Bacterial vaginosis is a very common but uncomfortable condition. The Centers for Disease Control and Prevention (CDC) estimates that nearly 30% of women will experience bacterial vaginosis–also known as BV–at some point in their lives. BV is “the most the most common vaginal condition in women ages 15-44”, according to the CDC. These infections are painful, uncomfortable and dangerous. But what is BV? And what causes it?

In this article, we walk you through everything you need to know about bacterial vaginosis including causes, risk factors, treatment and more. If you’re looking for more information, book a virtual vaginal infection visit on Sesame to talk directly to a licensed health care provider.

What causes BV?

Bacterial vaginosis is caused by a change in bacterial composition in the vagina. The vagina contains naturally occurring bacteria that help protect the area and keep it healthy. These organisms are known as “good bacteria” or “vaginal flora”. BV occurs when harmful vaginal bacteria start to overtake the “good bacteria” and the pH – or acid/base balance – changes. When this vaginal balance is thrown off, due to an overgrowth and/or change in the species of bacteria growing within it, it can result in bothersome symptoms.

There is no singular cause of BV.

• Sex: It is rare for women to develop bacterial vaginosis if they are not sexually active. Women with multiple sexual partners, women who have unprotected sex, and women who have sex with women are at greater risk of getting BV.
  

• Douching: Douching kills off healthy bacteria (lactobacilli) in the vagina, increasing the risk of BV-causing bacteria (anaerobes) overgrowing and causing an infection.
  

Doctors still do not fully understand the link between sexual activity and the increased risk for BV. However, BV does appear to occur more often in women with multiple sexual partners than in those who do not have regular sex or only have one sex partner.

You cannot get bacterial vaginosis from swimming pools, toilet seats or bedding.

What are the symptoms of BV?

BV symptoms range in severity. Some women may experience considerable discomfort while others experience little to no symptoms at all.

• Abnormal vaginal discharge (usually a thin, white or grey liquid)
  
• A foul-smelling, fishy odor
  
• Vaginal itching
  
• Pain during urination
  
• Vaginal pain or burning
  
  

Again, many people experience mild symptoms if they experience them at all. If you begin to notice any of the signs above, contact a health care provider right away to start treatment.

When should I see a doctor about BV?

Bacterial vaginosis symptoms are similar to those caused by other infections (like a UTI or bladder infection). BV may go away on its own, but if left untreated, this condition can recur and lead to serious medical complications. Because of this, it is important to seek medical advice right away if you begin to notice the signs of BV.

• You have abnormal vaginal discharge. This viscous fluid may be grey or white.
  
• You have abnormal vaginal discharge coupled with a fever.
  
• You have recently had more than one sexual partner.
  
• You have tried to treat a yeast infection with over-the-counter medication, but your symptoms persist.
  
  

Because BV symptoms may be similar to other types of genital infections (including sexually transmitted infections), you should seek medical attention as soon as you begin to notice symptoms. The earlier these infections are treated, the better. Early treatment can prevent serious–even life-threatening–complications caused by a bacterial infection.

What complications can BV cause?

BV is usually easily treatable with prescription medication. While BV may go away with time, it can cause serious complications if left untreated.

• Sexually-transmitted infections: BV can increase one’s risk for sexually-transmitted infections (also known as sexually-transmitted diseases or STDs) such as chlamydia, gonorrhea, or human immunodeficiency virus (HIV).
  

• Preterm birth: In pregnant women, BV has been shown to correlate with premature births and low birth weight babies.
  

• Pelvic inflammatory disease (PID): Recurrent bacterial vaginosis may lead to the development of PID, an infection of the reproductive tract that can cause infertility.
  
  

How is BV diagnosed?

To diagnose BV, your health care provider may perform several procedures. These diagnostic processes include:

• Questions about your medical history: Your provider will ask you about your medical history to determine your risk factors for BV. This will probably include questions about previous vaginal infections you’ve had, your sexual history and any history you’ve had with sexually transmitted infections (STIs).
  

