Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPreventionNext in Bacterial Vaginosis GuideCauses and Risk Factors of Bacterial Vaginosis

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Table of Contents

Symptoms

Causes

Diagnosis

Treatment

Prevention

Next in Bacterial Vaginosis Guide

Bacterial vaginosis(BV) is a common but frustrating condition in which the balance of bacteria in the vagina gets out of sync. Usually, the body is able to maintain the ideal balance. But if the balance is disrupted, certain types of bacteria can overgrow and cause symptoms.

BV is readily treated and usually doesn’t cause any other health problems. With that said, it can increase the risk of getting asexually transmitted disease (STD)or lead to birth complications in people who are pregnant.

Bacterial vaginosis symptoms

This article looks at the symptoms, causes, and risk factors of bacterial vaginosis. It also explains how BV is diagnosed, treated, and prevented.

Bacterial Vaginosis Symptoms

Of the 21 million women in the United States believed to have bacterial vaginosis each year, only around three million actually have symptoms.

When they occur, the symptoms of BV tend to be mild but persistent and may include:

While BV symptoms are rarely serious, they can weaken vaginal tissues and increase the risk of STDs such asgonorrhea,chlamydia,trichomoniasis, andHIV.

If an infection occurs during pregnancy, there is an increased risk ofpreterm (premature) birth, low birth weight, and, in rare instances,miscarriage.

RecapSymptoms of bacterial vaginosis include a vaginal discharge with a fishy smell. Itching, redness, swelling, burning with urination, and bleeding with intercourse are also common.

Recap

Symptoms of bacterial vaginosis include a vaginal discharge with a fishy smell. Itching, redness, swelling, burning with urination, and bleeding with intercourse are also common.

Causes of an Onion-Like Vaginal Odor

Bacterial vaginosis occurs when the level of “good” bacteria in the vagina suddenly drops. This allows “bad” bacteria to grow excessively. The main “good” bacteria, calledlactobacillus, makes the vagina slightly acidic so that “bad” bacteria can’t overgrow.

Some of the more common causes of BV include:

Bacterial Vaginosis Causes and Risk Factors

These include::

The microscopic exam would look for “clue cells” (meaning vaginal cells studded with bacteria). Agram stainwould also be used to differentiate “good” bacteria from “bad” ones, allowing the lab to check for imbalances in thevaginal flora.

Additional tests may be performed to rule out other possible causes, such as ayeast infectionorgenital herpes.

RecapThe diagnosis of bacterial vaginosis typically involves a review of symptoms and medical history, a pelvic exam, a vaginal pH test, and a microscopic evaluation of vaginal fluids.

The diagnosis of bacterial vaginosis typically involves a review of symptoms and medical history, a pelvic exam, a vaginal pH test, and a microscopic evaluation of vaginal fluids.

How Bacterial Vaginosis Is Diagnosed

Thestandard treatmentfor bacterial vaginosis is a short course of antibiotic drugs.Antibiotics are a class of drugs that specifically treat bacterial infections.

The first-line options are Flagyl (metronidazole) andclindamycin. Both are highly effective in treating BV and have relatively mild side effects.

The preferred first-line regimens include:

Alternate treatments include a clindamycin vaginal suppository or Tindamax (tinidazole) tablets.Despite the effectiveness of these drugs, recurrence is common and may require multiple treatments to fully clear the infection.

Side effects include nausea, stomach ache, cough, sore throat, runny nose, and ametallic taste in the mouth.

In addition to antibiotics, several supportive remedies may help. These includeprobiotics(beneficial live bacteria found in yogurt andprobiotic supplements) that may help prevent a recurrence.Boric acid(available as a capsule and vaginal suppository) is an old-time remedy attracting renewed medical interest.

RecapThe first-line antibiotics used to treat bacterial vaginosis include oral metronidazole (a.k.a. Flagyl), topical metronidazole, and topical clindamycin.

The first-line antibiotics used to treat bacterial vaginosis include oral metronidazole (a.k.a. Flagyl), topical metronidazole, and topical clindamycin.

How to Stop Bacterial Vaginosis From Recurring Again

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As common as bacterial vaginosis is, there are things you can do to reduce your risk. These include safer sex practices and practicing good vaginal hygiene.

To prevent bacterial vaginosis:

Summary

The diagnosis of BV typically involves a pelvic exam, a vaginal pH test, and a microscopic evaluation of vaginal fluids. BV is treated with oral or topical antibiotics, most commonly metronidazole and clindamycin.

A Word From Verywell

Even with the best prevention efforts, bacterial vaginosis can occur. Try not to stress it does. Instead, seek treatment and make every effort to avoid worsening the condition.

If prescribed antibiotics, do not stop early even if the symptoms disappear. If you do, antibiotic resistance can occur, making the infection harder to treat if it returns.

