Gynecologic Conditions

Bacterial Vaginosis (BV): Symptoms, Causes and Treatment

By the Find Her Doctor editorial team · Updated November 1, 2026 · 6 min read

Bacterial vaginosis (BV) is an imbalance of the bacteria that normally live in the vagina. The classic signs are thin gray or white discharge and a fishy smell that's often stronger after sex or during your period. It's treated with prescription antibiotics, as pills or a vaginal gel or cream, and most people feel better within a few days of starting.

The CDC reports that BV is the most common vaginal condition in people ages 15 to 44. It's easy to treat, it often comes back, and it gets mistaken for a yeast infection constantly. If you've been standing in the pharmacy aisle wondering which box to buy, this one's for you.

What BV actually feels like

The smell is usually what sends people in. Many patients describe noticing it right after sex, or when they pull down their underwear at the end of the day, and worrying that everyone else can smell it too. (They usually can't. You're closer to it than anyone.)

Common symptoms:

• Thin, white or gray discharge, more watery than usual
• A strong fishy odor, often more noticeable after sex or during your period
• Mild itching or irritation, if any
• Burning when you pee

Plenty of people with BV have no symptoms at all and only find out from a swab done for another reason.

BV usually doesn't cause much redness or swelling. Intense itching and thick, white discharge point more toward a yeast infection.

BV, yeast or trich? A side-by-side

Because the symptoms overlap, it's worth getting tested rather than guessing. A common story: someone uses an over-the-counter yeast cream for a week, nothing changes, and it turns out to be BV the whole time. More on the other one in our guide to yeast infections.

What's going on down there

A healthy vagina has lots of types of bacteria, usually dominated by Lactobacillus. Lactobacilli keep the vagina slightly acidic, which stops other bacteria from overgrowing. In BV, the lactobacilli drop and other bacteria multiply. The pH rises, and that shift causes the discharge and odor.

Experts don't fully understand why it happens. Things linked to higher risk:

• A new sex partner or multiple sex partners
• A female sex partner with BV
• Douching
• Not using condoms
• Low levels of lactobacilli

You can't get BV from toilet seats, bedding or swimming pools. Yes, people ask this all the time.

Myth vs. fact

Myth: BV means you're not clean enough. Fact: It's the opposite more often. Douching and scented washes disrupt the bacterial balance and raise your risk. Plain water or a mild, unscented soap on the outside only is all you need.

Myth: BV is an STI. Fact: It isn't considered one, though it's linked to sexual activity. People who have never had sex can get BV.

Myth: A yeast treatment will knock it out. Fact: Over-the-counter yeast medicines don't treat BV. You need a prescription antibiotic.

Myth: Probiotics will prevent it. Fact: They're popular, but the evidence that they prevent BV is still limited. Ask your clinician before relying on them.

The visit: what to expect

BV is often diagnosed and treated in a single visit, and it's a quick one. Your clinician may:

• Do a pelvic exam and look at the discharge
• Check the vaginal pH with a strip of test paper
• Look at a sample under a microscope
• Send a vaginal swab to a lab

The swab takes a few seconds and feels like a cotton swab brushing the inside of the vagina. Some offices give you the swab to do yourself.

Expect to be offered testing for chlamydia, gonorrhea and trichomoniasis too, since BV can show up alongside them. That's routine, not a judgment.

Tip: Don't douche, use vaginal creams or have sex for a day or two before the appointment if you can, since they can affect the results.

How BV is treated

The CDC recommends prescription antibiotics such as:

• Metronidazole pills or vaginal gel
• Clindamycin vaginal cream or pills
• Tinidazole or secnidazole as alternatives

Your clinician will pick the medicine and schedule that fit you. A few things people wish they'd known:

• Finish the whole course, even when the smell is gone by day two or three.
• Ask about alcohol. Your clinician or pharmacist can tell you whether to skip it with your specific medicine. With tinidazole, avoiding alcohol during treatment and for a few days afterward is recommended.
• Clindamycin cream is oil-based. It can weaken latex condoms and diaphragms during treatment and for a few days after.
• Skip sex or use condoms until treatment is finished.

Does my partner need treatment?

Guidance on treating partners has been changing as new research comes in. Ask your clinician whether partner treatment makes sense for you.

Can partners get BV?

BV affects the vagina, so people with a penis don't get it. It can pass between female partners, though, and sexual activity in general affects vaginal bacteria. If you and a female partner both have symptoms, you should both be checked.

"Why does it keep coming back?"

This is the most common frustration. BV often returns within a few months of treatment. If you're on your third or fourth round, your clinician may suggest:

• A longer course of antibiotics
• A suppressive plan, such as using a vaginal medicine regularly for several months
• A look at possible triggers, like douching

Keep a simple note on your phone with the dates and what you were prescribed each time. It helps your clinician choose the next step.

Why it's worth treating

BV usually isn't dangerous on its own, but it can raise your risk of:

• Getting STIs, including HIV, chlamydia and gonorrhea
• Pelvic inflammatory disease (PID) after some gynecologic procedures
• Pregnancy complications, such as preterm birth

BV during pregnancy

BV is common in pregnancy. Because it's been linked to preterm birth and other complications, the CDC recommends treating pregnant people who have symptoms. Not everyone without symptoms needs testing; your prenatal provider decides based on your history.

If you're pregnant:

• Tell your prenatal provider about any change in discharge or odor instead of treating yourself.
• Use only medicines your provider recommends. Metronidazole and clindamycin are both used during pregnancy.
• Don't douche, which can make symptoms worse.

Lowering your risk

• Don't douche. It disrupts the natural balance.
• Use condoms, which may lower the risk.
• Limit your number of sex partners.
• Wash only the outside with plain water or mild, unscented soap. Skip scented products in or around the vagina.

When to see a doctor

Book an appointment with a gynecologist or women's health nurse practitioner if you:

• Have new or unusual discharge or odor
• Think you have BV or a yeast infection for the first time
• Tried an over-the-counter yeast treatment and nothing improved
• Have symptoms that keep coming back
• Are pregnant and notice changes in discharge
• Have a new partner or think you may have been exposed to an STI

Call your provider promptly if you have pelvic pain, fever, or pain during sex along with discharge. That combination can signal pelvic inflammatory disease.

Finding care in New York

You can see a gynecologist, OB/GYN or women's health nurse practitioner, and many offices can fit a discharge visit in within the week. Use our provider search to find someone near you, or browse gynecologists and women's health nurse practitioners across the five boroughs, Long Island and the Hudson Valley.

Frequently asked questions

Sources

• CDC — Bacterial Vaginosis: STI Treatment Guidelines (2021)
• CDC — About Bacterial Vaginosis
• ACOG — Vaginitis (Patient FAQ)
• ACOG — Vaginitis in Nonpregnant Patients (Practice Bulletin 215)
• MedlinePlus — Bacterial Vaginosis

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.