What Is Bacterial Vaginosis? Symptoms, Testing and Treatment Options

Vaginal odor, unusual discharge, itching, and burning can be uncomfortable—and it is not always easy to tell what is causing them. Bacterial vaginosis, commonly called BV, is one possible explanation. However, yeast infections, sexually transmitted infections, urinary tract infections, and other vaginal conditions can cause symptoms that feel similar.

This guide explains what bacterial vaginosis is, which symptoms may occur, how BV differs from other common conditions, and what testing and treatment options are available.

What is bacterial vaginosis?

Bacterial vaginosis is a common vaginal condition caused by a change in the natural balance of bacteria in the vagina. BV occurs when certain types of bacteria become more abundant than the protective bacteria that normally help maintain the vaginal environment.

BV is not simply a matter of poor hygiene, and it can occur in people who are not sexually active. Certain factors, including douching and having a new or multiple sexual partners, may increase the likelihood of developing BV, but the exact cause is not always clear.

BV is treatable, although it can return after treatment.

What are the symptoms of BV?

Some people with bacterial vaginosis have no noticeable symptoms. When symptoms do occur, they may include:

• Thin white, gray, or milky vaginal discharge
• A strong or “fishy” vaginal odor, which may be more noticeable after sex
• Vaginal irritation or itching
• Burning during urination

These symptoms are not exclusive to BV. Yeast infections, trichomoniasis, other sexually transmitted infections, irritation, and some urinary conditions can cause similar discomfort.

Because symptoms can overlap, testing may be more reliable than trying to identify the condition based on odor, discharge, or discomfort alone.

BV vs. UTI: What is the difference?

BV affects the vaginal environment. A urinary tract infection affects part of the urinary system, which can include the urethra, bladder, ureters, or kidneys.

Both conditions may cause burning or discomfort during urination, but their other symptoms often differ.

Symptoms that may be more consistent with BV

• A noticeable change in vaginal discharge
• Thin gray or white discharge
• A fishy vaginal odor
• Vaginal irritation or itching

Symptoms that may be more consistent with a UTI

• A frequent need to urinate
• A sudden or urgent need to urinate
• Bladder pressure or discomfort
• Passing only a small amount of urine
• Pain or burning centered around urination
• Blood in the urine
• A vaginal odor or change in discharge is not a typical primary symptom of a bladder infection. However, it is possible to have more than one condition at the same time.

A urine-based UTI test does not diagnose bacterial vaginosis. BV is generally evaluated using information and samples from the vagina.

BV vs. yeast infection

BV and vaginal yeast infections can both cause irritation and changes in discharge, but they are different conditions and require different treatments.

BV is associated with an imbalance of vaginal bacteria. A yeast infection is caused by an overgrowth of Candida, a type of fungus normally present in small amounts in the vagina.

Yeast infections are often associated with significant itching and a thick, white discharge. BV is more commonly associated with thin discharge and a noticeable fishy odor. These are general patterns, however, and symptoms alone may not provide a dependable diagnosis.

Learn more about the differences between BV and a yeast infection.

Is BV a sexually transmitted infection?

BV is not currently classified in the same way as sexually transmitted infections such as chlamydia or gonorrhea, and it can occur in people who are not sexually active.

However, research increasingly shows that sexual partners can influence the vaginal microbiome. BV-associated bacteria may be present on the penis or within the urethra after penetrative vaginal sex, even when the partner has no symptoms. These bacteria may be shared between partners and may contribute to BV developing again after treatment.

This means recurrent BV is not necessarily the result of anything a person did wrong, poor hygiene, or a failure to follow treatment correctly. A partner may carry BV-associated bacteria without knowing it.

Research into partner treatment is continuing. A recent clinical trial found that treating both a woman with BV and her male partner reduced BV recurrence compared with treating the woman alone. However, recommendations may vary, and partner treatment is not yet offered routinely in every healthcare setting.

Because BV, yeast infections, urinary conditions, and some STIs can cause overlapping symptoms, a healthcare professional may recommend vaginal testing, STI testing, or evaluation of both partners depending on the symptoms, recurrence pattern, pregnancy status, and individual circumstances.

How is bacterial vaginosis tested?

