Bacterial Vaginosis (BV):
Symptoms, Treatment, and Prevention

A fishy odor and thin, grayish discharge. If that sounds familiar, you may be dealing with bacterial vaginosis — the most common vaginal condition in women of reproductive age, and one of the most frequently misdiagnosed.

BV is not a yeast infection, and it is not an STI. It requires different treatment entirely. Here is what you need to know to get the right diagnosis and the right care.

What Is Bacterial Vaginosis?

Bacterial vaginosis is not an infection you "catch." It is an imbalance of the bacteria that naturally live in the vagina.

A healthy vagina is dominated by Lactobacillus bacteria, which produce lactic acid and keep the pH low. When Lactobacillus levels drop, anaerobic bacteria (such as Gardnerella vaginalis) overgrow and shift the vaginal pH upward. That shift is what produces the characteristic symptoms of BV.

What Does BV Feel Like?

Many women with BV have no symptoms at all. When symptoms are present, they typically include:

• Thin, gray or white vaginal discharge — watery and uniform, unlike the thick clumpy discharge of a yeast infection
• Fishy odor — often more noticeable after sex or during menstruation
• Mild irritation or burning — much less intense than the itching caused by yeast
• Burning during urination — occasionally, but not always present

If you notice a strong odor with thin discharge but minimal itching, BV is more likely than a yeast infection.

BV vs Yeast Infection: The Key Differences

These two conditions are frequently confused. If your main symptom is intense itching with thick, white discharge, you may be dealing with a yeast infection, which has its own distinct treatment. Using the wrong treatment delays relief and can make symptoms worse. Here is how they compare:

Because there is no over-the-counter treatment for BV, getting a proper diagnosis matters. If you treat BV with an antifungal cream, the infection will persist.

What Causes BV?

The exact cause of the bacterial shift is not always clear, but several factors increase your risk:

• New or multiple sexual partners — sexual activity is a risk factor, though BV is not classified as an STI
• Douching — disrupts the natural vaginal flora and is one of the strongest risk factors
• Lack of Lactobacillus — some women naturally have lower levels, making them more susceptible
• IUD use — may increase risk in some women
• Smoking — associated with higher BV rates

BV is not caused by toilet seats, swimming pools, or wearing tight clothing. It is a bacterial imbalance, not a hygiene issue.

How Is BV Treated?

BV requires prescription antibiotics. The two most commonly used medications are:

• Metronidazole (Flagyl) — available as an oral tablet (500 mg twice daily for 7 days) or vaginal gel (once daily for 5 days)
• Clindamycin — available as a vaginal cream (once nightly for 7 days) or oral capsules. Important: Clindamycin vaginal cream can weaken latex condoms and diaphragms. Use an alternative contraceptive method during treatment and for 72 hours after completing the course.

Important: If you are taking oral metronidazole, avoid alcohol during treatment and for 48 hours after finishing. The combination can cause severe nausea and vomiting.

Complete the full course even if symptoms improve after a few days. Stopping early increases the risk of recurrence.

Why BV Treatment Matters

BV may seem like a minor inconvenience, but untreated bacterial vaginosis can lead to serious complications:

• Increased STI susceptibility — BV makes it easier to contract HIV, chlamydia, gonorrhea, and herpes. Because symptoms can overlap, it is important to know the early signs of an STD as well
• Pregnancy complications — including premature birth and low birth weight
• Pelvic inflammatory disease (PID) — infection of the uterus and fallopian tubes that can affect fertility
• Post-surgical infections — higher risk of infection after gynecological procedures such as IUD insertion or hysterectomy

Can You Treat BV Online?

Yes. A telehealth provider can evaluate your symptoms and medical history during a virtual visit. For most cases of BV, a symptom-based history is sufficient to begin treatment.

Your provider will prescribe metronidazole or clindamycin, and the prescription is sent electronically to your preferred pharmacy for same-day pickup.

Telehealth is especially helpful for BV because many women delay treatment out of embarrassment. A virtual visit is private, judgment-free, and takes minutes, not hours.

How to Prevent BV From Coming Back

BV recurrence is common — about 50 percent of women experience a return of symptoms within 12 months. While no prevention method is guaranteed, these strategies can help:

• Avoid douching — this is the single most impactful change you can make
• Skip scented products — avoid scented soaps, sprays, and wipes near the vaginal area
• Wear cotton underwear — allows airflow and reduces moisture buildup
• Consider probiotics — emerging evidence supports Lactobacillus-containing probiotics, though research is ongoing
• Use condoms consistently — may help maintain vaginal bacterial balance

If you experience recurrent BV (three or more episodes in a year), your provider may recommend an extended metronidazole course or a maintenance regimen.

Frequently Asked Questions