Bacterial Vaginosis (BV): Symptoms, Treatment Options, and Prevention
What is BV?
Bacterial vaginosis is an imbalance of the normal vaginal bacteria. The hallmark signs are a thin, gray or off-white discharge with a noticeable “fishy” odor, often worse after sex or during/after a period. It usually causes little to no itching or irritation.
How is BV different from a yeast infection?
BV: thin, gray/white discharge with fishy odor; minimal itching.
Yeast: thick, white “cottage cheese” discharge with intense itching/burning, little to no odor.
Trichomoniasis (an STI): frothy yellow-green discharge, irritation, sometimes pelvic discomfort.
If your symptoms don’t line up clearly, testing may be better than guessing.
Can TeleDirectMD diagnose and treat BV by video?
Yes—BV is often diagnosed clinically from history. For classic symptoms in non-pregnant adults, telehealth treatment is appropriate. If your symptoms are atypical, severe, recurrent, or you’re at risk for STIs, we’ll guide you to testing or in-person care.
Do I need a swab or lab test?
Not always. A swab is helpful if:
Symptoms are atypical, severe, or keep returning.
You recently had a new partner, multiple partners, or unprotected sex and want STI testing.
You tried treatment and didn’t improve.
Which treatments does TeleDirectMD use?
According to the CDC’s STI Treatment Guidelines, first-line options include:
Metronidazole tablets 500 mg by mouth twice daily for 7 days.
Metronidazole 0.75% vaginal gel (5 g) once nightly for 5 days.
Clindamycin 2% vaginal cream (5 g) once nightly for 7 days.
We’ll choose based on your preferences, side-effect profile, medication interactions, and whether you want oral vs local treatment.
Safety notes & what to avoid during treatment
Alcohol: Skip alcohol while taking metronidazole and for 2–3 days after your last dose.
Condoms/diaphragms: Clindamycin vaginal cream is oil-based and can weaken latex during use and for up to 72 hours after your last dose—use alternative protection or abstain.
Scented products & douching: Avoid—these disrupt vaginal pH and make BV more likely to recur.
What about pregnancy and breastfeeding?
Pregnancy: We do not manage pregnancy-related BV by video. If you’re pregnant or might be, we’ll route you to in-person OB care for diagnosis and treatment.
Breastfeeding: Some BV treatments are compatible with nursing; we’ll review options if relevant.
How fast will I feel better?
Most patients notice odor improvement within 1–3 days and discharge improvement by 3–5 days. Finish the full course even if you feel better.
Should my partner be treated?
Male partners: Routine treatment is not recommended.
Female partners: BV can occur in female partners; if they have symptoms, they should seek care.
Using condoms during treatment can reduce odor triggers and help restore balance.
Can BV come back?
Yes—recurrence is common. If you’ve had 3 or more episodes in 12 months, we’ll discuss a step-up plan. According to the CDC, options can include a different first-line regimen or suppressive vaginal metronidazole gel twice weekly for a defined period. For frequent recurrences, we often coordinate with a gynecologist.
What actually helps prevent recurrence?
Skip douching and scented washes/tampons; use plain warm water on the vulva.
Condoms if new or multiple partners.
Avoid over-washing inside the vagina; it self-cleans.
Consider timing: BV often flares around menses; unscented products help.
Don’t DIY with harsh home remedies—they can worsen symptoms.
When should I be seen in person right away?
Seek urgent in-person care for fever, severe pelvic or lower-abdominal pain, vomiting, new bleeding, rash or swelling after a medication, pregnancy, or worsening symptoms despite treatment.
How TeleDirectMD handles BV (what to expect)
Adults only (18+), video-only, cash-pay; no controlled substances.
We confirm symptoms, rule out red flags, discuss oral vs vaginal treatment, e-prescribe, and give precise after-care and recurrence-prevention tips.
Practical After-Care (copy/paste friendly)
Finish your medication exactly as prescribed.
Avoid sex or use condoms until you finish treatment and symptoms resolve.
No douching; avoid scented soaps, wipes, or detergents on the vulva.
If using clindamycin cream, avoid latex condoms/diaphragms during treatment and for 72 hours after the last dose.
Return if symptoms persist, recur, or you develop any red flags above.