BV testing usually involves a sample of vaginal fluid or discharge. Depending on the healthcare setting or testing service, the sample may be collected by a clinician or through an appropriate self-collection process.

A healthcare professional may evaluate:

• Vaginal discharge
• Vaginal pH
• The presence of certain cells under a microscope
• Odor produced during laboratory evaluation
• The presence or pattern of bacteria associated with BV

A vaginal pH result alone cannot confirm BV. Other vaginal conditions can also affect pH, so the result needs to be considered alongside symptoms and additional testing.

Testing can be especially helpful when:

• This is the first time you have experienced these symptoms
• Your symptoms could be caused by more than one condition
• Over-the-counter yeast treatment did not help
• Symptoms return after treatment
• You are pregnant
• You may have been exposed to an STI
• You have pelvic pain, fever, bleeding, sores, or worsening symptoms

Can BV be diagnosed with a urine test?

BV is a vaginal condition, so a standard urine culture or UTI test is not designed to diagnose it. A vaginal sample is typically used when evaluating BV.

Burning during urination can occur with BV, a UTI, an STI, or irritation of the vulvar and vaginal tissues. If urinary and vaginal symptoms occur together, it may be appropriate to discuss testing for more than one possible cause.

How is BV treated?

When treatment is needed, bacterial vaginosis is generally treated with prescription antibiotics. Depending on the individual and the clinician’s recommendation, treatment may be taken by mouth or applied vaginally as a gel or cream. Commonly used medications include metronidazole and clindamycin.

A healthcare professional should determine the appropriate medication and treatment plan. Products intended to treat yeast infections will not treat BV because yeast infections and bacterial vaginosis have different causes.

Take or use medication exactly as directed, even if symptoms improve before treatment is complete. Contact your healthcare provider if symptoms continue, worsen, or return.

Why does BV sometimes come back?

BV recurrence is common. The vaginal microbiome can change again after treatment, and some people experience repeated episodes.

If symptoms return, avoid assuming that every recurrence is BV. Similar symptoms can be caused by yeast, trichomoniasis, other infections, hormonal changes, skin conditions, or irritation.

A healthcare professional may recommend repeat testing or a different management strategy when BV recurs frequently.

Can you prevent BV?

There is no guaranteed way to prevent every case of bacterial vaginosis, but certain practices may help protect the vaginal environment:

• Avoid douching
• Avoid scented vaginal washes, deodorants, and fragranced products inside the vagina
• Wash the external vulvar area gently rather than attempting to clean inside the vagina
• Use medications only as directed
• Seek testing when symptoms recur instead of repeatedly self-treating without knowing the cause

The vagina does not need to be cleaned internally. Douching can disrupt its natural bacterial balance and is associated with a higher risk of BV.

When should you contact a healthcare professional?

Consider seeking medical care when:

• You have new or unexplained vaginal symptoms
• Symptoms are severe, persistent, or recurrent
• You have pelvic or lower abdominal pain
• You have fever, chills, sores, or unusual bleeding
• You are pregnant or may be pregnant
• You may have been exposed to an STI
• Symptoms developed after a new sexual partner
• An over-the-counter treatment did not help
• You are unsure whether your symptoms are vaginal or urinary

Seek prompt medical attention for severe pelvic pain, fever, significant bleeding, pregnancy-related concerns, or rapidly worsening symptoms.

Looking for BV testing or care?

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Could your symptoms be related to a UTI?

If your primary symptoms include urinary urgency, frequency, bladder pressure, pain during urination, or recurrent urinary discomfort, a urinary condition may also need to be considered.

Vaginal discharge and odor generally point toward a vaginal-health evaluation, while urinary urgency and frequency may support a urinary testing pathway. Symptoms can overlap, so testing for one condition does not always rule out another.

The bottom line

Bacterial vaginosis is common and treatable, but its symptoms can resemble those of yeast infections, STIs, irritation, and urinary conditions. Changes in discharge, odor, itching, or burning do not always reveal the cause on their own.

The right testing pathway depends on where the symptoms are occurring and which conditions need to be ruled out. When symptoms are new, persistent, recurrent, or difficult to distinguish, an appropriate vaginal evaluation can help guide the next step.

Medical disclaimer: This article is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Contact a qualified healthcare professional with questions about symptoms, testing, medications, pregnancy, or treatment decisions.