Bacterial vaginosis is a vaginal infection that occurs when there is an imbalance of naturally-occurring vaginal bacteria. This causes a change in vaginal pH, which promotes the growth of other, more harmful bacteria, like Gardnerella sp.

This infection is associated with symptoms like intense itching, pain with urination, foul odor, and a thick white, yellow or gray discharge.

Although it can cause discomfort, bacterial vaginosis treatment is relatively easy and is usually done with antibiotics. It is important to see your doctor for assessment and to initiate treatment promptly.

Main symptoms

The main symptoms of bacterial vaginosis include:

Intense
A white or gray discharge
Foul vaginal odor similar to rotten fish
Vaginal or vulvar irritation
Burning with urination

Many cases of bacterial vaginosis may not lead to any signs or symptoms. In these cases, BV is only identified after a routine vaginal swab.

In cases where symptoms are present, women are more likely to notice them after sex and before or after a period.

Confirming a diagnosis

BV is usually found during a routine pap test or vaginal swab, however, women who present with symptoms can have these tests ordered for diagnostic purposes.

The follow criteria should be met to confirm a bacterial vaginosis infection:

White, homogenough vaginal discharge in copious amounts
Vaginal discharge with a pH over 4.5
Foul vaginal odor
The presence of foreign bacteria and a microscopic change in epithelial cells of the vagina (also known as clue cells). These changes will especially be present with Gardnerella sp.

The doctor can also investigate for bacterial vaginosis through a urine test. Once confirmed, the doctor should start treatment promptly.

Common causes

Bacterial vaginosis occurs when there is an imbalance in naturally-occurring vaginal flora. This flora is mostly made up of lactobacillus bacteria. The main function of this bacteria is to maintain a slightly acidic vaginal pH to prevent illnesses.

Decreased levels of lactobacillus bacteria in the vagina can happen due to:

Frequent vaginal douching
Frequent sex
Multiple sexual partners
Having an STI
Having an IUD
Menstruation

These situations can promote the growth of more harmful bacteria, like Gardnerella sp., Prevotella sp., Mycoplasma sp. e Ureaplasma sp., leading to a BV infection.

Treatment options

Treatment for bacterial vaginosis is usually done with antibiotics, like metronidazole. Medication can be prescribed for topical application (as an ointment), for vaginal insertion, or as pills to take orally. Antibiotics are prescribed for 7 days, or as indicated by the doctor. You should complete the full course without interruptions to prevent recurrence.

Read more about bacterial vaginosis treatment with medication and home remedies.

When treating BV, you should use a condom during all sexual contact and avoid the use of antibiotics.

In addition, to prevent reinfection, you should avoid vaginal douching, use condoms during sex, avoid tight clothing, and use cotton underwear. Make sure you attend all routine screening as recommended by your doctor.

Possible complications

In most cases, bacterial vaginosis does not cause major complications. However, people with a weakened immune system are at higher risk for:

Uterine or fallopian tube infection, which can lead to pelvic inflammatory disease
AIDS infection if exposed to HIV
Contracting a sexually transmitted infection like chlamydia or gonorrhea.

In addition, if bacterial vaginosis is left untreated during pregnancy, there is a higher risk for spontaneous miscarriage, premature labor or low birth weight.