10 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.Koumans EH, Sternberg M, Bruce C, et al.The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health.Sex Transm Dis. 2007;34(11):864-869.McDonald HM, Brocklehurst P, Gordon A.Antibiotics for treating bacterial vaginosis in pregnancy.Cochrane Database Syst Rev. 2007;(1):CD000262. doi:10.1002/14651858.CD000262.pub3Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines.Bacterial vaginosis.Mackelprang RD, Scoville CW, Cohen CR, et al.Toll-like receptor gene variants and bacterial vaginosis among HIV-1 infected and uninfected African women.Genes Immun. 2015;16(5):362–365. doi:10.1038/gene.2015.13Money D.The laboratory diagnosis of bacterial vaginosis.Can J Infect Dis Med Microbiol. 2005;16(2):77–79. doi:10.1155/2005/230319Cook RL, Reid G, Pond DG, Schmitt CA, Sobel JD.Clue cells in bacterial vaginosis: immunofluorescent identification of the adherent gram-negative bacteria as gardnerella vaginalis.J Infect Dis. 1989;160(3):490-496.Bradshaw CS, Sobel JD.Current treatment of bacterial vaginosis-limitations and need for innovation.J Infect Dis. 2016;214(Suppl 1):S14–S20. doi:10.1093/infdis/jiw159Menard JP.Antibacterial treatment of bacterial vaginosis: current and emerging therapies.Int J Womens Health. 2011;3:295–305. doi:10.2147/IJWH.S23814Homayouni A, Bastani P, Ziyadi S, et al.Effects of probiotics on the recurrence of bacterial vaginosis: a review.J Low Genit Tract Dis. 2014;18(1):79-86.Muzny CA, Schwebke JR.Pathogenesis of bacterial vaginosis: discussion of current hypotheses.J Infect Dis. 2016;214(Suppl 1):S1–S5. doi:10.1093/infdis/jiw121Additional ReadingAllworth, J. and Peipert, J.Severity of Bacterial Vaginosis and the Risk of Sexually Transmitted Infection.Am J Obstet Gynecol.2011; 205(2):113.e1-113.e6. doi:10.1016/j.ajog.2011.02.060.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.CDC.Bacterial vaginosis (BV).Hainer, B. and Gibson, M.Vaginitis: Diagnosis and Treatment.Am Fam Physician.2011; 83(7):807-815.

10 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.Koumans EH, Sternberg M, Bruce C, et al.The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health.Sex Transm Dis. 2007;34(11):864-869.McDonald HM, Brocklehurst P, Gordon A.Antibiotics for treating bacterial vaginosis in pregnancy.Cochrane Database Syst Rev. 2007;(1):CD000262. doi:10.1002/14651858.CD000262.pub3Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines.Bacterial vaginosis.Mackelprang RD, Scoville CW, Cohen CR, et al.Toll-like receptor gene variants and bacterial vaginosis among HIV-1 infected and uninfected African women.Genes Immun. 2015;16(5):362–365. doi:10.1038/gene.2015.13Money D.The laboratory diagnosis of bacterial vaginosis.Can J Infect Dis Med Microbiol. 2005;16(2):77–79. doi:10.1155/2005/230319Cook RL, Reid G, Pond DG, Schmitt CA, Sobel JD.Clue cells in bacterial vaginosis: immunofluorescent identification of the adherent gram-negative bacteria as gardnerella vaginalis.J Infect Dis. 1989;160(3):490-496.Bradshaw CS, Sobel JD.Current treatment of bacterial vaginosis-limitations and need for innovation.J Infect Dis. 2016;214(Suppl 1):S14–S20. doi:10.1093/infdis/jiw159Menard JP.Antibacterial treatment of bacterial vaginosis: current and emerging therapies.Int J Womens Health. 2011;3:295–305. doi:10.2147/IJWH.S23814Homayouni A, Bastani P, Ziyadi S, et al.Effects of probiotics on the recurrence of bacterial vaginosis: a review.J Low Genit Tract Dis. 2014;18(1):79-86.Muzny CA, Schwebke JR.Pathogenesis of bacterial vaginosis: discussion of current hypotheses.J Infect Dis. 2016;214(Suppl 1):S1–S5. doi:10.1093/infdis/jiw121Additional ReadingAllworth, J. and Peipert, J.Severity of Bacterial Vaginosis and the Risk of Sexually Transmitted Infection.Am J Obstet Gynecol.2011; 205(2):113.e1-113.e6. doi:10.1016/j.ajog.2011.02.060.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.CDC.Bacterial vaginosis (BV).Hainer, B. and Gibson, M.Vaginitis: Diagnosis and Treatment.Am Fam Physician.2011; 83(7):807-815.

