Bacterial vaginosis (BV) happens when the vaginal microbiome shifts. Protective lactobacilli drop. Other bacteria grow. The result can be a thin, gray discharge and a fishy odor, often stronger after sex. BV is common. It is treatable. You deserve a plan that is clear and based on evidence.
BV is not a hygiene failure. It is not a moral issue. It is a biology problem. The vagina is an ecosystem; pH, hormones, sex, products, and antibiotics can tilt it. When lactobacilli fall, pH rises. That new setting favors overgrowth. Symptoms flare. With the right plan, balance returns.
Bacterial vaginosis (BV) is not generally considered to be contagious. It is not caused by a sexually transmitted infection (STI) and does not spread from person to person through contact.
However, some studies have suggested that BV may be more common in sexually active women and that it may be transmitted between partners in certain cases. This is because BV is associated with an imbalance in the vaginal microbiome, which can be affected by sexual activity.
Therefore, while BV is not typically considered contagious, it is possible that it may be transmitted in some cases, especially between sexual partners. It is important to note that more research is needed to fully understand the transmission of BV.
Why correct diagnosis matters
BV symptoms overlap with yeast infections and some STIs. Treating the wrong condition delays relief and raises the chance of a quick return. A short intake should cover:
- Current symptoms and timing
- Recent antibiotics or new medications
- Sexual exposure and new partners
- Douching or scented products
- Pregnancy status and any pelvic pain or fever
If red flags appear—fever, severe lower abdominal pain, pregnancy with concerning symptoms—get in-person testing. That protects your health and guides a safer plan.
How BV differs from yeast: BV tends to cause a thin gray discharge and a noticeable odor. Yeast often causes thicker, cottage-cheese-like discharge and marked itch. These patterns help, but they are not perfect. When in doubt, get tested.
First-line treatments that work
Two medicines lead most plans:
- Metronidazole — oral tablets or a vaginal gel
- Clindamycin — vaginal cream or ovules
Your clinician matches the form to your needs and preferences. Oral dosing is simple and fits busy days. Vaginal dosing can limit systemic side effects for some people and is useful when the gut is sensitive.
Finish the full course, even if symptoms fade early. Stopping early invites a rebound. Ask for simple written directions: when to take each dose, if sex should be avoided, and what to do if you miss a dose.
Common effects to expect: A metallic taste with oral metronidazole, mild stomach upset, or temporary local irritation with vaginal products. These usually pass. If you develop a rash, severe nausea, or worsening pain, contact your clinician.
Telehealth makes access simple
Telehealth reduces delay and removes guesswork. A structured intake, a short clinical review, and clear instructions get you started fast. If oral therapy fits best, you can receive BV pills online after a safe screening. If a gel or cream fits better, that option is ready too. Done well, BV treatment online includes:
- Clear dosing
- Alcohol advice when taking oral metronidazole
- Guidance on sex during treatment
- A follow-up plan if symptoms return
You choose local pickup or discreet delivery. You can message the care team if questions come up. You avoid crowded waiting rooms and long gaps between symptoms and treatment.
Recurrence is common; prevention helps
Up to half of people see BV return within 6–12 months. You can lower risk with steps that protect the microbiome:
- Do not douche.
- Avoid scented washes and internal products.
- Use condoms to reduce pH shifts from semen.
- Choose breathable underwear and avoid tight, non-breathable layers for long hours.
Ask about maintenance plans if you face frequent recurrences (for example, intermittent metronidazole gel).
Probiotics may help some people. Evidence is mixed and depends on strain and dose. If you plan to try them, ask which product and schedule your clinician recommends. Avoid jumping between products each week. Give one plan time to work.
Boric acid? Some people use vaginal boric acid as part of a maintenance plan. Do not self-start without guidance. It is not first-line for BV and should not be used during pregnancy. If your clinician suggests it, ask for a clear schedule and safety steps.
Sex, products, and daily habits
BV is about balance. Small changes can help the system stay steady.
