Bacterial Vaginosis
Bacterial vaginosis (BV) is a shift in the normal vaginal bacterial community, often causing thin grey-white discharge and a fish-like odour.
Key points
- BV is not simply poor hygiene and is different from candidiasis, which more often causes marked itching and thick discharge.
- Diagnosis can use examination, vaginal pH, microscopy or validated tests rather than symptoms alone.
- Recurrence is common; repeated symptoms warrant confirmation rather than indefinite empirical antibiotic courses.
The listings below do not confirm BV; pregnancy, pelvic pain, STI risk and previous recurrence affect assessment and treatment.
Distinguishing other causes
Trichomoniasis, candidiasis, cervicitis and retained foreign material can produce discharge or odour. BV usually causes little soreness, so substantial pain, ulcers or fever suggest another or additional problem. STI testing may be appropriate based on exposure rather than BV itself being labelled an STI.
Treatment and recurrence
Metronidazole or clindamycin can be used in oral or vaginal regimens according to individual factors and guidance. Douching and fragranced intravaginal products can disrupt the bacterial environment. Persistent or frequent recurrence may require a clinician-directed suppressive approach after the diagnosis is reconfirmed.
When to seek urgent care
Seek urgent assessment for fever with pelvic pain, severe lower abdominal pain, fainting, heavy bleeding, pregnancy with significant pain or bleeding, or marked illness after a gynaecological procedure.