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Bacterial Vaginosis - Causes, Symptoms, Risk Factors, and Treatment

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Bacterial vaginosis occurs when the bacteria usually present in the vagina start overgrowing, disturbing the natural balance. Read the article to know more.

Medically reviewed by

Dr. Richa Agarwal

Published At November 21, 2022
Reviewed AtMarch 17, 2023

What Is Bacterial Vaginosis?

Bacterial vaginosis (BV) is a medical condition in which the bacterias that normally reside in the vagina start overgrowing in numbers, which upsets the natural bacterial balance leading to infection and inflammation of the vaginal tissues. It can occur in women of all ages, but a higher predominance is present in women of reproductive ages. It is a treatable condition, but women with bacterial vaginosis are more likely to develop sexually transmitted diseases (STD).

What Are the Causes of Bacterial Vaginosis?

A bacteria known as lactobacillus is found naturally in the vagina; its objective is to keep the vaginal environment acidic so that other bacteria can not thrive. But, when the number of these lactobacillus bacterias decreases, other infectious bacterias start growing in numbers, leading to bacterial vaginosis.

What Are the Risk Factors Predisposing Bacterial Vaginosis?

Risk factors that can lead to bacterial vaginosis in women are as follows-

  • Smoking.

  • Pregnant women.

  • Unprotected sex.

  • Multiple sex partners.

  • Women with female sex partners are at higher risk as the transmission of bacteria is more oral and anal sex.

  • Douche- Douching (washing the vagina using water or other intimate wash products) is not necessary as the vagina is a self-cleaning organ.

  • Lack of lactobacilli bacteria naturally.

  • Intrauterine birth control devices and excessive bleeding can also lead to bacterial vaginosis.

  • Use of unhygienic undergarments.

  • Use of scented soaps or bubble baths.

However, a woman can not acquire bacterial vaginosis from swimming pools, toilet seats, or beddings.

What Are the Symptoms of Bacterial Vaginosis?

It is the most common infectious condition found in females, but about 75 % to 80 % of women have no symptoms.

The common signs and symptoms some women might develop are as follows-

  • Itching and burning sensation in the vagina during urination.

  • Thin, white, gray, or green vaginal discharge.

  • A strong unpleasant “fishy” smell from the vagina. This smell gets stronger after sex.

What Is the Difference Between a Bacterial Vaginosis and Yeast Infections in Vagina?

Both the conditions are vaginal infections and have increased discharge from the vagina. But the following points differ them from each other-

  • Bacterial vaginosis is a bacterial infection, while yeast infection in the vagina is due to the overgrowth of a fungus called candida.

  • Vaginal discharge in bacterial vaginosis is thin and with a fishy smell, whereas vaginal discharge in yeast infection is thick and non-smelly.

  • Yeast infections cause severe itching and burning sensation in the vagina.

  • Yeast infections can be self-treated using over-the-counter medication, but bacterial vaginosis needs medical attention from a doctor.

How Is Bacterial Vaginosis Diagnosed?

After a detailed medical history, overall physical examination is done to look for the following-

  • A sample of vaginal discharge is taken and sent to the lab to check for the presence of bacteria.

  • A pelvic examination is done.

  • Vaginal pH is checked to measure the level of acidity.

What Is the Treatment of Bacterial Vaginosis?

  • In many women, bacterial vaginosis resolves on its own.

  • There are no over-the-counter medications or home remedies for the treatment of bacterial vaginosis, but consuming daily probiotics can help in restoring natural bacteria in the body.

  • The treatment of bacterial vaginosis is mostly empirical.

  • Antibiotic medication- Doctor can prescribe the following antibiotics-

    • Metronidazole - Prescribed as oral tablets, single-dose tablets, or gel (to be applied in the vagina).

    • Clindamycin- Usually used as Clindamycin creams to be applied inside the vagina. The doctor may also prescribe oral doses.

    • Tinidazole - Oral doses.

    • Clindamycin and Tinidazole are usually used in cases where Metronidazole is ineffective.

    • Alcohol consumption is contraindicated during antibiotic therapy as it can lead to gastrointestinal upset, nausea, or vomiting.

  • Recurrence of bacterial vaginosis is very common; in such cases extended course of Metronidazole is given.

  • Intrauterine contraceptive devices can cause bacterial vaginosis, so alternate contraception techniques should be used.

  • Infected women’s female sexual partners must also visit the doctor.

What Are the Complications Associated with Bacterial Vaginosis?

If treatment of bacterial vaginosis is not done, it may cause the following conditions-

  • Preterm birth and low birth weight baby.

  • Sexually Transmitted Diseases (STD)- Bacterial vaginosis increases the chances of developing sexually transmitted infections like- Human immunodeficiency virus (HIV), herpes simplex virus (HSV), chlamydia, or gonorrhea.

  • Pelvic Inflammatory Disease (PID)- an infection of the uterus and the fallopian tubes. It can lead to infertility in women.

  • There is a high risk of getting a post-surgical infection after procedures like hysterectomy or dilation and curettage (D&C).

  • There is a very low success rate for fertility treatments like IVF (in vitro fertilization).

How to Prevent Bacterial Vaginosis?

The following measures can help in preventing and reducing the risk of bacterial vaginosis-

  • Avoid douching (rinsing the vagina) as it disrupts the natural bacterial flora of the vagina.

  • Avoid using toilet paper that touches the vagina after the anus. Always use it front to back.

  • Clean and sanitize sex toys before use.

  • Limiting the number of sex partners.

  • Protected Sex- Latex condoms must be used.

  • Wearing cotton or cotton-lined underwear to prevent any moisture in intimate areas.

  • Use water or mild soap to wash genitals.

  • Test to check for sexually transmitted diseases.

  • Avoid using scented soaps or vaginal deodorants.


Bacterial vaginosis is a mild infection caused due to an imbalance between the good and the harmful bacteria. Although the exact causes may not be known but limiting the number of sex partners, maintaining good intimate hygiene, and contacting healthcare providers on the appearance of symptoms are helpful. The prognosis or the outcome of this condition is good, but there are high chances of recurrence. The untreated cases of bacterial vaginosis make the women prone to complications like sexually transmitted diseases, preterm birth in pregnancy, or infertility. Antibiotic treatment is a very simple yet effective way to cure bacterial vaginosis. Sometimes the symptoms presented by bacterial vaginosis may mimic those of other medical conditions; thus, a doctor must be consulted before starting any medication or remedies.

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Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology


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