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

Key Points:

• Bacterial vaginosis may cause thin white or gray discharge and a strong fishy odor. It doesn’t always cause symptoms. So some people don’t know they have it.
• Bacterial vaginosis symptoms can be confused with other vaginal conditions. See a medical provider if you have new or concerning symptoms. These include 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 definitely not uncommon. 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.

BV can cause bothersome symptoms. Even if symptoms are mild, it’s important to treat BV. While rare, BV can lead to more serious problems—especially those related to fertility and pregnancy. And untreated bacterial vaginosis can increase the risk of sexually transmitted infections (STIs).

Here’s what to look out for when it comes to signs and symptoms of BV. Plus, how you can access bacterial vaginosis treatment online through Dr. B’s virtual health services.

What are the common symptoms of bacterial vaginosis?

Bacterial vaginosis doesn’t always cause symptoms. Symptoms can be so mild that some people don’t notice them. It’s also possible for symptoms to come and go.

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

The most common symptoms of bacterial vaginosis are:

• A watery discharge, thin white discharge or vaginal discharge that looks gray or greenish
• A strong vaginal smell including a fishy vaginal odor, which may be worse after sex
• Vaginal irritation or itching, including itchy vaginal lips and an itchy vulva
• Burning with urination

Bacterial vaginosis can cause some mild discomfort, vaginal itching or burning when you pee. 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 pee is usually a sign of a urinary tract infection (UTI). So BV can feel like a UTI.
• Itching or vaginal discomfort is also more common with a yeast infection. (And you can have BV and a yeast infection at the same time.)
• 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 a very light, transparent discharge.

What does bacterial vaginosis look like?

The symptoms of BV can be so mild that some people don’t even know they have it. Look for a milky, thin discharge that is white, gray, green or yellowish. As well as strong, sometimes fishy vagina smells.

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 new symptoms—see a medical provider. These symptoms could suggest another type of infection or problem.

Bacterial vaginosis—when to worry

Bacterial vaginosis is usually mild and it rarely causes long-term problems. Some cases of BV even clear up on their own. But the bad news is that BV can come back multiple times. So you may need to treat bacterial vaginosis more than once before it’s gone for good.

Getting a BV prescription is important—even if your symptoms are mild. Bacterial vaginosis can cause serious problems if left untreated. These include:

• 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

Speak with a medical provider if you have new or unusual symptoms. The symptoms of bacterial vaginosis can be similar to other conditions—like UTIs and yeast infections. A medical provider can help you understand which you have and the best treatment options.

Online treatment for bacterial vaginosis

Antibiotic treatment can help clear uncomfortable BV symptoms. There are no over-the-counter medications for BV. And while some lifestyle changes help prevent BV, no proven home remedies exist. So you can’t cure BV at home without a medical provider and a bacterial vaginosis prescription.

Dr. B can help!

You can start to treat BV online through our virtual health platform. You’ll first fill out a health assessment. A medical provider will take you through available BV pills and other BV medicines online. If appropriate, they’ll call a prescription into your pharmacy of choice.

Sources

Abou Chacra, L., et al. (2022). Bacterial vaginosis: what do we currently know? Frontiers in Cellular and Infection Microbiology.

Centers for Disease Control and Prevention. (2022). Bacterial vaginosis - CDC basic fact sheet.

Coudray, M. S., et al. (2020). Bacterial vaginosis-A brief synopsis of the literature. European Journal of Obstetrics, Gynecology, and Reproductive Biology.

Goje, O. (2021). Bacterial vaginosis (BV) - gynecology and obstetrics. Merck Manuals Professional Edition.

Koumans, E.H., et al. (2007). The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sexually Transmitted Diseases.

Leitich, H., et al. (2003). Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. American Journal of Obstetrics and Gynecology.

Planned Parenthood. What is bacterial vaginosis? Symptoms, signs and causes.

Ravel, J., et al. (2021). Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. American Journal of Obstetrics and Gynecology.