Bacterial vaginosis (BV) is one of the most common vaginal conditions affecting women in Singapore. It occurs when the natural balance of bacteria in the vagina becomes disrupted, often leading to changes in discharge and odour.
Many women mistake BV for a yeast infection, but the two are different conditions with different causes and treatments. BV is not classified as a sexually transmitted infection (STI), though sexual activity and lifestyle factors may increase the risk.
What Is Bacterial Vaginosis?
Bacterial vaginosis (BV) is a vaginal condition that occurs when the natural balance of bacteria in the vagina is disrupted. In a healthy vagina, Lactobacillus bacteria dominate and maintain an acidic pH of about 3.8–4.5, which helps protect against infection.
When Lactobacillus levels decrease, other bacteria such as Gardnerella vaginalis and Atopobium vaginae may overgrow. This shift raises the vaginal pH and leads to the release of amines, chemicals responsible for the characteristic fishy odour.
Bacterial vaginosis is distinct from yeast infections and trichomoniasis, which have different causes and require different treatments.
Causes and Risk Factors of Bacterial Vaginosis
Bacterial vaginosis develops when the natural balance of bacteria in the vagina is disturbed. Several factors can increase the risk of this imbalance.
Sexual health factors
- Multiple or new sexual partners
- Lack of condom use (semen raises vaginal pH)
- Sharing sex toys that are not cleaned properly
Hygiene and product use
- Vaginal douching, which washes away protective bacteria
- Use of high-pH feminine washes or scented cleansers
- Daily pantyliner use, which may trap heat and moisture
Medical and physiological factors
- Pregnancy, which alters hormones and immune defences
- Recent antibiotic use, which reduces protective Lactobacillus
- Copper intrauterine device (IUD), which has been linked to higher BV rates
Lifestyle factors
- Smoking, which weakens the immune system
- Chronic stress, which affects hormonal and immune balance
- Wearing tight or non-breathable underwear, creating a moist environment
What Are The Common Symptoms Of Bacterial Vaginosis?
Bacterial vaginosis (BV) may cause noticeable changes in discharge and odour, but some women have no symptoms at all. The most common features are thin grey or white vaginal discharge and a fishy smell, which may become stronger after sex. Mild vaginal irritation or discomfort during intercourse can also occur.
BV symptoms compared to other vaginal infections
| Feature | Bacterial Vaginosis (BV) | Yeast Infection | Trichomoniasis |
|---|---|---|---|
| Vaginal Discharge | Thin, grey/white | Thick, white, “cottage cheese” | Frothy, yellow-green |
| Odour | Strong, fishy | Usually no odour | Musty or unpleasant |
| Itching | Mild or absent | Prominent itching and burning | Itching, redness |
| Discomfort during sex | Sometimes present | Common due to irritation | Common |
| Vaginal pH | >4.5 | Normal (≤4.5) | >4.5 |
| Symptom presence | Symptoms can appear similar across all three infections | ||
Note: The symptoms of BV, yeast infection, and trichomoniasis can overlap, making it difficult to tell them apart based on symptoms alone. A vaginal swab test is needed for accurate diagnosis and proper treatment.
How Is Bacterial Vaginosis Diagnosed?
Bacterial vaginosis (BV) cannot be diagnosed by symptoms alone. Because its features often overlap with other vaginal infections – yeast infections and trichomoniasis, and even some sexually transmitted infections (STIs) like chlamydia or gonorrhoea. A medical consultation is important to confirm the diagnosis and rule out STIs or other underlying conditions. Doctors use a combination of clinical examination and laboratory tests to identify BV accurately.
Diagnostic methods used for BV
| Method | What It Checks | How It Works | Notes in Singapore |
|---|---|---|---|
| Amsel Criteria | Discharge, vaginal pH, clue cells, fishy odour | Diagnosis is made if at least three of these four features are present | Widely used in clinical settings |
| Nugent Score | Balance of bacteria | A Gram-stained swab is examined and scored from 0–10 | Considered the gold standard in diagnostic laboratories |
| NAAT (Molecular Test) | Bacterial DNA | Detects BV-associated bacteria using PCR from a vaginal swab | Available in some private clinics |
| pH Testing | Vaginal acidity | pH paper is applied to vaginal fluid | Quick, but less specific than other methods |
Diagnosis requires clinical expertise. A doctor’s voice here reassures readers that self-diagnosis is not enough and highlights professional experience.
“As a doctor who has treated thousands of women with vaginal infections, it is crucial to emphasise that many other types of infections can be mistaken as simply bacterial vaginosis. Many women try to self-medicate, only to have symptoms recur shortly after. You should consult a medical professional early for proper swab tests and treatment to reduce the risk of recurrence in future.”
Treatments for Bacterial Vaginosis
Bacterial vaginosis (BV) is treated with antibiotics that restore the natural balance of bacteria in the vagina. Treatment can be taken by mouth or applied directly into the vagina. The choice depends on individual preference, availability, and medical advice.
