BV does not always have symptoms, so many women do not even know they have it. Sometimes the symptoms mimic a yeast infection. One important distinction between BV and a yeast infection is that yeast infections cause itching in the vaginal area while bacterial vaginosis does not. The symptoms of bacterial vaginosis are:

• White/grey, or yellowish discharge
• Foul, often fishy, odor
• Burning when urinating
• Itching on the outside of the vagina

Bacterial vaginosis, as the name suggests, is caused by the overgrowth of bacteria in the vagina. BV occurs when the normal Lactobacillus species of bacteria become outnumbered and replaced by anaerobic (absence of oxygen) bacteria. This causes the pH to change in the vagina due to reduced levels of natural organic acids from the byproducts of bacterial respiration. The exact cause of the overgrowth is not yet fully known. However, it is hypothesized that semen (from sexual intercourse) and the presence of blood during menses changes the pH of the vagina to benefit the growth of anaerobic bacteria.

• Antibiotics
• Smoking cigarettes
• Intrauterine devices
• Multiple sex partners
• Douching
• Use of scented feminine products

Your healthcare provider will ask about your past medical history, including if you’ve had previous vaginal infections or sexually transmitted infections. Next, he or she will give you a pelvic exam to check for signs of infection and if the infection has spread to other pelvic organs. Lab tests will be taken to check for overgrowth of anaerobic bacteria and the pH of your vagina.

Antibiotics (e.g., metronidazole; clindamycin; tinidazole). This is the most commonly used treatment for BV as it reduces the number of anaerobic bacteria.  Metronidazole and tinidazole are usually taken orally (metronidazole also comes in topical gel form). Oral antibiotics may cause stomach upset and nausea so alcohol should be avoided. Clindamycin is a cream that is inserted into the vagina. The cream may weaken latex condoms for at least three days after you stop using the cream.

Probiotics. Research has shown that adding lactobacillus along with antibiotics may increase the effectiveness of the antibiotics by helping to restore the natural balance of bacteria in the vagina. Women who took lactobacillus orally and intravaginally showed lower rates of recurring infection and improved symptoms.

Apple cider vinegar. When you do take a bath, try using 1 cup of apple cider vinegar into your bath water and soak for 15 minutes. This can help kill bacteria and balance vaginal pH.

Yogurt. Make yogurt a regular part of your diet. It contains healthy probiotics that help balance your body’s bacteria.

Garlic. Garlic is a powerful natural antibiotic. Try eating one clove daily.

Fenugreek tea. Take one teaspoon of fenugreek seeds and soak them in water overnight. The next day, drink the water first thing in the morning before eating. Fenugreek is thought to help with a lot of different reproductive concerns in women.

Bacterial vaginosis left untreated can increase health risks for:

• Contracting HIV from HIV positive sexual partners
• Passing HIV to your sexual partner if you are HIV positive
• Premature delivery or low birth weight of baby if pregnant with BV
• Contracting other STDs like chlamydia and gonorrhea

Certain things we do may contribute to changes in that vaginal flora that cause BV. Here are some lifestyle tips that can help prevent BV.

Do not douche. Cleaning your vagina kills off the good bacteria that you need to keep bacterial levels in check.

Avoid too many baths. Baths are great but taking them often can lead to BV. This is especially true with little girls taking too many bubble baths. Do not use anything in your bathwater.

Change out of your swimsuit after swimming. Keeping a wet swimsuit on can lead to bacterial growth.

Increase water intake. Water can help balance the pH levels and flush out any infection.

Clean before and after sex. This means you and your partner. Otherwise, you may force bacteria into the vagina during sex.

Wear cotton panties. Cotton underwear reduce moisture and increase air flow, helping to keep the area dry.

Wipe front to back. Especially after a bowel movement. Otherwise, you may inadvertently wipe bacteria from your anus into your vagina.

Amaya‐Guio J., Viveros‐Carreño D. A., Sierra‐Barrios E. M., Martinez‐Velasquez M. Y., Grillo‐Ardila C. F. (2016). Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database of Systematic Reviews, 10. Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006055.pub2/full

CDC. (2020, February 10). Bacterial vaginosis – CDC fact sheet. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm

CDC. (2015, July 4). 2015 Sexually transmitted diseases treatment guidelines – Bacterial vaginosis. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/std/bv/default.htm

Hainer, G. L., and Gibson, M. V. (2011, April 01). Vaginitis: Diagnosis and treatment. American Family Physician, 83(7). Retrieved from American Academy of Family Physicians: https://www.aafp.org/afp/2011/0401/afp20110401p807.pdf

Mayo Clinic. (2019, May 9). Bacterial vaginosis – Symptoms & causes. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/symptoms-causes/syc-20352279

Oduyebo, O. O., Anorlu, R. I., Ogunsola, F. T. (2009, July 08). The effects of antimicrobial therapy on bacterial vaginosis in non‐pregnant women. Cochrane Database of Systematic Reviews. Retrieved from Cochrane Library: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006055.pub2/full

Spiegel, C. A. (1991, October). Bacterial vaginosis. Clinical Microbiology Reviews. (pp. 485-502). Retrieved from American Society for Microbiology: https://cmr.asm.org/content/4/4/485.short