Bacterial Vaginosis (BV)

Many people with BV do not have symptoms. When symptoms occur, they may include:

• Thin vaginal discharge that can be gray, white, or green
• Foul-smelling, “fishy” vaginal odor
• Vaginal itching or irritation
• Burning during urination

BV develops when the vaginal flora is imbalanced. The vagina contains “good” bacteria called lactobacilli and “bad” bacteria called anaerobes. BV occurs when the anaerobes outnumber lactobacilli.

Risk factors for BV include:

• Having a new sexual partner or multiple partners (risk higher if both partners are female)
• Douching, which disrupts natural vaginal bacteria
• Naturally low levels of lactobacilli

BV vs. Yeast Infection

BV and yeast infections are different conditions:

• BV is caused by bacteria; yeast infections are fungal.
• BV causes gray, white, or green discharge with a strong “fishy” odor; yeast infection discharge is usually odorless and thick like cottage cheese.
• BV requires prescription antibiotics; yeast infections can often be treated with over-the-counter antifungals.

BV is not an STD because it can occur in people who have never had sex. However, it can be transmitted between sexual partners.

Duration and Recurrence of BV

• With antibiotics, BV usually resolves within one week.
• About 10%-15% of people may need a second round of antibiotics.
• BV can rarely resolve on its own, but untreated BV may increase the risk of STIs and pregnancy complications.

Recurring BV can be linked to:

• Sexual contact with a partner who has BV
• Copper IUDs
• Douching
• Use of scented products (pads, tampons, perfumes)

No, men cannot get BV, but they can spread it between partners.

How to Reduce Your Risk of BV

While BV cannot be completely prevented, you can lower your risk by:

• Avoiding douching
• Avoiding vaginal contact with anything that has touched the anus
• Limiting sexual partners
• Using latex condoms or dental dams
• Wearing cotton underwear to reduce moisture

• Mayo Clinic
• Cleveland Clinic
• National Library of Medicine

Prescription antibiotics are the only clinically proven treatment. Common options include:

• Metronidazole tablets (Flagyl®)
• Metronidazole 0.75% gel
• Clindamycin (Cleocin®)

Boric acid suppositories may be used in some cases of recurring BV, usually alongside antibiotics.

There are no effective over-the-counter or home remedies for BV. Telehealth providers can prescribe antibiotics online for home delivery.

No, treatment usually takes up to one week.

Symptoms often improve within a few days of starting antibiotics.

Treatment for chronic or recurring BV:

• 10%-15% of people may need a second course of antibiotics.
• About 50% may experience recurrence within a year.
• Extended antibiotic use may be recommended for 3–6 months for chronic cases.

Avoid sexual activity during treatment and until all symptoms have cleared.

Yes, prescription BV treatment is available online. Complete a quick online assessment, and a licensed U.S. provider can prescribe medication if appropriate.

• Cleveland Clinic
• Mayo Clinic
• National Library of Medicine