Bacterial Vaginosis (BV): Symptoms, Treatment, and Diagnosis in Singapore

Bacterial vaginosis (BV) is a common vaginal condition caused by an imbalance of the natural bacteria in the vagina. Normally the vagina is dominated by Lactobacillus bacteria. In BV, these protective bacteria are reduced and other bacteria (commonly Gardnerella vaginalis and others) overgrow. BV is the most common cause of unusual vaginal discharge in women of reproductive age. Many women with BV have no symptoms.

BV develops when the natural balance of vaginal bacteria is disrupted. Common triggers include sexual activity (especially with new or multiple partners), douching or vaginal washing with harsh products, hormonal changes, and antibiotic use. The exact cause is not fully understood, and BV can occur in women who are not sexually active. BV is not caused by poor hygiene.

Many women with BV have no symptoms. When symptoms occur, the most common is thin, grey or white vaginal discharge with a fishy odour, often more noticeable after sex or during periods. Some women also experience vaginal itching or burning during urination. Pain is uncommon. BV symptoms can overlap with yeast infection or trichomoniasis, so testing helps confirm the diagnosis.

BV is not classified as a sexually transmitted infection, but sexual activity can influence BV risk. New or multiple partners, douching, and unprotected sex can disrupt the vaginal microbiome. BV can also occur in women who are not sexually active. Male partners do not typically need treatment, but female partners of women with BV may benefit from evaluation in some cases.

Yes. BV is curable with appropriate antibiotic treatment prescribed by a doctor. Most cases respond well to a short course. However, BV can recur after treatment, and recurrence within a year is common. Recurrent BV may require longer courses or maintenance treatment. Identifying and addressing triggers can help reduce recurrence.

BV is treated with prescription antibiotics. Your doctor will choose the appropriate antibiotic and form (oral tablet, vaginal cream, vaginal gel) based on your situation, pregnancy status, allergies, and current clinical guidance. Complete the prescribed course even if symptoms improve. Avoid alcohol with certain BV medications if advised by your doctor.

BV risk can be reduced by avoiding douching or vaginal washing with harsh products, using mild unscented soap externally only, wearing breathable cotton underwear, changing out of damp swimwear or workout clothes promptly, using condoms (which may help reduce risk especially with new partners), and limiting unnecessary antibiotic use. There is no proven way to fully prevent BV.

Many BV episodes may improve, but symptomatic or persistent BV should be assessed and treated. In pregnancy, untreated BV has been associated with preterm delivery, low birthweight, and post-delivery infection. Untreated BV may also increase the risk of acquiring other STIs (including HIV) and may contribute to pelvic inflammatory disease (PID) in some cases.

Recurrent BV is common, with recurrence within a year of treatment occurring in many women. Triggers may include resumption of sexual activity with the same untreated partner, ongoing douching, antibiotic use, hormonal changes, or persistent shifts in vaginal flora. A doctor can recommend longer treatment courses or maintenance therapy and help identify contributing factors.

You can be assessed at Mediway through a GP consultation. Diagnosis may include symptoms, examination, vaginal pH, microscopy, or a vaginal swab, depending on the clinical situation (the Amsel criteria are commonly used). The doctor will recommend appropriate treatment based on the diagnosis and your situation. Speak to our team to arrange a confidential consultation.