Written by Dr. Simon Khela MBChB MRCGP, GMC Registered Doctor
An unusual discharge. A smell that was not there last week. A nagging feeling that something is off, even though nothing hurts. These can be signs of bacterial vaginosis (BV), a common change in the balance of bacteria in the vagina.
BV is not a sign of poor hygiene and is not classed as a sexually transmitted infection (STI). It can, however, be associated with sex, and its symptoms overlap with those of other conditions. Here is what to look for, how a clinician checks the cause and which treatments are likely to help.
Bacterial vaginosis is an imbalance of the usual vaginal bacteria. Its main signs are thin, greyish-white discharge and a noticeable fishy smell, especially after sex. About half of people with BV have no symptoms. A clinician may recommend antibiotic tablets, vaginal gel, or cream if treatment is needed. If you are pregnant and notice a change in discharge, speak with your midwife or GP.
The vagina normally contains a mix of bacteria, including Lactobacillus species. In BV, that balance changes and other bacteria become more prominent. This can affect vaginal acidity and produce the characteristic discharge and odour. It is rarely possible to identify a single trigger for an individual episode.
BV is not classed as an STI, and people who have not had sex can develop it. Sexual activity can nevertheless trigger BV, and it can be passed between partners who have vaginas. If you suspect BV, our bacterial vaginosis testing and treatment page explains the available clinic service.
BV is a common cause of unusual vaginal discharge during the reproductive years, but it can also occur at other ages. Many people have no noticeable symptoms. Its frequency does not mean every change in discharge is BV: normal discharge varies over the menstrual cycle, and thrush or an STI can cause similar concerns.
Common bacterial vaginosis symptoms:
BV does not usually cause itching, soreness or significant pain. If these are the main symptoms, another cause may be more likely. Green or yellow discharge, pain when passing urine, bleeding between periods, fever or pelvic pain also warrants assessment rather than assuming you have BV. Symptoms alone cannot reliably distinguish every infection.
Seek prompt medical advice if you have pelvic pain, fever, bleeding that is unusual for you, or symptoms during pregnancy. If you might have been exposed to an STI, arrange appropriate testing. You can discuss a change in symptoms with a clinician even if you are unsure what it means.
If your symptoms don't cleanly match one column, that's normal. Plenty of women experience BV and thrush at different points in the same cycle, or confuse early signs of a genuine STI for BV. A chlamydia test or gonorrhoea test alongside a BV swab rules out the STI possibility properly rather than leaving you guessing. A clinician may discuss vaginal discharge assessment and STI tests when relevant.
BV develops when the usual bacterial balance in the vagina changes. Factors associated with it include:
These factors do not mean you caused BV. It may develop without an obvious trigger. If it repeatedly follows a particular event, tell your clinician; the pattern may help with a prevention plan. If you're noticing a pattern of BV alongside other hormonal changes, it's worth discussing with a GP through our menopause clinic if that timing lines up for you.
No. BV is not classed as an STI. Sex can influence the vaginal bacterial balance, though, and BV can be passed between partners who have vaginas. It is possible to have BV and an STI at the same time. If you have a new partner, have had sex without a condom, or have symptoms that do not fit typical BV, ask about sexual health testing as well.
A male partner does not usually need treatment for a single BV episode. If a partner has a vagina, they may need assessment or treatment, especially when BV keeps returning. Discuss partner treatment with a sexual health clinician rather than starting treatment for someone who has no symptoms.
A clinician will ask about your discharge, odour, sexual health, pregnancy status and any previous episodes. They may offer an examination and take a vaginal swab. Depending on the setting, testing can assess vaginal pH, the appearance of the discharge and other features of BV, or send a sample to a laboratory. A swab is not always necessary when symptoms are typical and there are no warning signs; the right approach depends on the clinical picture.
Testing becomes more useful when the diagnosis is uncertain, symptoms recur, you may have an STI, or treatment has not helped. Do not rely on a home pH test alone: a higher pH can have more than one cause.
