Bacterial Vaginosis (BV)
Bacterial Vaginosis (BV) is a common bacterial imbalance of the vaginal microbiome experienced by women. It is the result of a reduction in lactic acid producing bacteria, primarily lactobacillus, which leads to an overgrowth of opportunistic anaerobic bacteria, such as Gardnerella vaginalis, Prevotella, Sneathia and Atopobium.
The prevalence of BV is estimated to be 23-29% among women of reproductive age.1 Although it is quite common, it is associated with poorer health outcomes such as an increased risk of Pelvic Inflammatory Disease (PID), Sexually Transmitted Infections (STIs), as well as poorer fertility outcomes, so requires addressing.
Symptoms may include:
- Unusual, increased discharge (grey / white / gushy)
- A change in odour (often described as a 'fishy smell')
- Vaginal discomfort / itching
A doctor can test for BV using a vaginal swab, although some doctors may diagnose based on symptoms alone. BV is often treated with antibiotic tablets, gels or creams, prescribed by a doctor or sexual health clinic.
Frustratingly, BV has a high recurrence rate. This is not always because the treatment doesn’t work, but because protective lactic acid bacteria is not re-populated leaving the environment at risk of further opportunistic bacteria growth.
Probiotics designed to re-populate the vaginal microbiome with specific strains of lactobacillus can be useful to reduce recurrence risk.
A recent study found men carry BV causing bacteria in their semen, which can be passed to a female during unprotected sex. If a women gets recurrent BV, consider the male too, and discuss treatment with a healthcare practitioner for both partners to reduce microbe transfer.2
Various lifestyle factors can also contribute to BV, including poor gut health, poor vitamin D status, poor hygiene and lifestyle habits (which impact the vaginal PH), number of sexual partners, smoking, antibiotics, amongst others.3 Addressing the underlying cause or causes of BV is prudent in cases of chronic BV.
References
- World Health Organization. Bacterial vaginosis. Published Nov 21, 2024. https://www.who.int/news-room/fact-sheets/detail/bacterial-vaginosis. Accessed Mar 12, 2025.
- BBC News. Global economic outlook for 2025. BBC News. Published Mar 6, 2025. https://www.bbc.co.uk/news/articles/c2lj7e0519xo. Accessed Mar 12, 2025.
- Mojtahedi SF, Mohammadzadeh A, Mohammadzadeh F, Jalili Shahri J, Bahri N. Association between bacterial vaginosis and 25-Hydroxy vitamin D: a case-control study. BMC Infect Dis. 2023;23(1):208.
