Signs and Symptoms of Bacterial Vaginosis

Bacterial vaginosis (BV) is a common vaginal infection that can cause abnormal vaginal discharge color or odor, vaginal itching, or a burning sensation when you urinate (pee). Bacterial vaginosis affects each person differently—some people may be asymptomatic, while others do experience some symptoms. BV is most common in sexually active people assigned female at birth between the ages of 14 and 49.

The exact cause of BV is currently unknown. However, researchers believe that an imbalance of vaginal bacteria or a change in pH levels (acidity levels) during sexual intercourse may lead to the infection. You may also be at an increased risk of developing symptoms if you practice vaginal douching, have sex without condoms, smoke cigarettes, use an intrauterine device (IUD), or are pregnant. 

While bacterial vaginosis is not classified as a sexually transmitted infection (STI), having BV can increase your risk of developing an STI and pelvic inflammatory disease. That's why knowing the symptoms and understanding when to reach out for medical care are essential for your reproductive health.

Abnormal Vaginal Discharge

A change in your vaginal discharge (fluid) is one of the hallmark symptoms of BV. Some vaginal discharge is normal, as it helps clean and lubricate the vagina. Typically, vaginal discharge is white or clear and the amount you produce can vary throughout your menstrual cycle.

However, bacterial vaginosis can cause abnormal or excessive vaginal discharge that is watery, thin, and sometimes foamy, that may appear to be gray or green in color. You might notice changes in the consistency and color of the vaginal discharge on your underwear or toilet paper after wiping.

Foul Odor

Normal vaginal discharge either has a mild, inoffensive odor (smell) or is completely odorless. However, if you have BV, you may notice that your vaginal discharge smells foul or fishy. This odor is more noticeable after sexual intercourse and during menstruation. 

It's important to note that changes in the smell of your vaginal discharge do not always mean that you have BV. There are other vaginal infections, such as yeast infections or sexually transmitted infections (STIs), that can cause abnormal vaginal discharge.

Yeast infections typically cause a thick, white, “cottage cheese” like vaginal discharge that is either odorless or has a mild yeast smell. Trichomoniasis (an STI caused by a parasite) tends to produce fluid that looks like BV discharge, but it's typically more frothy, foamy, and abundant than the discharge that BV causes.

Vaginal Itching

In some cases, BV can cause vaginal itching. However, this symptom is not as common in BV as it is in other vaginal conditions, such as yeast infections. If you do experience itching as a result of BV, it could be due to an imbalance of vaginal microbiota (overgrowth of certain bacteria in the vagina). These bacteria can irritate the vaginal tissue, leading to itching or discomfort.

With BV, the itching should typically feel mild to moderate. Persistent or severe vaginal itchiness may indicate the presence of other conditions such as yeast infections or certain sexually transmitted infections (STIs). It's important to note that vaginal itching can also occur for a variety of other reasons, including allergies and hormonal changes. 

Painful Urination

Bacterial vaginosis can sometimes also cause pain or discomfort during urination (peeing). With BV, pain while peeing generally feels like mild irritation or a burning sensation. This feeling should go away once you're done urinating.

Keep in mind: painful urination is not the hallmark symptom of BV. If you have discomfort while peeing but aren't experiencing changes in your vaginal discharge, painful urination may be a sign of a urinary tract infection (UTI) or STI.

UTIs typically cause intense burning or stinging pain while you pee. You may also feel the need to urinate frequently or have pain in your stomach or pelvis. Chlamydia and gonorrhea are common STIs that can cause burning or pain during urination. Additionally, genital herpes is a type of STI that causes painful sores around the genitals, including in the urethra (the tube that carries pee out of the body). An outbreak of genital herpes can result in discomfort during urination.

When to See a Healthcare Provider 

If you suspect that you have symptoms of BV, there are at-home tests that are great for a quick answer. However, it's critical to consult with your healthcare provider to receive an accurate diagnosis if you have symptoms of bacterial vaginosis. Your provider can conduct tests to determine the cause of your symptoms which can also help your provider find the treatment options that are right for you.

If BV is left untreated, you may be at an increased risk of developing an STI or pelvic inflammatory disease (PID). PID is an infection in the female reproductive organs, which can cause the following if you don't receive proper treatment: 

• Infertility (inability to get pregnant) 
• Ectopic pregnancy (pregnancy outside the womb)
• Scar tissue in the reproductive organs
• Long-term abdominal or pelvic pain

It's also crucial for those who are pregnant to seek treatment if they are at high risk or have symptoms of bacterial vaginosis. This is because untreated BV can lead to premature or low birth weight deliveries.

The most common treatment includes the following antibiotics:

• Oral or vaginal Flagyl (metronidazole)
• Oral Tindamax (tinidazole) 
• Oral or vaginal Cleocin, Clindesse (clindamycin)

About 50% of people assigned female at birth with BV have a recurrence (another infection) within 12 months of treatment. That said, seeing a healthcare provider if you have symptoms is important, even after receiving treatment. 

A Quick Review 

Bacterial vaginosis (BV) is a vaginal infection that is most common in sexually active people assigned female at birth between the ages of 14 and 49. While the exact cause of BV is unknown, researchers believe that an overgrowth of normal vaginal bacteria or an upset in the pH (acid/base) balance in the vagina can lead to symptoms.

While BV is often asymptomatic (does not cause symptoms), you can sometimes experience abnormal vaginal discharge and a fishy or foul-smelling odor from your discharge. While less common, BV can also cause itching or painful urination. If you have symptoms, it's essential to receive care from a healthcare provider to reduce your risk of developing complications, such as an STI or pelvic inflammatory disease.