Medically reviewed on June 12, 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.
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Have you heard of bacterial vaginosis (BV) and aren’t exactly sure what it is, or what causes it? Here’s your overview of bacterial vaginosis, including the causes, symptoms, and differences between BV and other vaginal infections.
Bacterial vaginosis is a condition impacting vaginal health. While commonly roped in with conversations about STDs, BV is not considered a sexually transmitted infection.  Bacterial vaginosis is considered the most common vaginal problem (occurring in up to 70%) for people assigned female at birth (AFAB) ages 15 to 44. [1-2]
BV is caused by an imbalance of the naturally occurring bacteria found in the vagina.  This bacteria is known as the vaginal flora and is a normal part of a healthy vagina.  The vaginal flora is necessary for keeping the vagina at a healthy pH and limiting the growth of unwanted organisms and yeast.  Anything that can disrupt the natural balance of pH and bacteria in the vagina can lead to BV. Some potential causes include sexual activity, douching, and antibiotic use. 
Anyone assigned female at birth can get BV. You do not have to be sexually active, although most people who get BV are.  Some people may be genetically predisposed to the overproduction of certain bacteria, which can put them at a higher risk of having BV. Other risk factors for getting bacterial vaginosis include [1-2]:
While people assigned male at birth (AMAB) are unable to get bacterial vaginosis, they can spread the bacteria that causes BV.  Taking precautions with all partners when sexually active is the best way to protect yourself against STIs and other infections such as BV. This includes the use of condoms, dental dams, sanitizing sex toys, and so on. [1-2]
Not everyone that has BV will experience symptoms. In fact, up to 84% of people with bacterial vaginosis report not having symptoms. [1-2] Those that do experience symptoms may notice the following :
Many BV symptoms are very similar to other infections. If you are noticing any of these symptoms or if you’re concerned about your sexual health, you should speak with a healthcare provider.
So how do you know if you have BV? As previously mentioned, only some people with BV will have symptoms. A healthcare provider will be able to help you determine if you have BV or any other infections, including a yeast infection or an STI. In order to diagnose BV, a healthcare provider will conduct a pelvic exam, take a sample of vaginal discharge, or perform other tests as necessary.  Testing vaginal fluid or examining fluid under a microscope will help measure vaginal pH and identify what bacteria may be present. 
Many providers use the Amsel criteria to diagnose bacterial vaginosis. When using this criterion, at least two to three out of four possible symptoms need to be present :
About a third of cases can resolve on their own without medical treatment.  In other cases, antibiotics such as clindamycin or metronidazole can be used to treat BV. [1-2] Antibiotics can be in the form of oral tablets or vaginal creams. Taking antibiotics exactly as prescribed is important, meaning you should continue using the full dose of antibiotics that was given to you. Stopping treatment early may cause BV to return.  Most rounds of antibiotics will last around seven days and should eliminate the infection completely. In some cases, another round of treatment may be necessary. [1-2] While some cases of BV can resolve on their own, anyone experiencing symptoms may still benefit from speaking to a healthcare provider to rule out other infections. [1-2]
There are some potential complications associated with bacterial vaginosis, especially if left untreated. Failure to treat BV may lead to fertility and pregnancy complications, including pelvic inflammatory disease (PID), miscarriage, and premature birth. [1-2] BV also increases your risk of STIs, including HIV. If someone is living with HIV and gets BV, they may be at a higher risk of passing HIV to sexual partners. [1-2] Research shows that BV nearly doubles the risk of chlamydia or gonorrhea infection. 
BV is often talked about in relation to other vaginal infections, including yeast infections, urinary tract infections, and STIs. While some of the symptoms of these infections can be similar, there are some key differences you should know. An STI is an infection that occurs as a result of bacteria or other pathogens not normally found in the vagina.  A yeast infection is caused by an overgrowth of yeast in the vagina.  Urinary tract infections (UTIs) are caused by bacteria reaching the urethra and bladder.  Yeast infections, UTIs, and BV are not sexually transmitted, however, being sexually active may be a risk factor for these conditions. [5-6] Symptoms of these infections can overlap, but here are some key differences to note [1,4-6]:
Many of these symptoms can overlap and may even be a result of another type of infection. If you are noticing symptoms, it’s important to speak to a healthcare provider right away.
Bacterial vaginosis is the most common vaginal condition experienced by people AFAB and of reproductive age. BV is typically not a serious condition, but if left untreated, may cause severe complications down the line. Many people with BV don’t experience symptoms, however, BV can cause symptoms such as fishy vaginal odor, abnormally colored discharge, painful sex, painful urination, or vaginal irritation. If you are sexually active or have concerns about your sexual health, Everlywell can help. Book a women's telehealth consultation to discuss your concerns with a healthcare provider, or shop for various at-home sexual health tests.