Bacterial vaginosis (BV) is the most common cause of an abnormal vaginal discharge in women of child bearing age.
BV is common - any woman can get it, including women in same sex relationships and women who have never had sex. It is estimated that one in ten women will get BV at some point in their life. It is common in pregnant women.
Women with BV have an imbalance amongst the normal bacteria that are found in the vagina.
It is not a sexually transmitted infection (STI).
It can be easily treated with antibiotics.
In a few women BV recurs and further treatment may be needed.
Having BV makes it easier for your body to be infected with a sexually transmitted infection, so routine tests for all STIs including chlamydia, gonorrhoea, trichomonas, syphilis and HIV are recommended.
Bacterial vaginosis (BV) is a common cause of unusual vaginal discharge. BV is not a sexually transmitted infection (STI), but it can increase your risk of getting an STI such as chlamydia.
Check if you have bacterial vaginosis
The most common symptom of bacterial vaginosis is unusual vaginal discharge that has a strong fishy smell, particularly after sex.
You may notice a change to the colour and consistency of your discharge, such as becoming greyish-white and thin and watery.
But 50% of women with bacterial vaginosis do not have any symptoms.
Bacterial vaginosis does not usually cause any soreness or itching.
If you're unsure it's BV, check for other causes of unusual vaginal discharge.
See a GP or go to a sexual health clinic if you think you have BV:
The condition is not usually serious, but you'll need to be treated with antibiotics if you do have BV.
It's also important to seek treatment if you're pregnant as there's a small chance that BV can cause complications with pregnancy. If you are pregnant and found to have BV that is bothering you, it is safe to take any of the recommended treatments even in the first trimester (1st twelve weeks). There is some evidence to suggest that BV may increase the risk of premature delivery in women who have had a previous miscarriage, premature or low birth weight baby. For these women treatment in early pregnancy (preferably before 20 weeks) is advised.
Sexual health clinics can help with bacterial vaginosis
Sexual health clinics treat problems with the genitals and urinary system.
Many sexual health clinics offer a walk-in service, where you do not need an appointment.
They'll often get test results quicker than GP practices.
Find a sexual health clinic here
What happens at your appointment
Your GP or sexual health clinic will want to confirm it's BV and rule out an STI.
A doctor or nurse will perform an internal examination to examine the vagina for signs of BV and take a sample of vaginal fluid to analyse in the laboratory. The pH (acid/alkali balance) of the vaginal fluid is measured or it may be examined under the microscope for bacteria associated with BV. The results are usually available during your first visit to the clinic. You'll be asked about your symptoms, and a doctor or nurse may look at your vagina.
A cotton bud may be wiped over the discharge inside your vagina to test for BV and other infections.
Treatment for bacterial vaginosis
Bacterial vaginosis is usually treated with antibiotic tablets or gels or creams.
These are prescribed by a GP or sexual health clinic.
If you have a same-sex partner, they may also need treatment.
Important information about your treatment
- Metronidazole tablets or vaginal gel: you should avoid alcohol whilst taking the treatment and for 48 hours afterwards. Alcohol interacts with metronidazole and may make you feel nauseated and sick.
- Intravaginal clindamycin cream: weakens latex condoms so they may break – best to avoid sex or use non–latex condoms.
The treatment does not interfere with your contraception (with the exception of clindamycin cream and condoms as already described).
If you are breast feeding it may be preferable to use a vaginal treatment such as metronidazole gel or clindamycin cream as treatments by mouth may effect the taste of breast milk.
Recurring bacterial vaginosis
It's common for BV to come back, usually within 3 months.
You'll need to take treatment for longer (up to 6 months) if you keep getting BV (you get it more than twice in 6 months).
A GP or sexual health clinic will recommend how long you need to treat it.
They can also help identify if something is triggering your BV, such as sex or your period.
Things you can do yourself
To help relieve symptoms and prevent bacterial vaginosis returning:
Do:
- use water and plain soap to wash your genital area
- have showers instead of baths
Don't:
- do not use perfumed soaps, bubble bath, shampoo or shower gel in the bath
- do not use vaginal deodorants, washes or douches
- do not put antiseptic liquids in the bath
- do not use strong detergents to wash your underwear
- do not smoke
What causes bacterial vaginosis
Bacterial vaginosis is caused by a change in the natural balance of bacteria in your vagina.
What causes this to happen is not fully known, but you're more likely to get it if:
- you're sexually active (but women who have not had sex can also get BV)
- you have had a change of partner
- you have an IUD (contraception device)
- you use perfumed products in or around your vagina
BV is not an STI, even though it can be triggered by sex.
A woman can pass it to another woman during sex.
You're more likely to get an STI if you have BV. This may be because BV makes your vagina less acidic and reduces your natural defences against infection.
Bacterial vaginosis in pregnancy
If you develop bacterial vaginosis in pregnancy, there's a small chance of complications, such as premature birth or miscarriage.
But BV causes no problems in the majority of pregnancies.
It is safe to take any of the recommended treatments even in the first trimester (1st twelve weeks). There is some evidence to suggest that BV may increase the risk of premature delivery in women who have had a previous miscarriage, premature or low birth weight baby. For these women treatment in early pregnancy (preferably before 20 weeks) is advised.
Speak to a GP or your midwife if you're pregnant and your vaginal discharge changes.