When treatment is needed, a clinician will usually prescribe an antibiotic such as:
Tell the prescriber if you are pregnant, breastfeeding, have allergies or take other medicines. Use the medicine for the prescribed course even if symptoms settle sooner. If you take oral metronidazole, follow the instructions about avoiding alcohol during treatment and for 48 hours after finishing it. Vaginal creams and gels have their own instructions; ask about condoms and other vaginal products while using them.
Yoghurt, tea tree oil, vinegar douches and probiotics taken alone are not established replacements for prescribed treatment of symptomatic BV. Putting products inside the vagina may cause irritation or further disrupt its bacterial balance. A pharmacy product may relieve symptoms, but persistent or recurrent symptoms need a proper assessment.
It sometimes does, particularly when there are no symptoms. Treatment is not routinely needed for every person who has BV without symptoms. If you have bothersome discharge or odour, are pregnant, or are due a procedure for which your clinician has advised assessment, get individual advice. Do not wait for symptoms to disappear if you have pelvic pain, fever or unexplained bleeding.
BV can recur after successful treatment, sometimes within a few months. This does not mean you treated it incorrectly. If it keeps returning, a clinician can confirm that BV is the cause, check for another infection or contributing factor, and consider a different or longer treatment plan. For frequent recurrences, a course of vaginal antibiotic gel over several months may be recommended. Avoid repeating leftover antibiotics without an assessment.
A change in vaginal discharge during pregnancy deserves a conversation with your midwife or GP. BV causes no problems in most pregnancies, but it has been linked to a small increased chance of complications, including premature birth or miscarriage. The clinician can decide whether testing or treatment is appropriate and choose a medicine suitable for you. An asymptomatic result is not, by itself, a reason to self-treat.
Most cases of BV resolve without lasting issues once treated, but leaving it unaddressed, particularly if it's recurrent, can carry some added risk:
None of this is a reason to panic if you have BV it's a very treatable condition but it is a reason to treat it properly rather than repeatedly self-managing with unproven remedies.
Arrange an appointment if:
Assessment can identify whether the symptoms are BV, thrush, an STI or another condition, so treatment matches the cause.
At Private Medical Clinic, we offer same-day private testing and treatment for bacterial vaginosis, with results turned around quickly and no NHS waiting list to sit through. Every consultation is with a GMC-registered GP, carried out discreetly, and if you'd rather not discuss symptoms in person first, our online GP consultations let you start the conversation from home. Clinics are available across Birmingham, London, Newcastle, Leicester, Oxford, Derby, Sutton Coldfield, and Bournemouth & Dorset , Manchester and Cambridge. You can check current pricing on our fees page, and if you have any questions before booking, our FAQs cover most of what people ask.
Book a sexual health consultation or contact us to find your nearest clinic.
BV is a change in the usual balance of bacteria in the vagina. It may cause thin greyish-white discharge and a fishy smell, although many people have no symptoms.
The main signs are unusual thin discharge and a fishy smell, often more noticeable after sex. BV does not usually cause itching or soreness. Other symptoms may point to another condition.
A clinician may prescribe antibiotic tablets, gel, or cream if treatment is needed. The choice depends on your symptoms, medical history, and pregnancy status. Use the full course as directed.
It happens when the balance of vaginal bacteria changes. Sexual activity, perfumed products, douching and having an IUD are among the factors associated with BV, but an individual episode may have no clear trigger.
Avoid douching and perfumed products in or around the vagina. If BV recurs, discuss possible triggers and suitable treatment with a clinician. Prevention is not always possible.
No. It is not classed as an STI, although sex can trigger BV and it can be passed between partners who have vaginas. Ask about STI testing if there is a possibility of exposure.
BV describes an imbalance in the vagina, so a person without a vagina does not develop BV itself. Routine treatment of a male partner is not usually recommended for an isolated episode. Discuss recurrent BV and partner questions with a sexual health clinician.
BV does not automatically mean you will have fertility problems. During pregnancy, BV is associated with a small risk of complications, although most pregnancies are unaffected. Ask your midwife or GP about new discharge or odour.
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