Many women assume that any vaginal discharge or odor means they have a yeast infection. In reality, one of the most common causes of vaginal symptoms is bacterial vaginosis (BV). Although BV is extremely common, many women have never heard of it until they experience it themselves.
Unlike a yeast infection, bacterial vaginosis is caused by an imbalance in the normal bacteria that live in the vagina. It is not a reflection of poor hygiene, and it is not something to feel embarrassed about. Fortunately, BV is usually straightforward to diagnose based on symptoms and medical history, and many women can be evaluated through telehealth and begin treatment the same day.
What Is Bacterial Vaginosis?
The vagina naturally contains a healthy balance of bacteria. The most important are Lactobacillus species, which help maintain an acidic environment that prevents harmful organisms from overgrowing. Bacterial vaginosis develops when this balance changes — beneficial bacteria decrease while other bacteria become more abundant. The result is an imbalance rather than a true infection caused by a single organism.
According to the Centers for Disease Control and Prevention (CDC), bacterial vaginosis is the most common cause of vaginal discharge among women of reproductive age.
Common Symptoms
Some women have no symptoms at all, while others experience noticeable changes. Typical symptoms include:
- Thin white or gray vaginal discharge
- Fishy vaginal odor
- Odor that becomes stronger after sexual intercourse
- Mild vaginal irritation
- Mild burning during urination
Unlike yeast infections, BV usually causes little or no itching. The fishy odor is often the symptom that prompts women to seek medical care.
What Causes BV?
The exact cause is not completely understood, but risk factors include a new sexual partner, multiple sexual partners, douching, smoking, lack of condom use, and a prior history of BV. Importantly, BV is not considered a sexually transmitted infection, although sexual activity appears to influence the vaginal bacterial environment. Women who have never been sexually active can still develop BV.
BV vs. Yeast Infection
| Bacterial Vaginosis | Yeast Infection |
|---|---|
| Thin gray or white discharge | Thick white discharge |
| Fishy odor | Usually no odor |
| Mild irritation | Intense itching |
| Caused by bacterial imbalance | Caused by yeast overgrowth |
| Treated with antibiotics | Treated with antifungals |
Using an over-the-counter yeast medication when you actually have BV usually does not solve the problem.
Why Should BV Be Treated?
Some mild cases improve without treatment, but untreated BV can increase the risk of susceptibility to sexually transmitted infections, pelvic inflammatory disease after certain gynecologic procedures, pregnancy complications such as preterm birth, and persistent symptoms affecting quality of life. Fortunately, treatment is highly effective for most women.
How Is BV Diagnosed?
A physician begins by reviewing your symptoms and medical history — the type of discharge, whether there is an odor, when symptoms began, whether you have had BV before, whether you are pregnant, recent antibiotic use, and whether you have pelvic pain or fever. Women with classic symptoms often can be evaluated without an office visit, though certain situations require an in-person examination or laboratory testing.
Treatment Options
Bacterial vaginosis is treated with prescription antibiotics. Metronidazole is available as oral tablets or vaginal gel. Clindamycin is available as vaginal cream or oral medication for selected patients. Treatment choice depends on pregnancy status, medication allergies, previous treatment history, current medications, and physician judgment. Most women begin noticing improvement within two to three days after starting therapy.
Can BV Come Back?
Yes. Recurrence is common — studies suggest that nearly one-third of women experience another episode within several months. Recurrent BV does not necessarily mean treatment failed; it reflects the complex bacterial environment of the vagina. Your physician may recommend additional strategies if infections continue to recur.
When Telehealth Is Appropriate
Telehealth is an excellent option for many women with suspected BV. During an online visit, your physician reviews current symptoms, medical history, pregnancy status, medication allergies, previous episodes, and risk factors. If your symptoms are consistent with uncomplicated BV, treatment may be prescribed electronically to your pharmacy. If your symptoms suggest another condition, your physician may recommend further evaluation.
Preventing Future Episodes
Although BV cannot always be prevented, healthy habits may reduce recurrence: avoid douching, practice safer sex, avoid unnecessary vaginal products, complete the full course of prescribed antibiotics, and follow up with your physician if symptoms return.
Frequently Asked Questions
Is bacterial vaginosis sexually transmitted?
No. BV is associated with sexual activity but is not classified as a sexually transmitted infection.
Can I use over-the-counter yeast medicine?
Yeast medications do not treat bacterial vaginosis. Accurate diagnosis is important before beginning treatment.
Will my partner need treatment?
Routine treatment of male partners is generally not recommended. Recommendations vary depending on individual circumstances.
Can BV affect pregnancy?
Yes. Pregnant women with symptoms should discuss evaluation and treatment with their healthcare provider because BV has been associated with certain pregnancy complications.
How YourMD Telehealth Can Help
Vaginal symptoms can be uncomfortable to discuss, but getting treatment should not be. With YourMD Telehealth, Nevada residents can receive a confidential evaluation from a board-certified physician without visiting an urgent care clinic. When appropriate after your medical evaluation, secure chat visits start at $20, phone visits are $40, and video visits are $50, with prescriptions sent electronically to your preferred pharmacy the same day. If your symptoms suggest that additional testing or an in-person examination is needed, we will help guide you toward the appropriate level of care.
References
- Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021: Bacterial Vaginosis.
- American College of Obstetricians and Gynecologists. Practice Bulletin: Vaginitis in Nonpregnant Patients.
- Workowski KA, Bachmann LH, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recommendations and Reports. 2021;70(4):1-187.
- Sobel JD. Bacterial vaginosis. Annual Review of Medicine. 2000;51:349-356.
- Koumans EH, et al. The prevalence of bacterial vaginosis in the United States. Clinical Infectious Diseases. 2007;44(6):857-864.
This article is for general educational purposes and is not a substitute for individualized medical advice. Prescriptions are provided only when a physician determines treatment is clinically appropriate. Services currently available to Nevada residents 18 and older.