The Most Common Cause of Vaginal Discharge in Women – Bacterial Vaginosis

Bacterial Vaginosis (BV) is not a sexually transmitted infection.  It is the most frequent cause of vaginal discharge in women, but it can be difficult to know if the discharge is caused by BV or other types of vaginal infections.

Definition:  Discharge caused by a large change in the number and types of bacteria in the vagina.  For some reason, the number Lactobacilli (which is a normal bacteria found in the vagina) are actually decreased while other bacteria are increased.

Risk factors:  Multiple or new sexual partners, douching, cigarette smoking.  Again, BV is not a sexually transmitted infection, as it can occur in women who are not sexually active.

Symptoms:  50-75% of women with BV do not have symptoms.  Those with symptoms may note an unpleasant, “fishy smelling” vaginal discharge that is more noticeable after vaginal intercourse.  The discharge is usually a thin, yellow-white color.  Most of the time it does not cause pain with urination or sex, vaginal itching or intercourse.  Self-treatment with over-the-counter medications such as yeast creams or deodorants are not recommended.

Diagnosis:  Physical examination, which usually includes pelvic examination and laboratory testing may be used to test the vaginal secretions to determine if BV is present.

Complications:  Bacterial vaginosis is usually not considered harmful but has been associated with some health problems such as:

1)   Increases risks for becoming infected with HIV, genital herpes, gonorrhea or chlamydia

2)   Pregnant women with BV are at higher risk of preterm delivery

3)   Untreated BV in woman who have had hysterectomy or abortion can lead to infection at the surgery site

Treatment:  We commonly use one of two different treatment options for treating BV.  Either Metronidazole or Clindamycin can be taken in pill form or with a gel or cream that is inserted into the vagina.   There are more side effects possible if taken orally, but it is more convenient.

Sexual partners:  There is no need to treat sexual partners of those infected with BV as it doesn’t decrease the risk of infection coming back.  BV is not a sexually transmitted infection, remember?

Relapse:  Within 3 months after resolution of symptoms, 30% of women have recurrence.  More than 50% have recurrence after 12 months.  The reasons for recurrence are unknown.  Relapse may be treated with a more prolonged course of antibiotics and the CDC suggests a treatment regimen different from the initial treatment if recurrence occurs.

Some patients use a preventative treatment with metronidazole vaginal gel twice weekly for 3-6 months if they get more than 3 episodes in 12 months.

Prevention:  Some recommendations may include the following:

1)   Finish the entire course of antibiotics for the treatment of BV even if symptoms resolve rapidly

2)   Limit the number of sexual partners

3)   Do not douche.  There is no proven benefit to douching and the solution used to rinse the vagina may upset the balance of bacteria and actually flush other bacteria up into the uterus or fallopian tubes and cause other types of infections

If you have vaginal discharge or questions, please contact your medical provider.  Do not attempt to treat yourself as this can actually make the situation worse.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO



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