Bacterial Vaginosis Clinical Presentation

Updated: Jan 28, 2022
  • Author: Philippe H Girerd, MD; Chief Editor: Michel E Rivlin, MD  more...
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Symptoms of bacterial vaginosis include the following:

  • Vaginal odor is the most common, and often initial, symptom of bacterial vaginosis (BV). Odor may be recognized only after sexual intercourse. The alkalinity of semen may cause a release of volatile amines from the vaginal discharge and cause a fishy odor.

  • Increased vaginal discharge is typically mild to moderate.

  • Vulvar irritation is less common.

  • Dysuria or dyspareunia occur rarely.

Inquire about risk factors that may predispose patients to developing BV. Predisposing factors can include the following:

  • Recent antibiotic use

  • Decreased estrogen production of the host

  • Wearing an intrauterine device (IUD)

  • Douching

  • Sexual activity that could lead to transmission, as evidenced by the patient having a new sexual partner, an increased number of sexual partners in the month preceding the onset of BV symptoms, or having an increased number of lifetime sexual partners


Physical Examination

Vaginal discharge features include the following:

  • Most often gray, thin, and homogeneous

  • Adherent to the vaginal mucosa

  • May not visualize pooling of discharge in the posterior fornix because of adherence to the vaginal mucosa

  • May observe small bubbles in the discharge fluid

An increased light reflex of the vaginal walls may be observed, indicating a very wet appearance; however, typically, no or little evidence of inflammation is apparent.

The labia, introitus, cervix, and cervical discharge appear normal.

Evidence of cervicitis should prompt a workup for concomitant infection with Neisseria gonorrhoeae, Chlamydia trachomatis, or herpes simplex virus (HSV).