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.

Koumans EH, Sternberg M, Bruce C, et al.The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health.Sex Transm Dis. 2007;34(11):864-869.McDonald HM, Brocklehurst P, Gordon A.Antibiotics for treating bacterial vaginosis in pregnancy.Cochrane Database Syst Rev. 2007;(1):CD000262. doi:10.1002/14651858.CD000262.pub3Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines.Bacterial vaginosis.Mackelprang RD, Scoville CW, Cohen CR, et al.Toll-like receptor gene variants and bacterial vaginosis among HIV-1 infected and uninfected African women.Genes Immun. 2015;16(5):362–365. doi:10.1038/gene.2015.13Money D.The laboratory diagnosis of bacterial vaginosis.Can J Infect Dis Med Microbiol. 2005;16(2):77–79. doi:10.1155/2005/230319Cook RL, Reid G, Pond DG, Schmitt CA, Sobel JD.Clue cells in bacterial vaginosis: immunofluorescent identification of the adherent gram-negative bacteria as gardnerella vaginalis.J Infect Dis. 1989;160(3):490-496.Bradshaw CS, Sobel JD.Current treatment of bacterial vaginosis-limitations and need for innovation.J Infect Dis. 2016;214(Suppl 1):S14–S20. doi:10.1093/infdis/jiw159Menard JP.Antibacterial treatment of bacterial vaginosis: current and emerging therapies.Int J Womens Health. 2011;3:295–305. doi:10.2147/IJWH.S23814Homayouni A, Bastani P, Ziyadi S, et al.Effects of probiotics on the recurrence of bacterial vaginosis: a review.J Low Genit Tract Dis. 2014;18(1):79-86.Muzny CA, Schwebke JR.Pathogenesis of bacterial vaginosis: discussion of current hypotheses.J Infect Dis. 2016;214(Suppl 1):S1–S5. doi:10.1093/infdis/jiw121

Koumans EH, Sternberg M, Bruce C, et al.The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health.Sex Transm Dis. 2007;34(11):864-869.

McDonald HM, Brocklehurst P, Gordon A.Antibiotics for treating bacterial vaginosis in pregnancy.Cochrane Database Syst Rev. 2007;(1):CD000262. doi:10.1002/14651858.CD000262.pub3

Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines.Bacterial vaginosis.

Mackelprang RD, Scoville CW, Cohen CR, et al.Toll-like receptor gene variants and bacterial vaginosis among HIV-1 infected and uninfected African women.Genes Immun. 2015;16(5):362–365. doi:10.1038/gene.2015.13

Money D.The laboratory diagnosis of bacterial vaginosis.Can J Infect Dis Med Microbiol. 2005;16(2):77–79. doi:10.1155/2005/230319

Cook RL, Reid G, Pond DG, Schmitt CA, Sobel JD.Clue cells in bacterial vaginosis: immunofluorescent identification of the adherent gram-negative bacteria as gardnerella vaginalis.J Infect Dis. 1989;160(3):490-496.

Bradshaw CS, Sobel JD.Current treatment of bacterial vaginosis-limitations and need for innovation.J Infect Dis. 2016;214(Suppl 1):S14–S20. doi:10.1093/infdis/jiw159

Menard JP.Antibacterial treatment of bacterial vaginosis: current and emerging therapies.Int J Womens Health. 2011;3:295–305. doi:10.2147/IJWH.S23814

Homayouni A, Bastani P, Ziyadi S, et al.Effects of probiotics on the recurrence of bacterial vaginosis: a review.J Low Genit Tract Dis. 2014;18(1):79-86.

Muzny CA, Schwebke JR.Pathogenesis of bacterial vaginosis: discussion of current hypotheses.J Infect Dis. 2016;214(Suppl 1):S1–S5. doi:10.1093/infdis/jiw121

Allworth, J. and Peipert, J.Severity of Bacterial Vaginosis and the Risk of Sexually Transmitted Infection.Am J Obstet Gynecol.2011; 205(2):113.e1-113.e6. doi:10.1016/j.ajog.2011.02.060.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.CDC.Bacterial vaginosis (BV).Hainer, B. and Gibson, M.Vaginitis: Diagnosis and Treatment.Am Fam Physician.2011; 83(7):807-815.

Allworth, J. and Peipert, J.Severity of Bacterial Vaginosis and the Risk of Sexually Transmitted Infection.Am J Obstet Gynecol.2011; 205(2):113.e1-113.e6. doi:10.1016/j.ajog.2011.02.060.

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.

CDC.Bacterial vaginosis (BV).

Hainer, B. and Gibson, M.Vaginitis: Diagnosis and Treatment.Am Fam Physician.2011; 83(7):807-815.

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