Comparison of BV treatment options
| Option | Route | Duration | Pros | Cons / Precautions |
|---|---|---|---|---|
| Metronidazole (oral) | Tablet | 7 days | Effective, widely used | Gastrointestinal upset, avoid alcohol |
| Tinidazole (oral) | Tablet | 2–5 days | Shorter course | Not always available |
| Secnidazole (oral) | Granule | Single dose | Convenient, one-time treatment | Limited availability in Singapore |
| Clindamycin cream | Vaginal | 7 days | Alternative for those unable to use metronidazole | May weaken condoms for up to 72 hours |
| Clindamycin ovule | Vaginal | 3 days | Shorter treatment duration | Same condom precaution |
Recurrent or Persistent BV
Bacterial vaginosis (BV) can return even after successful treatment. Recurrence is common and may happen within a few months. This is usually due to lingering bacterial biofilms, reinfection, or other factors that disturb the vaginal microbiome.
Options for managing recurrent BV
| Approach | How It Works | Notes / Considerations |
|---|---|---|
| Repeat or longer antibiotic courses | Extends the duration or repeats the cycle of oral or vaginal antibiotics | Used if symptoms return soon after treatment |
| Suppressive therapy | Low-dose metronidazole gel applied twice weekly for several months | Helps reduce recurrence, under medical supervision |
| Boric acid capsules | Restores vaginal acidity and disrupts biofilms | Not suitable in pregnancy; requires specialist care |
| Probiotics (oral or vaginal) | Introduces Lactobacillus to rebalance the microbiome | Evidence is mixed but may help in prevention |
Lifestyle changes, such as avoiding douching and smoking, may also support long-term vaginal health.
Complications and Risks
Bacterial vaginosis (BV) does not always cause discomfort, but untreated BV can have health consequences. Studies have linked BV to higher risks in sexual, reproductive, and emotional health.
Possible complications of BV
| Category | Potential Risks | Notes |
|---|---|---|
| Sexually transmitted infections (STIs) | Chlamydia, gonorrhoea, HIV, herpes simplex virus (HSV-2) | BV alters the vaginal microbiome, making infection more likely |
| Pelvic inflammatory disease (PID) | Infection spreading to the uterus, fallopian tubes, and ovaries | Increases risk of chronic pelvic pain and infertility |
| Obstetric complications | Preterm birth, miscarriage, premature rupture of membranes | Risk is higher if BV is untreated during pregnancy |
| Psychological and emotional impact | Anxiety, embarrassment, reduced sexual intimacy | Fishy odour and discharge can affect quality of life |
Bacterial Vaginosis in Pregnancy
BV is especially important to address during pregnancy. The condition has been linked to:
- Preterm birth
- Premature rupture of membranes
- Postpartum infections
Treatment during pregnancy is considered safe and may involve:
- Oral metronidazole
- Clindamycin
Routine screening for BV is not recommended for all pregnant women. However, women with a history of obstetric complications may benefit from early testing and treatment if symptoms develop.
When to See a Doctor in Singapore
Mild changes in vaginal discharge or odour can sometimes settle on their own, but it is important to seek medical advice if symptoms are persistent or recurrent. A doctor can confirm whether bacterial vaginosis (BV) is the cause and recommend the most appropriate treatment.
When to book a consultation
- Strong or persistent fishy odour
- Thin grey or white discharge that does not improve
- Recurrent symptoms after treatment
- Vaginal discomfort that affects daily life or intimacy
- Symptoms during pregnancy, as BV may increase obstetric risks
At EzraClinic, you will find a discreet and supportive environment to discuss your concerns. A medical consultation allows for accurate diagnosis and treatment tailored to your needs.
Conclusion
Bacterial vaginosis is common among women in Singapore. While it may cause vaginal discharge, odour, or discomfort, it can also be silent. Left untreated, BV may increase risks in sexual, reproductive, and pregnancy health.
With proper diagnosis and treatment, BV can be effectively managed. If you notice symptoms or experience recurrent episodes, consulting a doctor is the next step. At EzraClinic, you will find a safe and private environment to address your concerns and receive the care you need.
Dr. Michelle has more than 10 years of experience treating women who struggle with such vaginal infection symptoms and is a strong advocate for women’s healthcare issues. Consult us today!
FAQs About Bacterial Vaginosis
1. Can bacterial vaginosis go away on its own?
In some cases, BV may clear without treatment, but recurrence is common. Medical treatment is recommended to reduce risks and prevent complications.
2. Do sexual partners need treatment for BV?
Male partners usually do not require treatment. Female partners may be checked if they develop symptoms.
3. Can men get bacterial vaginosis?
No, BV only affects the vaginal environment and does not occur in men.
4. Is it safe to have sex during treatment for BV?
Sex is possible, but symptoms may worsen. Condoms are advised, especially when using clindamycin cream, as it can weaken latex for up to 72 hours.
5. Do probiotics help with BV?
Some research suggests probiotics containing Lactobacillus may help restore vaginal balance and reduce recurrence, but evidence is still evolving.
6. Is BV linked to fertility problems?
BV does not directly cause infertility. However, untreated BV can increase the risk of pelvic inflammatory disease (PID), which may affect fertility.
