Bacterial vaginosis does not cause bumps, rashes, or lesions (sores). If you are experiencing these symptoms, you could have a sexually transmitted infection (STI) and should see a healthcare provider. 

This article reviews symptoms, similar conditions, diagnosis, treatment, and prevention of bacterial vaginosis.

Bacterial Vaginosis Symptoms

Some women don’t realize they have bacterial vaginosis because they do not have symptoms. For others, symptoms may be intermittent (come and go). When symptoms are present, the most common include:

Douching regularlyHaving multiple sex partnersNot using condomsSmokingHaving vaginal sex with women (typically, both women get the infection)Pregnancy

BV is also more prevalent in Black and Hispanic populations.

A strong fishy smelling vaginal discharge (often the strongest after vaginal sexual intercourse or menstruation). Increased vaginal discharge that is usually thin (and sometimes foamy), gray, greenish, yellow, or white.  

Less common symptoms include:

Vaginal discomfortBurning or itching in or outside of the vaginaBurning while urinatingBleeding after intercourse

What Other Conditions Could It Be?

Vaginitis is an inflammation of the vagina that causes vaginal discharge or irritation. Bacterial vaginosis (BV) is the most common type of vaginitis.

Other vaginal infections share symptoms such as vaginal irritation, increased discharge, or burning during urination, but can be distinguished by their characteristic symptoms. These include:

Yeast infection: A yeast infection usually causes a thick or chunky (cottage cheese-like) vaginal discharge that does not have a foul odor.   Vaginal atrophy: This results from a thinning in the vaginal tissues. It typically occurs after menopause when estrogen levels decrease and causes vaginal dryness, irritation, and burning.   Noninfectious vaginitis: This is vaginal irritation caused by scented products such as vaginal sprays or detergents, spermicides, douches, or forgotten tampons.   Trichomoniasis: This STI can cause a strong vaginal odor and a yellow-green, sometimes frothy, vaginal discharge. Sexual intercourse may also be painful. Chlamydia: Symptoms of this STI include foul-smelling discharge, bleeding between periods, painful sex, and abdominal (tummy) or pelvic (between the hips) pain. Gonorrhea: This STI can cause increased vaginal discharge, vaginal bleeding between periods, painful urination, and pelvic pain.

Diagnosing Bacterial Vaginosis

Your healthcare provider will start with a medical history, physical, and vaginal exam to diagnose BV. This is similar to a pelvic exam and Pap smear (exams you get during routine gynecological wellness checks). 

During the exam, they use a cotton-tipped applicator (a long Q-tip) to get a sample of vaginal discharge. They test the pH (acidity) of the discharge and look at it under the microscope or send it to a lab.

Three of the four criteria must be met to diagnose bacterial vaginosis:

pH above 4. 5Thin increased vaginal dischargeFishy odor when 10% potassium solution is added to the discharge sample20% or greater clue cells (fuzzy-looking cells that indicate bacteria)

If your healthcare provider suspects BV, they will also check for STIs. They do this by testing the vaginal sample or taking a blood or urine sample. Getting STIs is easier with BV, and both infections can be present simultaneously.

Treatment

It’s important to see your healthcare provider if you have symptoms of bacterial vaginosis. Even if the infection is mild, treatment is essential to reduce the risk of complications or contracting STDs. BV is typically treated with one of the following antibiotics: 

Try not to schedule your exam while you are on your period. Do not have sexual intercourse for at least 24 hours before the exam. Do not douche for 24 hours before your exam (most healthcare providers don’t recommend douching at all). Try not to use any vaginal sprays or other irritants. Do not use tampons or put anything in your vagina (like a menstrual cup) before your appointment.

Flagyl (metronidazole) Clindam, Cleocin, Clindesse (clindamycin) Tindamax, Fasigyn, Simplotan (tinidazole)

Your healthcare provider may also consider:

Probiotics (oral or vaginal) Boric acid  Vaginal vitamin C Xifaxan (rifaximin) Sucrose gel

Your healthcare provider may prescribe these medications as pills taken orally or as vaginal creams or gels. Sometimes, they will prescribe oral and vaginal medicines for you to take simultaneously, especially if it’s a recurring infection. 

You must finish the medication anytime you are prescribed antibiotics, even if symptoms go away. Stopping medication early can cause the infection to return or cause you to build up resistance to that antibiotic. 

Prevention

The following guidelines can prevent or reduce the risk of bacterial vaginosis:

Preterm delivery (if you have BV while pregnant) Increased risk of STIs, including human immunodeficiency virus (HIV) Pelvic inflammatory disease (PID) Infertility Increased risk of infection after gynecologic surgeries

Avoid douching  Quit smoking Avoid highly fragranced soaps, detergents, sprays, or feminine hygiene products Wear underwear made with a breathable fabric, such as cotton Wipe from front to back after bathroom use Avoid intrauterine devices (IUDs) if you have a recurrent BV infection

Though bacterial vaginosis isn’t sexually transmitted, it is linked to sexual activity. The following tips can help decrease the risk of bacterial vaginosis related to sexual activity: 

Use condoms or dental dams Avoid flavored condoms or lubricants Limit the number of sexual partners or abstain from sexual intercourse Avoid vaginal contact with anything that has touched your anus  Clean sex toys after every use

Summary 

Bacterial vaginosis (BV) is a vaginal infection resulting from an overgrowth of “bad” bacteria in the vagina. Though it is not considered a sexually transmitted infection (STI), it is linked to sexual activity. BV does not cause bumps, sores, or rashes. 

Multiple vaginal infections can cause vaginal irritation. BV is characterized by increased and foul-smelling or “fishy” vaginal discharge. Vaginal discharge is usually thin (and sometimes foamy), gray, greenish, yellow, or white.

BV is typically treated with oral or vaginal antibiotics. Healthcare providers may also include probiotics or boric acid. Prevention includes avoiding douching or introducing products that cause an imbalance of pH (acidity) in the vagina and using precautions during sexual intercourse. 

A Word From Verywell

Bacterial vaginosis is a common infection; many women have had it at least once. Talking about symptoms with your healthcare provider may feel embarrassing, but telling them to receive early treatment and decrease the risk of complications is essential. Bumps in the vaginal area may indicate other STIs and should be discussed with and diagnosed by your healthcare provider.