Bacterial vaginosis (BV) is an infection that develops due to an imbalance in the natural bacteria in the vagina. It occurs when “bad” bacteria, which do not need oxygen to survive, outnumber “good” bacteria, known as lactobacilli.

BV is the most common condition affecting the vagina in people aged 15–44 years. BV is not a sexually transmitted infection (STI), and a person does not have to be sexually active to develop BV.

The symptoms of BV include:

  • a thin vaginal discharge that is white or gray
  • a bad-smelling discharge, which may become worse before a period or after having sex
  • pain when having sex
  • itchy or discolored genitals
  • a burning sensation when urinating

In this article, we examine the home remedies and medical treatments for BV. We also explain when a person should see a doctor.

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BV can sometimes clear up by itself, but treatment is often necessary. In either case, BV can reoccur.

Factors that can make a person more likely to develop BV include:

  • having sex with more than one person
  • using vaginal douches or other hygiene products on the vagina, such as scented soaps or washes
  • using an intrauterine device (IUD)
  • having sexual intercourse without using barrier protection, such as a condom
  • smoking

People can make changes to their everyday habits to reduce the chance of BV developing or recurring.

These include wearing breathable cotton underwear, which may help prevent the growth of bacteria around the genitals by preventing moisture from building up in the area. This moisture enables bacteria to grow.

Practicing good hygiene can also help keep the natural bacteria in the vagina in balance. However, it is important not to use vaginal douches or strong scented soaps or washes on the vagina.

Using barrier protection, such as condoms, during sexual activity may prevent BV, especially if a person has more than one sexual partner. BV is not technically an STI, but it does have a link with sexual activity.

It can also increase the likelihood of getting an STI, such as chlamydia. Using barrier protection is important in preventing the spread of STIs.

Some people may find that BV recurs frequently even when they take steps to reduce their risk factors. In these cases, people may need to accept that the recurrences could be out of their control.

It is not usually possible to treat BV with over-the-counter (OTC) medication. The Centers for Disease Control and Prevention (CDC) recommend antibiotics to treat BV.

The types of antibiotics include:

  • Oral metronidazole: 500 milligrams twice a day for 7 days.
  • Metronidazole 0.75% gel: One full 5-gram (g) applicator intravaginally once a day for 5 days. Doctors recommend not drinking alcohol while taking metronidazole.
  • Clindamycin 2% cream: One full 5-g applicator intravaginally at bedtime for 7 days.

During treatment, people should avoid having sex or ensure that they are using barrier methods. BV is particularly common among women who have sex with women. These individuals may wish to consider using gloves during digital-genital stimulation and condoms with sex toys.

If the symptoms reoccur, a person should make their doctor aware. The doctor can adjust the individual’s treatment plan accordingly.

A person should see a doctor if BV does not clear up after treatment or continues to come back. A doctor or gynecologist will check that BV is the cause of the symptoms and not another condition.

If a person develops BV during pregnancy, they should see a doctor for appropriate treatment. BV may cause premature labor.

Without treatment, BV can increase a person’s risk of contracting HIV.

A doctor will begin the diagnostic process for BV by asking the individual questions about their symptoms and lifestyle. They may also ask about:

  • previous treatments
  • sexual activity
  • risk of STIs
  • vaginal douching or soap use
  • use of deodorants or vaginal washes

A doctor may take a swab sample from the vagina to send for testing. They will need to do this at a time when the person is not menstruating. A chaperone can accompany a person during this examination, and the person must give consent to the doctor.

A healthcare professional can test the vaginal fluid to check its pH level. According to the National Institute for Health and Care Excellence, a pH level of 3.5–4.5 is normal for people of reproductive age.

If the pH level is higher than 4.5, BV may be the cause. However, other conditions can also raise the pH level of vaginal discharge.

BV is a common infection in the vagina that affects people of all ages. BV is not an STI, but people with multiple sexual partners may have a higher risk of developing it.

A person needs to restore the balance of natural bacteria in the vagina to treat BV.

Several treatments are available to help ease symptoms and get rid of BV. Anyone who suspects that they have BV should speak with a doctor for a diagnosis and treatment.