A Specialist GP arranges your test over a quick phone call — they review your symptoms and send your pathology referral by SMS. BV, thrush and trich cause similar symptoms, so a test confirms which one it is.
Book a telehealth consult — free with Medicare (bulk-billed)
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Bacterial vaginosis, usually shortened to BV, is a very common condition where the natural balance of bacteria in the vagina is disrupted. Normally the vagina is dominated by protective bacteria that keep it slightly acidic; in BV, these are outnumbered by other bacteria, which changes the environment and causes symptoms. It’s the most common cause of abnormal vaginal discharge in people of reproductive age — more common than thrush.
BV isn’t dangerous in most situations, and it’s straightforward to treat. Its main frustrations are that it’s easily confused with thrush (and treated with the wrong thing), and that it has a tendency to come back — both of which this page addresses.
BV Symptoms — BV or Thrush?
Many people with BV have no symptoms at all. When symptoms do occur, the hallmark is a change in discharge and, above all, smell:
A thin, greyish-white discharge
A distinctive fishy odour, often more noticeable after sex
Usually little or no itch or soreness — which helps distinguish it from thrush
The fishy smell is the standout feature of BV. If a smell is the main thing you’ve noticed, and there’s little itching, BV is more likely than thrush. That said, symptoms overlap enough that they can’t be relied on alone — and BV and thrush are constantly mistaken for one another, each needing different treatment.
Bacterial vaginosis (BV)
Thrush
Discharge
Thin, greyish-white
Thick, white, cottage-cheese-like
Odour
Fishy, worse after sex
Usually none
Itch
Usually little or none
Intense — the main symptom
Cause
Bacterial imbalance
Yeast overgrowth
Treatment
Antibiotics
Antifungals
A simple rule of thumb: smell points to BV, itch points to thrush. But the two can overlap or occur together, and self-diagnosis is often wrong — so if you’re unsure, or over-the-counter treatment hasn’t worked, a swab sorts it out.
What triggers BV?
BV happens when the vaginal bacterial balance is disturbed. Things that can contribute include douching and vaginal washes (one of the biggest culprits, as they wash away protective bacteria), perfumed soaps and vaginal hygiene products, a new or multiple sexual partners, and having periods — and sometimes there’s no identifiable trigger at all. Getting BV doesn’t mean poor hygiene — in fact, over-washing and using cleaning products inside the vagina makes it more likely, not less. The vagina cleans itself, and disturbing it is what causes the problem.
Is BV a sexually transmitted infection?
The understanding of BV has shifted. It was long considered not to be an STI, but recent research has changed that picture: BV is now understood to be sexually transmissible, and can be passed between partners. A landmark trial showed that treating male partners of women with recurrent BV significantly reduced how often it came back — strong evidence that partners can play a role. This matters mostly for people with recurrent BV: if BV keeps returning, treating a regular partner as well may now be part of the approach. For a one-off episode, this is less of a consideration.
Testing for BV
BV is diagnosed with a simple vaginal swab, which can often be self-collected in private rather than needing an examination. The swab is checked for the signs of bacterial imbalance that indicate BV, and it can also test for thrush and trichomoniasis at the same time — the two conditions most often confused with BV. This is why testing is worthwhile when the diagnosis isn’t clear: it confirms what you actually have, so you get the right treatment first time. Results are usually available within a few days.
How testing works with Clinic365
A Specialist GP reviews your symptoms over a quick phone call and sends your pathology referral by SMS. You walk into any pathology lab Australia-wide — no appointment needed — and results come back by SMS, usually in 2-3 days. Because the swab can check for BV, thrush and trichomoniasis together, you get the right diagnosis and the right treatment rather than guessing. You can also add a full STI test if there’s any chance of an infection.
BV Treatment and Recurrent BV
BV is treated with antibiotics, given either as a course of tablets or as a vaginal gel or cream. Both work well, and a clinician will help you choose based on your preference and situation. Symptoms usually improve within a few days. Complete the full course even once symptoms settle, follow your clinician’s advice about alcohol if you’re given a particular oral treatment (as some can interact with it), avoid douching and vaginal washes (which can undo the benefit and trigger BV again), and tell your clinician if you are or might be pregnant, as this affects the choice of treatment. For a straightforward first episode, a single course usually clears it. The bigger challenge for many people is recurrence.
Recurrent BV
BV has a real tendency to come back — recurrence within a few months is common, and it’s one of the most frustrating things about the condition. If BV keeps returning, the approach is different from treating a one-off: confirm it’s actually BV with a swab each time (since recurring symptoms aren’t always BV), longer or maintenance treatment may be used to keep it at bay over several months, treating a regular partner may now be considered (given the evidence that this reduces recurrence), and removing triggers — especially stopping douching and vaginal washes — helps. If you’re getting BV again and again, don’t just keep self-treating: see a clinician, get a swab, and discuss a proper plan.
