as much as oral medication.
Your healthcare provider may also consider the following to treat BV:
Intimate partners who also are women should see their healthcare provider. This is because BV can spread between female sex partners. Both women typically get the infection, and partners may need treatment even if they don’t have symptoms.
Male partners typically do not need medical treatment. Most research indicates treating your male partner does not help to prevent your recurrent BV. This may change if further studies show that treatment is helpful.
Recurring BV During PregnancySometimes healthcare providers prescribe both oral and vaginal medications for you to take at the same time. This is especially true if the infection is recurring (comes back). With recurring infections, healthcare providers may increase the medication’s dose and duration (time). They may also prescribe a maintenance dose of vaginal cream to prevent it from returning.
Recurring BV During Pregnancy
Sometimes healthcare providers prescribe both oral and vaginal medications for you to take at the same time. This is especially true if the infection is recurring (comes back). With recurring infections, healthcare providers may increase the medication’s dose and duration (time). They may also prescribe a maintenance dose of vaginal cream to prevent it from returning.
How to Prevent Bacterial Vaginosis
While BV is not an STI, it can be passed during sexual activity. The following decreases your risk of bacterial vaginosis related to sexual activity:
The following tips can also reduce the risk of bacterial vaginosis:
Natural Remedies to Restore pH Balance in Your Vagina
Summary
Bacterial vaginosis (BV) is a vaginal infection that occurs when there is an imbalance in the normal vaginal flora. With BV, the unhealthy bacteria outweigh the healthy bacteria in the vagina.
The most common symptoms of bacterial vaginosis are a pungent “fishy” smelling discharge and an increase in vaginal discharge.
A Word From Verywell
While bacterial vaginosis is common, having a vaginal infection during pregnancy can be unnerving. Women are often concerned it will harm their unborn babies. Fortunately, BV is easily treated with safe antibiotics during pregnancy and while breastfeeding. If you have any symptoms, call your healthcare provider as early diagnosis and treatment decrease the risk of complications such as premature delivery or low birth weight.
Your healthcare provider will talk to you about your symptoms and do a vaginal exam. During the exam, they will take a sample of the vaginal discharge with a long cotton-tipped swab. They may also use a pH strip to test the acidity level of the vaginal fluid.
While this topic is still controversial in the scientific community, the U.S. Preventive Services Task Force (USPSTF) recommends against screening for bacterial vaginosis for women at low risk for preterm labor. However, your healthcare provider may suggest screening if you have symptoms or are at high risk for preterm birth.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Std facts - bacterial vaginosis.Planned Parenthood.What is bacterial vaginosis?Sim M, Logan S, Goh L.Vaginal discharge: evaluation and management in primary care.Singapore Med J. 2020;61(6):297-301. doi:10.11622/smedj.2020088Ibrahim A.Comparison of in vitro activity of metronidazole and garlic-based product (tomex®) on trichomonas vaginalis.Parasitol Res. 2013;112(5):2063-2067. doi:10.1007/s00436-013-3367-6Eunice Kenedy Shriver National Institute of Child Health and Human Development (NIH).How do healthcare providers diagnose bacterial vaginosis (bv)?Bagnall, P, Rizzolo, D.Bacterial vaginosis: a practical review.J Am Acad Phys Assist.2017; 30(12):15-21. doi:10.1097/01.JAA.0000526770.60197.faUpToDate.Bacterial vaginosis: Treatment.Additional ReadingBagnall, P. and Rizzolo, D.Bacterial vaginosis: A practical review.J Am Acad Phys Assist.2017; 30(12):15-21. doi:10.1097/01.JAA.0000526770.60197.fa
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Std facts - bacterial vaginosis.Planned Parenthood.What is bacterial vaginosis?Sim M, Logan S, Goh L.Vaginal discharge: evaluation and management in primary care.Singapore Med J. 2020;61(6):297-301. doi:10.11622/smedj.2020088Ibrahim A.Comparison of in vitro activity of metronidazole and garlic-based product (tomex®) on trichomonas vaginalis.Parasitol Res. 2013;112(5):2063-2067. doi:10.1007/s00436-013-3367-6Eunice Kenedy Shriver National Institute of Child Health and Human Development (NIH).How do healthcare providers diagnose bacterial vaginosis (bv)?Bagnall, P, Rizzolo, D.Bacterial vaginosis: a practical review.J Am Acad Phys Assist.2017; 30(12):15-21. doi:10.1097/01.JAA.0000526770.60197.faUpToDate.Bacterial vaginosis: Treatment.Additional ReadingBagnall, P. and Rizzolo, D.Bacterial vaginosis: A practical review.J Am Acad Phys Assist.2017; 30(12):15-21. doi:10.1097/01.JAA.0000526770.60197.fa
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.Std facts - bacterial vaginosis.Planned Parenthood.What is bacterial vaginosis?Sim M, Logan S, Goh L.Vaginal discharge: evaluation and management in primary care.Singapore Med J. 2020;61(6):297-301. doi:10.11622/smedj.2020088Ibrahim A.Comparison of in vitro activity of metronidazole and garlic-based product (tomex®) on trichomonas vaginalis.Parasitol Res. 2013;112(5):2063-2067. doi:10.1007/s00436-013-3367-6Eunice Kenedy Shriver National Institute of Child Health and Human Development (NIH).How do healthcare providers diagnose bacterial vaginosis (bv)?Bagnall, P, Rizzolo, D.Bacterial vaginosis: a practical review.J Am Acad Phys Assist.2017; 30(12):15-21. doi:10.1097/01.JAA.0000526770.60197.faUpToDate.Bacterial vaginosis: Treatment.
Centers for Disease Control and Prevention.Std facts - bacterial vaginosis.
Planned Parenthood.What is bacterial vaginosis?
Sim M, Logan S, Goh L.Vaginal discharge: evaluation and management in primary care.Singapore Med J. 2020;61(6):297-301. doi:10.11622/smedj.2020088
Ibrahim A.Comparison of in vitro activity of metronidazole and garlic-based product (tomex®) on trichomonas vaginalis.Parasitol Res. 2013;112(5):2063-2067. doi:10.1007/s00436-013-3367-6
Eunice Kenedy Shriver National Institute of Child Health and Human Development (NIH).How do healthcare providers diagnose bacterial vaginosis (bv)?
Bagnall, P, Rizzolo, D.Bacterial vaginosis: a practical review.J Am Acad Phys Assist.2017; 30(12):15-21. doi:10.1097/01.JAA.0000526770.60197.fa
UpToDate.Bacterial vaginosis: Treatment.
Bagnall, P. and Rizzolo, D.Bacterial vaginosis: A practical review.J Am Acad Phys Assist.2017; 30(12):15-21. doi:10.1097/01.JAA.0000526770.60197.fa
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