Bacterial Vaginosis: Symptoms, Treatment, and When to Seek Medical Care
Bacterial vaginosis, often called BV, is a common vaginal condition that happens when the normal balance of bacteria in the vagina changes. BV is not the same as a yeast infection, and it is not treated the same way.
BV can cause discharge, odor, itching, burning, or irritation, but some people have no symptoms at all. BV symptoms may include thin white or gray discharge, vaginal pain, itching or burning, a strong fish-like odor especially after sex, burning with urination, and itching around the outside of the vagina.
What causes bacterial vaginosis?
BV happens when there is an imbalance in vaginal bacteria. The vagina normally contains helpful bacteria, especially lactobacilli, that help maintain a healthy environment. With BV, there may be fewer protective bacteria and more of certain other bacteria.
BV is not caused by being “dirty.” It is a common vaginal microbiome imbalance.
Possible contributors may include:
New or multiple sexual partners
Douching
Scented vaginal products
Smoking
Recent antibiotic use
Hormonal changes
Having BV before
Changes in vaginal pH
Common symptoms
BV may cause:
Thin white, gray, or off-white vaginal discharge
Fish-like vaginal odor
Odor that is more noticeable after sex
Vaginal irritation
Itching or burning
Burning with urination
Mild pelvic discomfort
Some people with BV have no symptoms and only find out during an exam or testing.
BV vs. yeast infection
BV and yeast infections can have overlapping symptoms, but they are different conditions.
BV commonly causes:
Thin gray or white discharge
Fish-like odor
Mild itching or irritation
Higher vaginal pH
Yeast infection commonly causes:
Thick white “cottage cheese-like” discharge
Intense itching
Redness or swelling
Burning or soreness
Usually no fish-like odor
Because symptoms can overlap with yeast infections and sexually transmitted infections, testing may be needed.
Is BV an STI?
BV is not usually classified as a traditional sexually transmitted infection, but it can be associated with sexual activity and may occur more often with new or multiple partners. Symptoms of BV can also look similar to some STIs, so testing may be important if there is a new partner, exposure concern, pelvic pain, or unusual symptoms.
Schedule an appointment for medical evaluation if vaginal discharge smells unusual with discomfort, if discharge seems different than prior infections, if there is a new or different sex partner, or if symptoms continue after trying yeast treatment.
How is BV diagnosed?
BV may be diagnosed based on symptoms, exam findings, vaginal pH, microscopy, or lab testing. Mayo Clinic notes that a vaginal pH of 4.5 or higher can be a sign of BV, and testing may also look for clue cells, which are vaginal cells covered in bacteria.
Telehealth may help review symptoms and decide next steps, but in-person testing may be needed if the diagnosis is unclear or symptoms are recurrent, severe, or mixed.
BV during pregnancy
If you are pregnant and have BV symptoms, contact a healthcare professional. The CDC recommends treatment for all symptomatic pregnant women because symptomatic BV has been associated with adverse pregnancy outcomes, including premature rupture of membranes, preterm birth, intra-amniotic infection, and postpartum endometritis.
When to seek medical care
Schedule a medical evaluation if you have:
New vaginal discharge
Fish-like odor
Vaginal itching, burning, or irritation
Burning with urination
Symptoms after a new sexual partner
Symptoms after possible STI exposure
Symptoms that seem different from prior infections
Recurrent BV
Symptoms that do not improve after treatment
Pregnancy or possible pregnancy
Pelvic pain
Bleeding not related to your usual period
When to seek urgent or emergency care
Seek urgent or emergency care for:
Severe pelvic or abdominal pain
Fever with pelvic pain
Fainting or severe weakness
Heavy vaginal bleeding
Pregnancy with pain, bleeding, or fever
Severe allergic reaction symptoms
Trouble breathing
Severe dehydration
Confusion
Rapidly worsening symptoms
Can telehealth help?
Yes. Telehealth can often help with mild vaginal symptoms by reviewing your history, symptoms, risk factors, prior infections, medication allergies, pregnancy status, and whether testing or treatment may be appropriate.
In-person evaluation or lab testing may be needed if symptoms are severe, recurrent, unclear, associated with pelvic pain or fever, pregnancy, STI exposure, or if treatment does not work.
Prevention tips
To reduce BV recurrence risk:
Avoid douching
Avoid scented vaginal products
Use condoms if appropriate
Limit irritants
Follow treatment instructions fully
Seek care for recurrent symptoms
Consider STI testing when risk is present
Avoid repeated self-treatment without confirmation
Final thought
Bacterial vaginosis is common and treatable. It is not a hygiene failure. Because BV can look like yeast infection or an STI, proper evaluation is important, especially with new symptoms, pregnancy, pelvic pain, recurrent symptoms, or symptoms that do not improve.
This information is for educational purposes only and does not replace medical advice, diagnosis, or treatment. If you are experiencing severe symptoms, signs of infection, severe allergic reaction symptoms, trouble breathing, or a medical emergency, call 911 or go to the nearest emergency room.
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