Bacterial vaginosis: can it clear up alone?

Written by: Dr Nneka Nwokolo
Edited by: Laura Burgess

Bacterial vaginosis (BV) is the most common vaginal infection, but most women have never even heard of it! BV arises from an imbalance in the natural vaginal environment. We’ve asked one of our top sexual health physicians Dr Nneka Nwokolo to explain more, from the cause of BV to how the infection is treated.


What is BV or bacterial vaginosis?

Under normal circumstances the vagina is full of bacteria called lactobacilli, which keep it healthy and produce lactic acid, making it acidic.

However, if the vagina becomes alkaline for any reason, such as during a period or after sex, then the normal bacteria are suppressed. Other bacteria that usually present in small quantities and that are suppressed in an acid environment, may then overgrow. The overgrowth of some of these bacteria is what causes BV.

What are BV symptoms?

Many women may have BV with no symptoms at all and only find out when swabs are taken during a sexual health check-up.

When they do occur, the most common symptom is a vaginal discharge that typically has a fishy or unpleasant smell. Unlike thrush, BV doesn’t typically cause itching although some women notice some vaginal discomfort.

Women with BV often notice that symptoms are worse after sex or after a period because semen and blood are alkaline and an alkaline environment encourages the growth of BV organisms.

Is BV considered to be an STD?

No, BV isn’t considered to be a sexually transmitted infection, however, some women notice that they develop BV when they change sexual partners. The reasons for this aren’t completely clear, but it’s thought that sex with a new partner introduces new and unfamiliar bacteria into the vagina. This alters the natural ecosystem (microbiome), which results in the growth of BV organisms.

How can you treat BV over-the-counter?

BV can be treated with a course of antibiotics, but several over-the-counter preparations are also available that work just as well.

Relactagel, Canes Balance and Balance Activ are all lactic acid treatments that are inserted into the vagina and can be used to both prevent and treat BV. BV can also be prevented by avoiding scented bath products and soaking in the bath for long periods, both of which may change the normal vaginal environment and promote BV.

Can BV go away without antibiotics?

Yes, BV can go away without antibiotics as the normal lactobacilli re-establish themselves. If this happens, there is often no need for treatment.

Do not hesitate to book an appointment for a sexual health check with Dr Nwokolo at one of her London clinics.

By Dr Nneka Nwokolo
Genitourinary Medicine

Dr Nneka Nwokolo is a London based consultant physician in Sexual Health and HIV Medicine who is known for her sensitivity and discretion.

Dr Nwokolo has extensive experience in the management of sexually transmitted infections STIs and HIV in men and women, and a special interest in the management of chronic and recurrent problems such as genital herpes, recurrent thrush and bacterial vaginosis. She has particular expertise in the treatment of syphilis and antibiotic-resistant gonorrhoea.

Other areas of expertise include contraception, management of the menopause, the sexual health of women and adolescents and pre and post-exposure prophylaxis against HIV infection.

She was the lead author of the 2015 UK National Guideline for the Management of Genital Chlamydia Infection. She has many publications in the fields of sexual health and HIV.

Dr Nwokolo provides the full range of contraceptive methods including implants and intrauterine contraception and is an instructing doctor for the Faculty of Sexual and Reproductive Health, providing training in contraception to doctors and nurses. She is the lead for young people in her NHS practice and provides sympathetic sexual health care and contraception to adolescents over the age of 16.


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