Sex and condoms
Semen raises vaginal pH. For many, consistent condom use lowers recurrence. If odor flares after sex, track that. Share the pattern with your clinician. It can shape your plan.
Products
Use water or a mild, unscented cleanser on the vulva only. Nothing internal. Skip scented wipes, bubble baths, and perfumed pads. Avoid harsh soaps and strong detergents for underwear. A free-and-clear laundry detergent helps.
Underwear and clothing
Breathable cotton helps. Change out of wet swimsuits and workout clothes soon after activity. Tight synthetic layers trap heat and moisture and may aggravate symptoms.
Lube and toys
Choose lubes that do not irritate tissue. Wash toys with warm water and a gentle, unscented cleanser after each use. Let them dry fully. Shared items need condoms or covers changed between partners.
Alcohol and metronidazole
Oral metronidazole can react with alcohol. You may need to avoid alcohol during the course and for a period after the last dose. Your clinician will specify the window. Follow that advice to prevent nausea, flushing, and cramps. If alcohol avoidance is hard due to an event or trip, ask whether the vaginal gel is a better short-term fit.
Tracking patterns
A simple log improves care:
- Date and symptoms
- Period start and end
- Sex, condom use, and any flare afterward
- New products or antibiotics
- What treatment you used and how it worked
Patterns emerge. Some people flare after periods. Some flare after antibiotics. Some flare with a new partner. Once you see the pattern, you can act early: schedule a check, use a maintenance gel, or adjust habits around known triggers.
Red flags that need in-person care
Seek care if you have:
- Fever or severe lower abdominal pain
- Pregnancy with persistent discharge or odor
- No improvement after a full, correctly taken course
- Exposure risk for STIs or signs of pelvic inflammatory disease
- New bleeding, severe itching, or ulcers
Testing guides a better plan. It also protects long-term health and fertility.
Maintenance plans for frequent recurrences
If you have three or more episodes in a year, ask about a step-down plan. A common approach uses a full treatment course followed by a maintenance gel on a set schedule (for example, twice weekly for several months). The aim is to hold pH in a protective range while the microbiome stabilizes. Pair maintenance with the habit steps above. Review progress every 8–12 weeks and adjust.
Travel, exercise, and everyday life
Travel
Pack your medication, liners, and a small sample of gentle cleanser. If you expect a flare after long flights or swims, message your clinician before you go. Agree on a backup plan.
Exercise
Movement is fine. Change out of wet gear soon after your workout. Rinse off sweat and apply treatment after your shower if you are using a vaginal product.
Workdays
If discharge increases during treatment, use unscented liners. Change them often. Avoid fragranced products.
How to talk about BV without shame
Use clear, neutral words. Tell partners, “I have BV, which is a microbiome imbalance. I’m treating it.” Ask for condoms and for patience while you complete the course. Most partners respond well when you speak plainly.
If fatigue or embarrassment makes care feel heavy, write your questions down before the visit. A short list helps you leave with a plan you understand.
The bottom line
BV is common and manageable. Fast access and clear guidance make the difference between a cycle of flares and a steady return to balance. Telehealth lets you move from symptoms to treatment without delay, and it keeps communication open if questions come up. With the right medicine, straight instructions, and a few daily habits, most people get relief and longer stretches without symptoms.
You do not need to guess or feel stuck. Start with a clear diagnosis. Pick oral or vaginal treatment that fits your life. Protect the microbiome with simple steps. Track patterns so you can act early next time. And if BV keeps boomeranging, ask about a maintenance plan. Balance is possible—and with a calm, simple plan, you can keep it.
This article was written for WHN by Sara Fedah, a certified skincare expert with years of experience helping people achieve healthy, radiant skin through science-backed routines and natural care. Passionate about holistic wellness, Sara shares practical skincare advice, product insights, and self-care tips to help readers glow from the inside out.
As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before changing your wellness routine. WHN neither agrees nor disagrees with any of the materials posted. This article is not intended to provide a medical diagnosis, recommendation, treatment, or endorsement.
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