• Pelvic examination: When performing a pelvic exam, your health care provider will visually examine the vagina for signs of infection (like white or grey discharge). In addition, they might insert two fingers into the vagina while pressing on the abdomen if they are concerned that an infection is affecting your pelvic organs.
  

• Sample vaginal fluid: Your health care provider may take a sample of vaginal fluids to visually examine under a microscope or test for pH balance. Vaginal fluid with higher pH levels is a strong indicator of a bacterial infection. If examining the fluid under a microscope, your provider will look for the presence of bacteria cells covering normal vaginal cells. This indicates the presence of an infection.
  

If your health care provider needs to test a sample of vaginal fluid, you will likely hear about your results within a day or two.

How is BV treated?

Bacterial vaginosis is most commonly treated with a course of antibiotic treatment.

• Metronidazole: Available as an oral tablet or medicated vaginal gel. Metronidazole may cause nausea or an upset stomach. Avoid alcohol use while taking this medication.
  

• Clindamycin: Clindamycin is an antibiotic medication commonly prescribed as an oral medication that can be supplied as a vaginal cream or vaginal suppository–small medications that are inserted into the vagina via an applicator – for the treatment of BV. Clindamycin cream may cause vaginal itching or abnormal discharge. Oral clindamycin may cause stomach pain or nausea.
  

• Tinidazole: Tinidazole is available as an oral tablet. Like metronidazole, it can cause abdominal pain and an upset stomach. Talk to your doctor if you experience any adverse effects while taking this medication.
  

• Secnidazole: Secnidazole is available as a fine powder that is meant to be taken with food. Simply sprinkle the powder over soft food such as applesauce or yogurt, and be careful not to bite down on the powdered crystals. Secnidazole is usually taken as a single dose.
  
  

How do I prevent BV?

You can decrease your risk of developing bacterial vaginosis with a few self-care practices. These include:

• Use latex condoms. Unprotected sexual activity has been linked to BV, so use latex condoms during sex to minimize your risk of contracting an infection.
  

• Limit sexual partners. BV has been linked to sex with new partners, or sex with multiple partners. Limiting sex partners may help minimize your risk of contracting BV or STIs.
  

• Don’t douche. Douching eliminates good bacteria from the vagina, which can lead to an overgrowth of harmful bacteria. Avoid douching and using cleansing products (such as harsh soaps or deodorants) on the vagina.
  

• Avoid irritation. Wear breathable - preferably cotton - underwear to wick moisture from the genital area and prevent irritation. Avoid scented cleaning products and tampons.
  

To prevent serious complications or recurring infections, seek medical attention from a health care provider as soon as you notice signs and symptoms of BV (like those listed above). In addition, if you have multiple sexual partners you should undergo regular STI testing and sexual health check-ups as a preventative measure against dangerous infections.

How do I get a prescription for BV?

If you’re looking to get a prescription for BV treatment without the hassle of going to a doctor’s office, book a convenient and affordable bacterial vaginosis prescription visit on Sesame today.

These convenient and affordable appointments allow you to discuss your condition with a highly-experienced health care provider from the comfort of your home. Providers can prescribe BV medication during these video visits, if appropriate. Depending on the medication, you can have your prescription delivered to your home or ready for same-day pickup at a pharmacy of your choice. Book a visit today to get started on treatment right away.

• Bacterial Vaginosis. NIH. (2021). https://www.nichd.nih.gov/health/topics/bacterialvaginosis.
  
• Bacterial vaginosis-A brief synopsis of the literature. Coudray, M. S., & Madhivanan, P. (2020). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989391/.
  
• Which treatments are effective for bacterial vaginosis? Cologne, Germany: Institute for Quality and Efficiency in Health Care. (2009). https://www.ncbi.nlm.nih.gov/books/NBK298830.