What to look out for: symptoms of bacterial vaginosis (BV)

Key Points:

• Bacterial vaginosis (BV) may cause thin white or gray discharge and a produce strong fishy odor. It doesn’t always cause symptoms, and some people don’t know they have it.
• Sometimes the symptoms of bacterial vaginosis can be confused with other vaginal conditions, like yeast infections, urinary tract infections (UTIs) or sexually transmitted infections (STIs). It’s important to see a medical provider if you have new or concerning symptoms, including vaginal discharge, pain, bleeding, pain with urination or sores in the genital area.
• Bacterial vaginosis can be treated with a short course of antibiotics. There are no over-the-counter medications that can treat BV.

Bacterial vaginosis (BV) can be uncomfortable or unpleasant, but it’s very common. In fact, more than one in three people with vaginas will develop BV in their lifetime. The rate is even higher among Black women.

Bacterial vaginosis is caused by an imbalance of “good” and “bad” bacteria in the vagina. It’s not a sexually transmitted infection, and you don’t have to have sex to develop BV.

It’s important to treat BV--although rare, BV can lead to more serious problems, especially with fertility and pregnancy. Additionally, untreated bacterial vaginosis can also increase the risk of sexually transmitted infections (STIs).

What are the common symptoms of bacterial vaginosis?

Bacterial vaginosis may not cause any symptoms at all, or the symptoms may be so mild that some people don’t even notice them. It’s also possible for the symptoms to come and go.

If bacterial vaginosis does cause symptoms, the hallmark sign is a strong, fishy odor along with lots of white or gray discharge. The smell may be worse after sex. Discharge tends to have a thin consistency (unlike a yeast infection, which might be clumpy, like cottage cheese).

The most common symptoms of bacterial vaginosis are:

• A white, gray or greenish discharge that is thin in consistency
• A strong fishy odor, which may be worse after sex
• Itching in the vagina
• Burning with urination

Bacterial vaginosis can cause some mild discomfort or vaginal itching as well as burning when you urinate, but these aren’t the most common symptoms. If itching and vaginal discomfort are your primary symptoms, it might be something else.

Pain and burning when you urinate is usually a sign of a urinary tract infection (UTI). Itching or vaginal discomfort is also more common when you have a yeast infection.

The type of discharge is also a clue to the type of infection. Yeast infections usually cause a thick, clumpy discharge that may look like cottage cheese. UTIs do not cause any discharge. Chlamydia, another common vaginal infection, may cause very light, transparent discharge.

What does bacterial vaginosis look like?

The symptoms of BV can be very mild. Some people don’t even know they have it. If you suspect you have bacterial vaginosis, look for a milky, thin discharge that is white, gray or green, along with a strong odor.

Bacterial vaginosis does not cause bleeding, bumps or sores. If you have unusual vaginal bleeding, sores or blisters around the vagina or vulva, or any other symptoms that are new, it’s important to see a medical provider. These symptoms could indicate another type of infection or problem.

Bacterial vaginosis: when to worry

The good news is that bacterial vaginosis is usually mild and rarely causes long-term problems. Some cases of BV clear up on their own. The bad news is that BV can come back multiple times, and may require additional treatment.

It’s important to get treatment for BV, even if your symptoms are mild. Bacterial vaginosis can cause more serious problems if left untreated, like:

• Pelvic inflammatory disease
• Infertility
• Increased risk of sexually transmitted infections, including chlamydia, gonorrhea, human papillomavirus (HPV) and human immunodeficiency virus (HIV)
• Miscarriage and preterm delivery

You can reduce the chances of getting BV by making some changes to the products you use and by practicing safe sex.

If you are pregnant and think you might have BV, it’s especially important to seek treatment right away. Bacterial vaginosis can cause preterm labor, miscarriage and other problems with delivery for both the mother and fetus.

It’s also important to speak with a medical provider if you have new or unusual symptoms. Since the symptoms of bacterial vaginosis can be similar to other conditions, like UTIs and yeast infections, it’s a good idea to talk to a medical provider who can help you diagnose what’s going on.

Online treatment for bacterial vaginosis

Bacterial vaginosis is treated with a short course of antibiotics prescribed by a medical provider. There are no over-the-counter medications that work for bacterial vaginosis. If you have symptoms of BV, it’s important to seek treatment to keep the condition from getting worse or causing other issues.

Learn more at about treatment options with Dr. B.

Sources:

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Centers for Disease Control and Prevention. (2022, January 5). Bacterial Vaginosis - CDC Basic Fact Sheet. Centers for Disease Control and Prevention. Retrieved February 6, 2023.

Coudray, M. S., & Madhivanan, P. (2020). Bacterial vaginosis-A brief synopsis of the literature. European journal of Obstetrics, Gynecology, and Reproductive Biology, 245, 143–148. https://doi.org/10.1016/j.ejogrb.2019.12.035

Goje, O. (2021, April 31). Bacterial vaginosis (BV) - gynecology and obstetrics. Merck Manuals Professional Edition. Retrieved February 6, 2023.

Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, Markowitz LE. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007 Nov;34(11):864-9

Leitich, H., Bodner-Adler, B., Brunbauer, M., Kaider, A., Egarter, C., & Husslein, P. (2003). Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis00230-8/pdf). American Journal of Obstetrics and Gynecology, 189(1), 139–147. https://doi.org/10.1067/mob.2003.339

Parenthood, P. (n.d.). What is bacterial vaginosis?: Symptoms, signs and causes. Planned Parenthood. Retrieved February 6, 2023.

Ravel, J., Moreno, I., & Simón, C. (2021). Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease31193-5/fulltext). American Journal of Obstetrics and Gynecology, 224(3), 251–257. https://doi.org/10.1016/j.ajog.2020.10.019