Bacterial Vaginosis or BV

Bacterial Vaginosis or BV




What is Bacterial Vaginosis (BV)?

Bacterial vaginosis is a common vaginal condition. It results from an imbalance of good and bad bacteria in the vagina. Normally, the vagina contains a balance of various bacteria. Lactobacilli are the most common and help keep the vagina acidic. This prevents the overgrowth of bad bacteria. When this balance is disrupted, BV can develop.

Unlike some infections, BV isn't spread through sexual contact. However, it can increase the risk of getting sexually transmitted infections (STIs). What causes BV is not fully understood. It's different from yeast infections or trichomoniasis.

Organisms Involved

Several types of bacteria can be involved in BV, but it's not caused by one single type. Instead, a decrease in lactobacilli and an increase in other bacteria lead to symptoms. These bacteria may include:

  • Gardnerella vaginalis: Once thought to be the sole cause of BV, now known to be one of many bacteria involved.

  • Anaerobic bacteria: These bacteria thrive in an environment with no oxygen. They include Prevotella, Mycoplasma, and Mobiluncus.

  • Atopobium vaginae: Recently identified as a key bacterium in BV.

  • Mycoplasma hominis: While often present in the vagina without causing problems, it can contribute to the bacterial imbalance of BV.

What Does Not Cause BV

Understanding what does not cause BV is just as important. BV is not caused by poor hygiene. In fact, excessive washing or douching can disrupt the vaginal flora and increase the risk of developing BV.

What are the Symptoms?

BV symptoms include a fishy smell. Discharge may be white, grey, or thin. Some women feel burning during urination. However, many don't notice symptoms. It's important to recognize bacterial infection symptoms.

Distinguish BV from other types of vaginal discharge

Testing for BV

Testing for BV involves a simple exam. Doctors test vaginal discharge. The aim is to identify the bacteria causing the imbalance. This helps distinguish BV from conditions like vaginitis or STIs. You can do this test yourself at home or at a lab.

thrush-bacterial-vaginosis-swab Thrush / Bacterial Vaginosis Swab Test (London)

 thrush-bacterial-vaginosis-bv-test Home Thrush / Bacterial Vaginosis Swab Test Kit


BV treatment often includes antibiotics like metronidazole. For recurrent BV, longer treatment may be needed. Home remedies and lifestyle changes can help. 

Treatments for bacterial vaginosis (BV) help to restore the natural balance of bacteria in the vagina. The most common treatments include:

  1. Metronidazole: This is the most common antibiotic treatment for BV. It can be taken orally (by mouth) or applied topically (gel) inside the vagina. The oral form is typically a 400 mg tablet taken twice or thrice daily for 7 days. The gel is usually applied once at night for 5 days.
  2. Clindamycin: Available as a cream that is applied inside the vagina at bedtime for 7 days.
  3. Tinidazole: Uncommonly used but can be an alternative treatment. It is an oral antibiotic, taken as a 2 g dose once daily for 2 or 3 days, depending on the doctor's prescription.


How to Use BV Treatments

  • Follow the prescription: Complete the full course of treatment as prescribed by your doctor, even if symptoms improve before the medication is finished.
  • Avoid alcohol: When taking metronidazole or tinidazole, avoid alcohol during treatment and for at least one day after finishing the medication to prevent adverse reactions.
  • Use as directed: If using a topical treatment (gel or cream), follow application instructions carefully for the best results.

Additional Tips and Considerations

  • Recurrent BV: Some women experience recurrent BV and may require a longer course of treatment or a combination of medications.
  • Treatment during pregnancy: Pregnant women with symptoms of BV should be treated to reduce the risk of pregnancy-related complications. Your healthcare provider will select a safe treatment option for you which will usually be a gel rather than an oral antibiotic.
  • Sexual partners: While BV is not considered an STI, treating sexual partners is not usually necessary but can be considered in recurrent cases.


Preventing BV

Preventing BV involves maintaining a healthy balance of vaginal bacteria. This can include avoiding douching, using mild, unscented soaps, and practicing safe sex. Probiotics may help but consult a healthcare provider for personalised advice.


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