Vaginal Health

Updated 12 August 2019

Bacterial vaginosis, most common vaginal infection

Sponsored: Know the causes, symptoms and how to treat BV.

There are many health issues or conditions unique to women, from pregnancy and menopause to certain gynaecological conditions, one of which is bacterial vaginosis (BV)1.

Even though any woman can get BV2, and it affects up to 30% of women at some time3, many women still feel embarrassed or ashamed about having this condition3.

Bacterial vaginosis is the most common cause of unusual vaginal discharge, with one in three women experiencing this condition at some time in their lives4.

Alarmingly, even though BV is more common than thrush5-7, one study found that for many women who are diagnosed with BV, it is the first time they have heard of it8.

However, once they find out just how common BV is, they seem to be more at ease about managing the condition and are relieved that the infection is not their fault8.

It is also common for women to confuse bacterial vaginosis with a yeast infection (also known as candida vulvovaginitis)9, especially since they have similar symptoms2. In fact, results from a recent online survey showed that almost 22% of women thought their vaginal discharge was caused by a yeast infection, even though the symptoms described by 57% of the respondents were consistent with bacterial vaginosis9.

So, what is BV?
Bacterial vaginosis results from overgrowth of one of several bacteria naturally found in your vagina.

Usually, the "good" bacteria (lactobacilli) outnumber the "bad" bacteria. However, if there are too many bad bacteria, the natural balance of microorganisms in your vagina can be affected, causing a shift in the vagina’s PH levels (more alkaline) resulting in bacterial vaginosis4,10.

What are the symptoms of BV?
Common symptoms include increased thin white or grey vaginal discharge, increased fishy odour, and possible minimal burning during urination or itching around the vulva or both6,7,11.

Many people do not experience soreness, itchiness or irritation 4, therefore many BV sufferers might not seek treatment for this infection. The table below demonstrates the key symptom differences between bacterial vaginosis and thrush 6,11.

bacterial vaginosis

Causes of BV
While the exact cause of BV may be difficult to clarify8, it can be brought on by using medicated or perfumed soap or bubble bath, using antiseptic liquids in the bath, using a douche or vaginal deodorant, using strong detergents to wash underwear, smoking, hormonal changes during the menstrual cycle or even semen in the vagina after sexual intercourse without a condom4

How to treat bacterial vaginosis? 
The most effective treatments for bacterial vaginosis are prescribed antibiotics like metronidazole or clindamycin or tinidazole. They are available as oral medications, which are taken by mouth, or as a gel or cream, both of which are inserted into the vagina with an applicator12

One option, a treatment preferred by most South African gynaecologists13,14, is a water-based gel treatment which is administered vaginally, meaning that the infected area is treated directly and topically with a once a day dose for five consecutive days15.

It is effective, convenient and time saving15-17, and is available over the counter at leading pharmacies.

Visit My Vaginal Gel and complete a self-assessment questionnaire to check if your symptoms might be BV. For information about bacterial vaginosis, speak to your doctor or healthcare professional.

DISCLAIMER: This editorial has been commissioned and brought to you by iNova Pharmaceuticals.  Content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional. 

Further information is available on request from iNova Pharmaceuticals. Name and business address: iNova Pharmaceuticals (Pty) Ltd. Co. Reg. No. 1952/001640/07. 15E Riley Road, Bedfordview. Tel. No. 011 087 0000. IN3436/19

1. NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development. What health issues or conditions are specific to women only? (2016) at
2. Office on Women’s Health. Bacterial Vaginosis (2014) at
3. Bilardi, JE et al. The Burden of Bacterial Vaginosis: Women’s Experience of the Physical, Emotional, Sexual and Social Impact of Living with Recurrent Bacterial Vaginosis. PLOS ONE (2013) at
4. Thrush and Bacterial Vaginosis. FPA (Sexual Health Charity). NHS. January 2014 ( Website accessed on 8 February 2018
5. Hoosen AA. Management of vaginal discharge. CME 2004; 22(2):72-78. 
6. Eckert L. Acute Vulvovaginitis. N Engl J Med 2006;355:1244-52. 
7. Centers for Disease Control and Prevention. CDC Fact Sheet. Bacterial Vaginosis .June 2017 at
8. How Vaginal Infections Impact Women’s Everyday Life. Advances in Sexual Medicine (2017) at
9. Healthy Women. What is the difference between a yeast infection and bacterial vaginosis? (2017) at
10. Mayo Clinic. Bacterial vaginosis. [online] July 2017 [cited April 2019]; Available from URL:
11. Ries AJ. Treatment of Vaginal Infections: Candidiasis, Bacterial Vaginosis and Trichomoniasis. J Am Pharm Assoc. 1997;NS37(5):563-569
12. What are the treatments for bacterial vaginosis (BV)? [online] 12 January 2016 [Cited] 5 November 2018. Available from URL:
13. Impact Rx. April 2019. 
14. Data on file, February 2019
15. Approved product package insert. October 2000.
16. Wain A. Metronidazole Vaginal Gel 0.75% (MetroGeI-Vaginal®) A Brief Review. Infectious Diseases in Obstetrics and Gynecology 6:3-7 (1998). 
17. Beigi R, Austin M, Meyn L, et al. Antimicrobial resistance associated with the treatment of bacterial vaginosis. American Journal of Obstetrics and Gynecology (2004) 191, 1124-9.