The lowdown on BV

What is Bacterial Vaginosis?

Bacterial Vaginosis, otherwise known as BV, is a common vaginal bacterial imbalance characterised by a loss of health promoting lactobacillus, and an increase in anaerobic bacteria. In BV, the vagina tends to lose its normal acidity, and its pH increases to greater than 4.5.

Symptoms may present as:

• Unusual discharge - grey / white / clear, gushy and copious
• Unusual odour - a strong fishy smell, especially noticeable after sex or during menstruation
• Mild irritation or itching

BV is asymptomatic in up to 50% cases, meaning symptoms are not always present in some women.¹ Women experiencing symptoms may notice a cyclical pattern with their menstrual cycle, with worse symptoms after a bleed, but also after sex.

BV is the most common cause of abnormal vaginal discharge in women of childbearing age, but may also be encountered in peri or postmenopausal women. The prevalence of BV is estimated to be 29% among women aged 14 - 49 years.²

Some of the anaerobic bacteria associated with BV include Gardnerella Vaginalis, Prevotella Bivia, Finegoldia Magna, Fannyhessea Vaginae, amongst others. We detect for 23 strains in our vaginal microbiome report.

Why do women get BV?

Women commonly get BV as a result of a comprised lactobacillus environment. Lactobacillus are the beneficial, protective bacteria, that keep the canal acidic, and if these are reduced for some reason, anaerobic bacteria can take up space. Oestrogen is supportive of lactobacillus species, hence low oestrogen states can be compromising, as we mention below.

Some of the risk factors for BV:

• Lifestage and low oestrogen periods - BV is particularly common post partum and post menopause.
• Pregnancy, due to the impact of fluctuating hormones.
• Lifestyle factors that disrupt the vaginal pH - douching, chemicals in personal hygiene products.
• Sexual partner reinfection: partners can carry BV associated microbes in their semen and pass these across during intercourse.⁴
• Nicotine found in cigarettes can increase one’s risk of BV.⁵
• Ethnicity - BV is more common in women of Afro-Caribbean descent.⁶
• Immune dysfunction: specifically, vitamin D deficiency during pregnancy can increase one’s risk of BV.⁷

BV has a very high recurrence rate after antibiotic treatment.³ With a 15-50% recurrence in 3 months, and a 50-70% recurrence in 12 months.³ Some of the reasons for these figures include - resistant microbes, microbes in biofilms (protected habitats), reinfection by a sexual partner, failure to establish lactobacilli dominance and ongoing hormonal and systemic drivers.

Why is BV an issue for women’s genitourinary and gynaecological health.

BV has been associated with several adverse fertility outcomes including: pre-term birth, low birth rate, neonatal intensive care unit admission, premature rupture of membranes (PROM) and intrauterine infection.⁸ BV can increase one’s risk of of Pelvic Inflammatory Disease (PID), which can cause infertility and increase the risk of ectopic pregnancy.

BV can also lead to endometritis (inflammation of the uterine lining) and salpingitis (inflammation of the fallopian tubes), given these microbes ascend from the vaginal canal, up past the cervix (causing cervicitis in some), and into the uterus. BV can make it easier for women to contract sexually transmitted infections (STIs) like HIV, chlamydia, and gonorrhea too. Overall, BV is ideally treated and the vaginal microbiome environment rebalanced.

What are the medical treatment options for BV?

BV can be diagnosed by a medical professional, either based on symptoms or via a swab. A vaginal microbiome test can also act as input for a GP’s diagnosis. Treatment is often considered in light of an individual’s symptoms and health goals. If a woman is pregnant, or trying to conceive, treatment is especially important.

The current medical treatment regimens for BV are antibiotics, such as metronidazole and clindamycin. These can be prescribed as oral tablets or vaginal routes. Some GPs recommend both modes of delivery. Over the counter options include BV gels containing glycogen and lactic acid, which promote growth of healthy lactobacillus bacteria, thereby suppressing growth of BV associated microbes.

