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What Happens if BV Goes Untreated?

Medically reviewed on June 22, 2023 by Morgan Spicer, Medical Communications Manager. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

The treatment for bacterial vaginosis (BV) typically includes a short round of antibiotics. While some cases of BV can resolve on their own, it’s important to know the potential complications of leaving BV untreated.

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Causes and Symptoms of Bacterial Vaginosis

BV is a condition impacting vaginal health that is caused by an imbalance or overgrowth of certain kinds of bacteria. [1] Various behaviors and risk factors have the ability to disrupt the natural vaginal pH and vaginal flora, leading to BV. These behaviors and risk factors include douching, sexual activity, IUD use, having partners assigned female at birth (AFAB), pregnancy, antibiotic use, and others [1].

A large majority of people with BV won’t have symptoms and may not be aware they have BV. [1] For those that do experience symptoms, they may notice the following [1-2]:

  • Fishy or foul-smelling discharge
  • Gray, off-white, or green discharge
  • Painful sex
  • Painful urination
  • Vaginal irritation

Symptoms of BV mimic many sexually transmitted infection (STI) symptoms, yeast infections, or urinary tract infection (UTI) symptoms. It’s important to speak to a healthcare provider that can confirm the cause of these symptoms. Read What Is Bacterial Vaginosis? for more information.

How is BV Treated?

Bacterial vaginosis can be treated with prescribed antibiotics or antimicrobial medications. The most commonly prescribed treatments include clindamycin or metronidazole in the form of oral tablets or vaginal suppository gels. [3] There are also home remedies such as probiotics, boric acid, oral garlic tablets, and other supplements that have been shown to be effective in some cases. [4-6] Home remedies are not recommended unless approved by a healthcare provider.

When prescribed medications, BV is typically remedied within seven days. In some cases, infections may return or need another round of medication. [1-3]

What Happens if BV Goes Untreated?

Because BV doesn’t always cause symptoms, it can sometimes go untreated. In about 30% of cases, BV will actually resolve without treatment. [1] However, if left untreated for long periods of time, BV may increase the risk of various infections, complications, and health conditions. [1]

Increased Risk of STIs

Bacterial vaginosis is not a sexually transmitted infection, but it is closely tied to sexual health. Research shows that having BV increases the risk of contracting STIs, including HIV. [7] Those living with HIV also have a higher risk of passing HIV to sexual partners if they have untreated BV. [1,7] The risk of contracting other infections such as gonorrhea and chlamydia nearly doubles when BV is left untreated. [1,3] Data also shows that BV is a risk factor for herpes simplex virus type 2, and the infection or reactivation of human papillomavirus (HPV). [1,7] Many symptoms of BV mimic those of other infections, including STIs. It’s important to speak to a healthcare provider about testing and treatment to protect yourself and your partner(s).

Pelvic Inflammatory Disease and Other Infections

Pelvic inflammatory disease (PID) is the inflammation of the upper genital tract. [8] PID can impact the uterus, fallopian tubes, and ovaries, causing damage to pelvic tissues and organs and leading to problems with infertility, such as ectopic pregnancy, infertility, and pelvic pain. [8] In the majority of cases, PID is caused by untreated sexually transmitted infections that travel up the reproductive tract. Research shows that prolonged cases of BV have been associated with a higher risk of PID. [9]

Pregnancy or Fertility Complications

BV can also cause complications with fertility and pregnancy. Prolonged cases of BV have been associated with ectopic pregnancies, miscarriage, low birth weight, and induction of early labor. [7,9] BV may also increase the risk of other pregnancy implications, such as rupture, postpartum endometriosis, and others. [1,7,9] Some data show an association between BV and infertility, with more infertile people AFAB having BV than fertile people AFAB. Studies have also shown that in vitro fertilization (IVF) implantation rates are lower in people with a history of BV. [1] Fortunately, BV can also be treated during pregnancy with antibiotics, and outcomes for those treated are usually positive. [1]

Get Peace of Mind with Everlywell Services

Getting treatment for BV early is the best way to support reproductive and sexual health. Treatment given early on during pregnancy can decrease the risk of early labor and other pregnancy complications. [1-3] Screening for BV in asymptomatic people is not generally recommended, so if you are concerned that you may have BV or another infection, be sure to speak to a healthcare provider about testing. [1] You can schedule a virtual women’s health visit with Everlywell today or purchase at-home lab tests to screen for other infections like STIs, HPV, and more.

Get BV help online

Is Bacterial Vaginosis an STD?

What is Bacterial Vaginosis? Causes and Symptoms of BV

BV vs. UTI: The Differences Explained

What Is Pelvic Inflammatory Disease?

How to Treat Bacterial Vaginosis (BV): Medications and Home Remedies

How to Prevent BV: Methods for Preventing Bacterial Vaginosis

References

  1. Kairys N, Garg M. Bacterial Vaginosis. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459216/
  2. Bacterial Vaginosis. Cleveland Clinic. February 6 2023. URL. Accessed June 16 2023.
  3. Bacterial Vaginosis - STI Treatment Guidelines. CDC. Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. July 22 2021. URL. Accessed June 13 2023.
  4. Mohammadzadeh F, Dolatian M, Jorjani M, Alavi Majd H, Borumandnia N. Comparing the therapeutic effects of garlic tablet and oral metronidazole on bacterial vaginosis: a randomized controlled clinical trial. Iran Red Crescent Med J. 2014;16(7):e19118. doi:10.5812/ircmj.19118
  5. Wang Z, He Y, Zheng Y. Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(20):3859. Published 2019 Oct 12. doi:10.3390/ijerph16203859
  6. Powell A, Ghanem KG, Rogers L, et al. Clinicians' Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis. Sex Transm Dis. 2019;46(12):810-812. doi:10.1097/OLQ.0000000000001063
  7. Wigan R, Vaughn C, Vodstrcil L, et al. "It's just an issue and you deal with it… you just deal with it, you move on and you do it together.": Men's experiences of bacterial vaginosis and the acceptability of male partner treatment. PLoS One. 2020;15(6):e0235286. Published 2020 Jun 29. doi:10.1371/journal.pone.0235286
  8. Jennings LK, Krywko DM. Pelvic Inflammatory Disease. [Updated 2023 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499959/
  9. Safwat F, Safwat S, Daka N, Sivanathan N, Lazarevic M. Recurrent Bacterial Vaginosis: A Case Report and Review of Management. Cureus. 2023;15(4):e37348. Published 2023 Apr 9. doi:10.7759/cureus.37348
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