Treating partners
Following recent evidence, treating a regular male partner is now sometimes recommended for people with recurrent BV, because it can reduce how often BV returns. This is a change from older advice, which didn’t recommend treating partners. For a single, first episode of BV, partner treatment generally isn’t needed. A clinician will advise whether it’s appropriate for your situation based on current guidance.
BV and pregnancy. BV in pregnancy is worth knowing about, as it’s associated with a higher risk of some pregnancy complications, including premature birth. If you’re pregnant and have BV symptoms, it’s worth being tested and treated. Treatment in pregnancy is safe and effective, but the choice of treatment differs, so always tell your clinician if you are or might be pregnant.
Prevention and Self-Care
You can reduce your chances of BV — and, importantly, avoid some common habits that make it worse:
Don’t douche or use vaginal washes. This is the single most important step — the vagina cleans itself, and these products disturb the balance and cause BV.
Avoid perfumed soaps and vaginal hygiene products. Wash the vulva with water or a plain non-soap cleanser.
Avoid getting soap and shower gel inside the vagina.
Wipe front to back, and change out of damp clothing promptly.
Probiotics and other remedies are often suggested online; the evidence is mixed, and they’re no substitute for proper treatment or for finding out what’s actually causing your symptoms.
Frequently asked questions
BV is a very common condition where the natural balance of bacteria in the vagina is disrupted, with protective bacteria outnumbered by others. It’s the most common cause of abnormal vaginal discharge in people of reproductive age — more common than thrush. It isn’t dangerous in most situations and is straightforward to treat, though it can be prone to coming back.
Many people have no symptoms. When present, the hallmarks are a thin, greyish-white discharge and a distinctive fishy odour, often worse after sex, usually with little or no itch or soreness. The fishy smell is the standout feature — if a smell is the main thing you’ve noticed and there’s little itching, BV is more likely than thrush.
A useful rule of thumb: smell points to BV, itch points to thrush. BV causes thin greyish discharge with a fishy smell and little itch; thrush causes thick white discharge with intense itch and usually no smell. But they can overlap or occur together, and self-diagnosis is often wrong, so a swab confirms which you have and ensures the right treatment.
Understanding has shifted. BV was long considered not an STI, but recent research shows it’s sexually transmissible and can be passed between partners. A landmark trial found that treating male partners of women with recurrent BV significantly reduced recurrence. This matters mainly for recurrent BV, where partner treatment may now be part of the approach; for a one-off episode it’s less of a consideration.
BV is diagnosed with a simple vaginal swab, often self-collected in private. The swab is checked for the signs of bacterial imbalance that indicate BV, and can test for thrush and trichomoniasis at the same time — the conditions most often confused with BV. This confirms what you actually have so you get the right treatment. Results usually take a few days.
BV is treated with antibiotics, given as a course of tablets or as a vaginal gel or cream — both work well. Symptoms usually improve within a few days. Complete the full course even once symptoms settle, avoid douching and vaginal washes, follow any advice about alcohol with certain oral treatments, and tell your clinician if you’re pregnant, as it affects the choice.
BV has a real tendency to recur, often within a few months. If it keeps returning, the approach differs: confirm it’s actually BV with a swab each time, consider longer or maintenance treatment, remove triggers like douching, and — given recent evidence — consider treating a regular partner. Don’t just keep self-treating; see a clinician for a proper recurrent-BV plan.
Following recent evidence, treating a regular male partner is now sometimes recommended for recurrent BV, because it can reduce how often BV returns — a change from older advice. For a single, first episode, partner treatment generally isn’t needed. A clinician will advise whether it’s appropriate for your situation based on current guidance.
BV sometimes settles by itself, but it often doesn’t, and it can persist or recur. If you have symptoms — particularly the characteristic fishy smell — it’s worth testing and treating rather than waiting, as treatment is simple and effective. Treatment also matters more in pregnancy and before some gynaecological procedures, so it’s best not to just leave it.
Yes. BV in pregnancy is worth treating, as it’s associated with a higher risk of some complications including premature birth. Treatment in pregnancy is safe and effective, but the choice of treatment differs, so always tell your clinician if you are or might be pregnant. If you have symptoms in pregnancy, it’s worth being tested.
BV happens when the vaginal bacterial balance is disturbed. Common triggers include douching and vaginal washes (a major culprit), perfumed soaps and hygiene products, a new or multiple partners, and having periods — and sometimes there’s no identifiable trigger. Getting BV doesn’t mean poor hygiene; over-washing and cleaning inside the vagina actually makes it more likely.
The single most important step is to not douche or use vaginal washes, which disturb the natural balance and cause BV. Also avoid perfumed soaps and vaginal hygiene products, don’t get soap inside the vagina, wash the vulva with water only, and change out of damp clothing promptly. These simple measures reduce your chances of BV and recurrence.
