Bacterial Vaginosis (BV)

Bacterial vaginosis (BV) is a common bacterial infection in the vagina. There are many different types of bacteria that usually live in the vagina. These rarely cause problems. BV occurs when there is a change in the balance of these vaginal bacteria. BV can be passed on during sexual contact and sexual activity may make symptoms worse,

Read about sexually transmissible infections (STIs)

The reason people get BV is not entirely understood.

BV causing bacteria can be carried on the penis, specifically on the penile skin and inside the urethra (the tube that urine and semen exit through). During penile-vaginal sex, these bacteria can be transmitted from the penis to the vagina where they can cause a BV infection.

There is also evidence that BV-causing bacteria can be exchanged during sex between partners where both have a vagina.

You may be more likely to get BV if you:

• have a new sexual partner
• have sex without using barrier protection (external condoms, internal condoms or dams)
• have sex with a partner with an uncircumcised penis.
• have a sexual partner(s) with a vagina
• douche or clean inside your vagina with water, soap or other products
• are a smoker.
• have an intrauterine device (IUD), particularly a copper IUD

BV can affect anyone with a vagina who is sexually active. It can happen whether your sexual partner/s is the same sex as you or a different sex.

People who have a regular or ongoing sexual partner are more likely to get BV back again after treatment.

Many people with BV do not know because they do not have symptoms. Some people may have symptoms such as:

• an unusual “fishy” or sometimes metallic smell from the vagina,
• thin, white/grey discharge (fluid) from the vagina or a change in their normal vaginal discharge,
• irritation or discomfort in the vagina and/or on the vulva,
• difficulty or pain (discomfort, stinging or burning) during urination (peeing),
• pain or discomfort during sex.
• BV causing bacteria do not usually cause symptoms in or on the penis; however, some people notice an unpleasant odour on their penis (sometimes described as a “fishy” odour).

It is recommended you see a doctor or nurse if you are experiencing any BV symptoms. Treating these yourself may worsen the condition.

The doctor or nurse will usually take a detailed medical and sexual health history. Any information or details you discuss will be kept private and confidential. This will help them to assess the symptoms and guide any tests and possible treatment options.

It can often be helpful if you have symptoms of BV, for a doctor or nurse to do a genital examination and use a cotton swab to collect a sample from your vagina. You can also self-collect a sample from your vagina.

However, diagnosis of BV and treatment options can be determined sometimes just from the history you give and the symptoms you describe.

Tests to detect BV-causing bacteria on the penis are not currently available.

You may choose to test for other STIs or BBVs at the same time as testing for BV. As sometimes BV can be a symptom caused by an STI. More information on STI and BBV testing

Sexual Health Victoria (SHV) provides expert, confidential STI and BBV testing to Victorians. We also provide expert information, healthcare and support on a range of reproductive and sexual health matters. For more information on SHV clinical services, see our clinics or you can book an appointment online.

BV symptoms will sometimes resolve (go away) without treatment.

Treatment is recommended if you:

• have symptoms that are bothering you
• are pregnant
• are going to have a procedure on your uterus (womb) or vagina (e.g. abortion, intrauterine device (IUD) insertion, surgery).

BV is treated with antibiotics. This is usually a 5 – 7 day course of oral tablets or a gel or cream you put inside the vagina. Occasionally, you may need a longer course of antibiotics.

With one of the main antibiotics used it is not recommended to drink alcohol while taking the tablets and within 24 hours after you’ve finished taking the course of tablets. You can speak to your doctor or nurse for more information.

If you have symptoms and your doctor or nurse thinks they are most likely to be caused by BV, you may be offered treatment before your test results come back.

Due to the sexual transmissibility of BV, it can be helpful to involve regular sexual partners in treatment. Giving BV antibiotics to regular sex partners aims to treat and eliminate any BV-bacteria they may be carrying, which reduces the risk of reinfection. This strategy is most effective when both partners start and finish their antibiotics at the same time.

It may be recommended you avoid sexual contact until you have finished treatment and your symptoms have settled.

If you are having sex and use condoms (external condoms or internal condoms), you may need to avoid sexual contact or use a different contraceptive option during BV treatment. Some creams or gels used to treat BV can affect condoms and cause them to break easily.

Treatment for regular sexual partners with a penis:

Antibiotic treatment for partners with a penis is recommended. Treatment is an oral antibiotic tablet and a topical antibiotic cream which requires a prescription. No testing or symptoms for the partner with a penis are needed.

For regular sexual partners with a vagina:

• Antibiotic treatment is available following testing and confirmation of a BV diagnosis with or without symptoms.

BV is very common, and symptoms may resolve without treatment. However, BV can cause health complications if not treated.

Untreated BV with symptoms can increase the risk of pelvic inflammatory disease (PID), or complications of medical procedures involving the vagina or uterus (IUD insertion, abortion). If you have symptoms of BV, you can tell the health practitioner who will be able to discuss testing and treatment for BV before having a surgical termination or IUD insertion.

Having BV can increase the risk of getting other sexually transmissible infections.

Untreated BV with symptoms in pregnant people can lead to pregnancy problems. If you have symptoms of BV, you can tell your doctor or midwife who will be able to discuss testing and treatment for BV.

BV can resolve (go away) with effective treatment. You do not develop any immunity to BV once you’ve had it. However, 50% of people who are treated for BV will get another BV infection within the next 3 months to a year. Do I need to let my sexual partner/s know I have bacterial vaginosis (BV)?

People who are pregnant or breastfeeding can get BV.

If you experience BV during pregnancy, it can cause serious health complications for both you and the baby. Complications can include:

• Infection in the uterus (womb)
• Passing the infection to the baby (during pregnancy, birth or breastfeeding) causing health conditions
• Miscarriage
• Premature (early) birth.

If you are planning a pregnancy or are already pregnant, testing for bacterial vaginosis is not a routine part of health care. You will only be tested if you have symptoms.

The antibiotic treatments for BV are usually safe to take while pregnant or breastfeeding, although one antibiotic may affect the taste of breast milk. If you are pregnant or breastfeeding and considering treatment for BV, ask your doctor, nurse or midwife about the possible effects of the treatment and/or medicine on your baby or breastfeeding.

You may be able to lower your risk of getting BV by the following:

• Avoid douching or cleaning inside your vagina as this changes the balance of bacteria that live in the vagina.
• Avoid scented soap, bubble baths and products around the vagina. Use only water or soap-free products to wash around your genitals.
• Using barrier protection (external condoms, internal condoms or dams) correctly during any type of sex (vaginal, anal, oral sex and sex toys).

Barrier protection is not 100% effective at preventing bacterial vaginosis or STIs and BBVs.

• Sexual Health Victoria
• A doctor or nurse
• Your local community health service
• An obstetrician or gynaecologist
• Better Health Channel
• Melbourne Sexual Health Centre – a specialist sexual health clinic
• Jean Hailes
• Multicultural Centre for Women’s Health – for culturally and linguistically diverse women.
• The Labia Library
• What’s Going on Down There - an interactive website that can help self-assess vaginal discharge changes
• The Women’s (The Royal Women’s Hospital)
• Equinox – for transgender services
• The Centre Clinic – a safe and friendly general practice, providing care for LGBTI community members as well as specialist medical care for people living with HIV, and expert sexual health screening and treatment.