Bacterial Vaginosis – Diagnosis and Treatment
Bacterial vaginosis—usually called BV—is a common vaginal infection that shows up when the normal balance of bacteria in the vagina gets thrown off. You might notice unusual vaginal discharge, an odd odor, or maybe just some discomfort.
It’s not officially a sexually transmitted infection, but things like sexual activity and a few other factors can bump up your risk.
If you’ve had new or multiple sexual partners, douche regularly, or experience hormonal changes, your odds of getting BV go up.
Knowing about these factors can help you make better choices for your health. If you spot any warning signs, don’t hesitate to bring them up with your healthcare provider.
Diagnosis
Doctors usually take a few steps to figure out if you have bacterial vaginosis or another vaginal infection. First, they’ll ask about your medical history—past vaginal infections, STIs, or symptoms like discharge, itching, burning, or irritation.
Next comes a pelvic exam. They’ll look for any signs of inflammation, strange discharge, or that classic fishy smell. The doctor might gently press on your abdomen to check for tenderness or pain.
Lab tests play a big role too. The doctor collects a sample of vaginal discharge and checks it under a microscope. If they spot clue cells, that points to bacterial vaginosis.
They may also check your vaginal pH. If it’s over 4.5, that could mean an infection like BV or trichomoniasis.
Some infections—like vulvovaginal candidiasis, chlamydia, gonorrhea, or trichomonas vaginalis—need extra tests, such as nucleic acid amplification or a Gram stain.
Treatment
Doctors usually treat bacterial vaginosis (BV) with antibiotics. The specific medicine depends on your symptoms, medical history, and how your body reacts to certain drugs.
A nitroimidazole antibiotic is a common choice. You can take it as a pill or use it as a gel inside the vagina. If you’re on this, steer clear of alcohol during treatment and for a day after—it can make you feel pretty sick.
| Medication | Form | Key Advice |
|---|---|---|
| Nitroimidazole | Pill/Gel | No alcohol; complete full course |
| Lincosamide | Cream/Pill/Supp. | Pause sex; condoms less effective |
A lincosamide antibiotic is another option and comes as a vaginal cream, pill, or suppository.
The cream and suppositories can weaken latex condoms, so you’ll want to pause sex or use a backup birth control method during and just after treatment.
Doctors don’t treat male partners for BV. For female partners, testing and treatment might be suggested if they show symptoms. No matter what, finish your full course of medicine—even if you feel better halfway through.
Wellness Aids and Items
Along with medication, your provider might recommend some simple lifestyle tweaks to support healing and help lower the chance of BV coming back.
| Product Type | Example Use |
|---|---|
| Cotton underwear | Promotes airflow, comfort |
| Latex condoms | Reduces infection spread |
| Fragrance-free soap | Gentle cleaning without disrupting vaginal balance |
| Menstrual products | Opt for unscented pads or tampons to avoid irritation |
| Avoid douches/sprays | These can upset the vaginal flora and raise BV risk |
Sticking to breathable fabrics and skipping scented products can make a real difference in keeping your vaginal environment balanced. If you’re ever unsure what’s okay to use, your provider can help guide you toward safe, helpful choices.
BV That Comes Back After Treatment
BV can be stubborn and often returns within a year, even if you follow all the rules. If you keep getting it, your provider might suggest a longer or extended-use nitroimidazole treatment.
People sometimes try probiotics, like yogurt or supplements, but studies haven’t shown them to work any better than a placebo. So, most experts don’t recommend them for BV.
Antifungal medicines won’t help with BV since it’s not a yeast infection. But if you have a yeast infection at the same time, those might come into play.
If BV keeps coming back, it’s definitely worth talking to your provider about next steps.
Getting Ready for Your Visit
A little planning before your appointment can make things go smoother. Here’s what you can do:
- Pick the Right Day: Try to schedule your visit for a day you’re not on your period. This helps your provider get a clear look at any discharge or symptoms.
- Avoid Certain Products and Activities: For 24 hours before your appointment, skip tampons, vaginal sprays, and douches. Also, avoid sex. These steps help make test results more accurate.
- Write Down Symptoms: Jot down all your symptoms—even the ones you’re not sure are related. Note when they started and if they’ve changed.
- List All Medications and Supplements: Include everything you take: prescriptions, over-the-counter meds, vitamins, and herbal products. Mention how much and how often.
- Prepare Questions: Make a list of questions for your provider. Start with your top concerns, in case you run out of time.
- Bring a Notepad or Device: Take notes during your visit—anything important, instructions, or answers you want to remember.
Example Table: Personal Preparation Checklist
| Preparation Step | Notes/Details |
|---|---|
| Choose appointment day | Avoid days with menstruation |
| Products/activities to avoid | Tampons, sprays, douching, sex (24 hours) |
| List all symptoms | Include dates, changes, all unusual signs |
| List medicines/supplements | Name, dosage, frequency |
| Prepare main questions | Prevention, treatment, medicine, partners |
| Bring notepad/device | For taking notes during visit |
Sample Questions for Your Provider:
- How can I prevent bacterial vaginosis?
- What symptoms should I watch out for?
- Will I need medicine, and for how long?
- Should my partner get checked or treated?
- Any special instructions for my medicine?
- Can any over-the-counter products help?
- What if my symptoms come back later?
If you’re confused or something doesn’t make sense during your appointment, ask for more details. Don’t be shy.
Questions the Provider Might Ask
During your visit, your healthcare provider will probably ask some questions to get a better handle on your symptoms and the best way to treat you. If you’re ready for these, the appointment usually goes faster.
Possible Provider Questions:
- What symptoms have you noticed?
- When did these symptoms start?
- Is there any strong smell or unusual discharge?
- Have you had a vaginal infection in the past?
- Have you already used any over-the-counter products for your symptoms?
- Have you taken antibiotics recently for any reason?
- Are you having sex, and if so, are you using protection?
- Are you currently pregnant or planning to be?
- Do you use anything with added scents like soaps or bubble baths?
- Have you used feminine sprays or douches?
Tips for Answering:
- Be as honest and clear as you can.
- If you’re not sure about something, just say so.
- The more complete your answers, the better your provider can help.
Question-and-Answer Table:
| Question Example | Example Response |
|---|---|
| What symptoms are present? | Unusual discharge, itching |
| When did symptoms begin? | Two weeks ago |
| Have you used any treatments already? | Tried an OTC cream |
| Have antibiotics been used recently? | Yes, for a sinus infection |
| Are you sexually active? | Yes |
Bringing this info with you can speed up your visit and make sure nothing slips through the cracks. Your provider will use these details to figure out the best care plan.
