What is bacterial vaginosis?
Bacterial vaginosis (BV) is an imbalance of the normal vaginal bacteria — Lactobacillus species drop and anaerobes overgrow. It's the most common vaginal condition in women aged 15–44.
The hallmark is a thin grey-white discharge with a fishy odor, especially after sex. Itching is usually milder than yeast. Easy to treat but recurrence is common.
Do I have bacterial vaginosis? Common signs
If most of these describe what you're experiencing, telehealth may be a good next step:
What causes it
Disrupted vaginal flora — Lactobacillus loss with overgrowth of Gardnerella and other anaerobes. Triggers: new or multiple sex partners, douching, smoking, intrauterine devices. Not strictly an STI but linked to sexual activity.
Is it contagious?
Not classically considered an STI. Female partners of women with BV are at higher risk.
If the discharge has a strong fishy smell — especially after sex — it's almost certainly BV, not yeast.
Can it be treated online?
Routine BV in non-pregnant women is well-suited to telehealth. Recurrent BV (3+ in a year), pregnancy, or atypical presentations benefit from in-person exam.
How bacterial vaginosis is treated
Oral metronidazole 500mg twice daily for 7 days or vaginal metronidazole gel 5 days, or vaginal clindamycin cream 7 days. Single-dose secnidazole 2g oral is convenient alternative. Avoid alcohol with metronidazole — causes severe nausea.
Self-care while you wait
- Don't douche
- Avoid scented soaps and vaginal products
- Cotton breathable underwear
- Probiotics with Lactobacillus may help prevent recurrence
- Condoms can reduce recurrence
- Don't use spermicide if it triggers BV
- Treat consistent female partners if applicable
How long does it last?
Treated cases usually clear in days. Recurrence happens in about 30% within 3 months.
Frequently asked questions
How is BV different from yeast?
BV: thin grey discharge, fishy odor, mild itch. Yeast: thick white cottage-cheese, intense itch, no odor.
Can my partner cause it?
Sexual activity can disrupt flora, but BV isn't strictly an STI. Male partners aren't routinely treated; consistent female partners may benefit.
Why does it keep coming back?
Hard to fully restore healthy flora. Probiotics, condoms, and avoiding triggers (douching, scented products) help.
Can I treat it OTC?
No effective OTC treatment for BV — needs prescription.
Is BV dangerous?
Usually not. Untreated BV in pregnancy raises miscarriage and preterm birth risk; can also raise STI risk.