Non medical options for microbiome re-balancing

Other options to restore the balance of the vaginal microbiome include lactobacillus targeted probiotics aimed at restoring health in the vagina. These oral bacteria, reach the vagina alive and have been shown to improves the microbial pattern in vaginal dysbiosis.⁹

We sell Ultimate V, designed to promote vaginal microbiome health, and Ultimate UT (containing D mannose in addition to probiotics), designed to support bladder and vaginal microbiome health. For those wanting a more natural route to antibiotics, oral garlic capsules are an option. In a randomised clinical trial, the therapeutic effects of garlic on BV were similar to that of metronidazole.¹⁰

Please pay attention to the generic tips below to support a healthy vaginal microbiome.

Actions to prevent BV

A mix of lifestyle, diet and supplement interventions can help a woman avoid BV long term. For more personalised advice please seek the advice of a healthcare professional or a nutritionist working in this area.

Diet

• Regularly consume probiotic containing foods such as kefir, sauerkraut, kombucha, live yogurt, sourdough bread, olives in brine.
• Regularly consume prebiotic foods: artichoke, berries, banana, oats, leeks, onions, garlic.
• Avoid processed foods, and foods high in refined sugar e.g. cake, biscuits, milk chocolate. Make sensible swaps e.g. honey with plain yogurt instead of flavoured yogurt, dark chocolate (over 70%) instead of milk chocolate.
• Include oily fish, chia seeds, and walnuts, alongside good sources of protein. These support tissue and immune health.

Lifestyle

• Ensure a good level of vitamin D (ask your GP for a check, and supplement during the winter).
• Avoid chemicals in your washing products (soaps, laundry etc). Choose plant based and unscented.
• Use a pH balanced lubricants such as our YES range.
• Use a condom if its an option and sex triggers symptoms, or consider partner treatment with your GP.
• Be wary of hot-tubs which can harbour pathogens, and always change out of lycra after sweaty exercise.

Supplements

• Take a probiotic designed to support the vaginal microbiome, such as our Ultimate V product.

Further investigation is warranted if BV is recurring and traditional treatment isn’t working. Areas to consider include hormone health, specifically oestrogen status (some women find vaginal oestrogen helpful for reducing BV post menopause) and partner reinfection which can be discussed with a GP.

Our Vaginal Microbiome Test is a useful, exploratory test to consider if you have not been able to get a proper diagnosis of your vaginal symptoms, and want more granularity and insights to support treatment.

Disclaimer: Please note that this is not medical advice. Please see a healthcare professional about any new symptoms or ongoing conditions.

References

1. National Institute for Health and Care Excellence. (n.d.). Bacterial vaginosis. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/bacterial-vaginosis/
2. Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, Markowitz LE. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007 Nov;34(11):864-9.
3. Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Front Reprod Health. 2023 May 31;5:1100029.
4. Vodstrcil LA, Plummer EL, Fairley CK, Hocking JS, Law MG, Petoumenos K, Bateson D, Murray GL, Donovan B, Chow EPF, Chen MY, Kaldor J, Bradshaw CS; StepUp Team. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2025 Mar 6;392(10):947-957.
5. Brotman RM, He X, Gajer P, Fadrosh D, Sharma E, Mongodin EF, Ravel J, Glover ED, Rath JM. Association between cigarette smoking and the vaginal microbiota: a pilot study. BMC Infect Dis. 2014 Aug 28;14:471.
6. Alcendor DJ. Evaluation of Health Disparity in Bacterial Vaginosis and the Implications for HIV-1 Acquisition in African American Women. Am J Reprod Immunol. 2016 Aug;76(2):99-107.
7. Ma L, Zhang Z, Li L, Zhang L, Lin Z, Qin H. Vitamin D deficiency increases the risk of bacterial vaginosis during pregnancy: Evidence from a meta-analysis based on observational studies. Front Nutr. 2022 Nov 22;9:1016592.
8. Kenfack-Zanguim J, et al. Systematic review and meta-analysis of maternal and fetal outcomes among pregnant women with bacterial vaginosis. Eur J Obstet Gynecol Reprod Biol. 2023 Oct;289:9-18.
9. Mändar R, Sõerunurk G, et al. Impact of Lactobacillus crispatus-containing oral and vaginal probiotics on vaginal health: a randomised double-blind placebo controlled clinical trial. Benef Microbes. 2023 Apr 18;14(2):143-152.
10. Mohammadzadeh F, et al. Comparing the therapeutic effects of garlic tablet and oral metronidazole on bacterial vaginosis: a randomized controlled clinical trial. Iran Red Crescent Med J. 2014 Jul;16(7):e19118.