Bacterial Vaginosis (BV) – What You Need to Know

The Basics

Bacterial Vaginosis (BV) is the most common cause of abnormal vaginal discharge in women of childbearing age. It happens when there is an imbalance in the natural bacteria found in the vagina. While it’s not a sexually transmitted infection (STI), having BV can increase the risk of getting an STI. The good news is that BV is easy to treat with antibiotics.

Key Points About BV

  • Not an STI: BV is not sexually transmitted.

  • Common Condition: Around 1 in 10 women will experience BV at some point in their lives. It can affect women who have never had sex, as well as those in same-sex relationships.

  • Pregnancy: BV is also common during pregnancy and may require treatment to reduce risks.

How Do You Get BV?

The exact cause of BV isn’t fully understood, but it’s linked to an imbalance in vaginal bacteria. Normally, the vagina has more “good” bacteria (lactobacilli) and fewer “bad” bacteria (anaerobes). BV occurs when the bad bacteria grow out of control, making the vaginal environment more alkaline.

Things That Can Upset the Balance:

  • New or multiple sexual partners.

  • Tight non-breathable clothing around the groin area.

  • Douching or using vaginal washes and deodorants.

  • Soaps and bath bombs.

  • Bathing and not showering.

  • Smoking.

  • Oral sex (licking of the vulva).

Symptoms of BV

Not all women with BV have symptoms, but if you do, you might notice:

  • Abnormal discharge: Thin, white or pale grey, and often smelly (described as “fishy”).

  • Smell worsens: This can be more noticeable after sex.

BV does not usually cause itching, soreness, or irritation unless there is another condition, such as thrush, at the same time.

Getting Tested for BV

A doctor or nurse will:

  1. Perform an internal examination to check for signs of BV.

  2. Take a sample of vaginal fluid to test the pH (acid/alkaline balance) or look under a microscope for bacteria associated with BV.

Results are often available during your first visit.

Sometimes getting to a sexual health clinic or GP is not possible, so a home test can also be done. Click here for our recommended BV home test*

How Is BV Treated?

BV can be treated with antibiotics. Your doctor or nurse will discuss the best option for you:

  • Metronidazole tablets: Taken as a single dose or over 5 to 7 days.

  • Vaginal treatments: Metronidazole gel or clindamycin cream can be applied directly.

  • Other non-antibiotic treatments can also be used such as Canesbalance gel* or Balance Activ BV Gel* But if these are not successful we recommend you telephone your local sexual health service to book an appoitment.

Important Information About Treatment:

  • Avoid alcohol: If taking metronidazole, avoid alcohol during the treatment and for 48 hours afterwards to prevent nausea and sickness.

  • Clindamycin cream: Weakens latex condoms, so consider using non-latex condoms or avoiding sex during treatment.

  • Breastfeeding: Vaginal treatments (like gels or creams) are often better for breastfeeding women to avoid affecting the taste of breast milk.

What Happens If BV Is Untreated?

BV can sometimes clear up on its own. Treatment is recommended if:

  • It’s causing bothersome symptoms.

  • You’re having a surgical procedure involving the womb, such as an abortion.

  • You’re pregnant and at risk of complications.

BV During Pregnancy

BV in pregnancy can increase the risk of premature delivery or low birth weight. Treatment is safe and recommended, especially before 20 weeks for women with previous complications.

Does BV Recur?

Yes, BV can return. Recurrences usually respond well to treatment, but if BV keeps coming back, a full sexual health screen is advised to check for other infections.

Preventing BV

The best ways to prevent BV involve maintaining the natural balance of vaginal bacteria. Avoid:

  • Douching.

  • Using bubble baths, scented soaps, or antiseptics like Dettol.

  • Frequent washing or bathing.

Instead, use a gentle, unscented soap substitute like aqueous cream or an emollient for washing the genital area (available at pharmacies).

Watch a video on 16 tips to prevent BV here:

Final Thoughts

BV is a common and manageable condition. If you’re experiencing symptoms or have concerns, speak with a healthcare professional for testing and treatment. Understanding your body and making small changes to your habits can help maintain vaginal health.

In you are unable to see a doctor or GUM clinic, then click here for tests and treatments.