Bacterial Vaginosis

Bacterial vaginosis occurs as often as yeast but no one talks about it. It is estimated to affect approximately 25% of women and about half of them will not have any symptoms. It can be difficult to distinguish bacteria from yeast so a pelvic examination by your provider is necessary.

The vagina normally has harmless bacteria present that help the body fight off other vaginal infections such as yeast. Sometimes the balance of good and bad bacteria shifts, and undesirable bacteria predominate and cause an infection.


The color and amount of discharge varies among women. Often women report vaginal discharge with an unpleasant odor (fishy) that is worse after sexual relations or menstruation.


The diagnosis can be made with microscopic examination of the discharge in the office. We also have the capability to do PCR testing which is much more specific and sensitive.


Treatment includes the use of prescription medication. We recommend avoiding sexual activity for one week. Unfortunately, reoccurrence of BV is common. Avoid douches or deodorant sprays that mask odor. They may eliminate the odor, but they will cause worsening of the condition. Women may be encouraged to take showers rather than tub baths. If you do opt to take a bath, do not add any salts, bubbles, or fragrances to the water. The use of cotton crotch underwear is recommended. Changing tampons or sanitary pads frequently during the menstrual cycle is also urged. Finally, we suggest wiping from front to back after using the bathroom.

There are many treatment options that can be used orally or vaginally. One of the most effective treatments includes oral or vaginal metronidazole. It should be taken orally with meals or a snack to prevent stomach upset. The combination of metronidazole and alcohol will cause stomach pain, nausea, vomiting and headache. Therefore, do not drink alcoholic beverages or use other alcohol containing preparations such as cough syrups while you are taking this medication. Clindamycin is also an option; if severe diarrhea occurs with the use of the medication, please make sure to tell your provider.

A woman may have other infections of the vaginal or cervix at the same time as she has bacterial vaginosis. If symptoms persist after treatment a repeat examination is indicated.