Understanding BV: Diagnosis & Treatment

You may have suffered for many years with symptoms of bacterial vaginosis, but getting properly diagnosed is important. You may not have BV.

We recommend talking to your doctor about your diagnosis and asking what tests were performed. Always always get a copy of your lab results after every visit. Not all tests are created equal and if your BV doesn’t go away, you need to be able to investigate with another practitioner or on your own.

In BV, or any vaginal dysbiosis, you have lost all or some of your naturally beneficial vaginal flora, and another bug has filled taken up residence.

BV can be really hard to get rid of, and most doctors won’t treat you for a number of suspect bacteria that could keep your BV hanging around and resistant to treatments. Get yourself a comprehensive vaginal microbiome test or ask your doctor for a complete PCR panel to rule out lurkers and get proper treatment.

The diagnosis for BV – three of these four signs and symptoms:

Evenly coloured grey-white discharge on the vaginal walls (you may not be able to see this)
‘Clue cells’ on the wet-mount slide (wet mounted but performed in all countries as standard)
Vaginal pH over 4.5 (G. vaginalis and other bacteria make the vagina less acidic, but the natural flora, Lactobacilli, make it acidic)
Fishy odour, which if not present by ordinary smelling by your doctor, is found by adding in potassium hydroxide, called the Whiff Test
A test (culture, NGS or PCR) will likely be performed to determine the microbes present and the best treatment – but remember not all microbes are able to be cultured (grown in a petri dish) so opt for the more comprehensive NGS or PCR tests

Don’t wash away or overpower the bad bacteria before your tests – a false negative is bad!

Keep in mind that if you have been douching to get rid of the smell, you have probably washed away most of the ‘clues’ so if you want a positive diagnosis, don’t douche or use any treatments before your doctor’s visit. This guideline applies to STI testing too.

Usual BV prescription

Your doctor will give you a prescription for antibiotics, usually metronidazole, because, for many, they do work, at least at first. At three months, however, the recurrence rate is very high.

Most literature says that male sexual partners do not need to be treated, however, this is not true – men respond well to local treatments.

Penises can pass the infection back to the vagina very easily, and BV-causing bacteria has been found in urine and semen samples of men. Oral antibiotics have not been shown to be effective in reducing recurrence rates in female partners, though they may be prescribed.

You will likely be prescribed oral or vaginal (or both) antibiotics. This may be a mixture of metronidazole oral tablets or gel, clindamycin cream, or tinidazole and clindamycin cream or pessaries (vaginal inserts).

Your doctor may do a range of tests, particularly for STIs, possibly allergies (condoms, etc.) and may do abdominal tests for pelvic inflammatory disease (PID).

If the antibiotic treatment doesn’t work, another round will probably be prescribed.

Check your pH at home, and if your treatment doesn’t work, we recommend thorough testing and seeking alternative treatments such as those found in Killing BV.