Bacterial vaginosis is the most common cause of abnormal vaginal discharge in women of reproductive age. It occurs when protective Lactobacillus bacteria in the vagina are reduced, allowing other bacteria to overgrow and disrupt the natural vaginal microbiome balance. It is not an infection in the traditional sense but rather a shift in the vaginal bacterial community.

Symptoms can vary and some women experience none at all. When present, they may include thin grey or white discharge, an unusual or strong odour (often more noticeable after sex), vaginal irritation or discomfort, and a noticeable change in vaginal pH or balance. Because symptoms overlap with other conditions, assessment is important for an accurate diagnosis.

BV, thrush, aerobic vaginitis and other vaginal conditions can produce similar symptoms, particularly discharge and discomfort. The type, colour and odour of discharge, along with your history and any test results, help differentiate between them. Self-diagnosing is unreliable. A clinical assessment is recommended if you are unsure or if symptoms keep recurring.

BV is often described as producing a fishy or unusual odour, which may be more noticeable after sexual intercourse or during menstruation. Not all women with BV notice an odour, and some experience odour without other symptoms.

In some cases, symptoms may improve without treatment. However, if symptoms persist, recur, or are causing concern, medical assessment is recommended to confirm the diagnosis and determine the most appropriate management approach.

Recurrent BV is common, studies suggest up to 58% of women experience recurrence within 12 months of treatment. Antibiotics can reduce BV-associated bacteria but may not fully restore the protective Lactobacillus needed for long-term vaginal microbiome stability. Contributing factors including hormonal influences, partner-related factors, and microbiome susceptibility are not always addressed in standard treatment.

Antibiotics are effective at reducing BV-associated bacteria and remain an important part of evidence-based care. However, they do not always restore the protective Lactobacillus bacteria that help maintain a healthy vaginal environment. In some women, repeated antibiotic use may further disrupt an already sensitive microbiome, contributing to ongoing recurrence.

No. BV is not classified as a sexually transmitted infection. However, sexual activity can influence the vaginal microbiome. Emerging evidence suggests that sexual partners may play a role in recurrence in some women, potentially contributing to reseeding of the vaginal microbiome after treatment.

BV is not classified as an STI, but emerging research suggests that sexual partners may be a contributing factor in recurrent BV. Studies have found BV-associated bacteria in the penile microbiome of male partners, and partner-related reseeding after treatment may explain why some women experience persistent recurrence despite effective treatment. Partner management is an evolving area of recurrent BV care, and whether it is appropriate depends on individual circumstances — this is something that can be explored during a consultation.

The vaginal microbiome is the community of bacteria that naturally live in the vagina. In most women, this community is dominated by a group of protective bacteria called Lactobacillus, they keep the vaginal environment acidic and stable, which makes it harder for unwanted bacteria to take hold. When that balance shifts and Lactobacillus levels fall, other bacteria can overgrow. This is what happens in BV and it's also why symptoms often return. For some women, treating the acute episode does not restore a stable Lactobacillus-dominant vaginal microbiome, and symptoms may recur. This is one reason I consider microbiome health alongside other contributing factors when assessing recurrent BV.

Negative test results don't always mean there is nothing to investigate further. Standard swab cultures identify specific pathogens but may not fully capture the overall state of the vaginal microbiome — including pH shifts, reduced Lactobacillus levels, or patterns consistent with vaginal dysbiosis. If symptoms persist despite negative results, a more detailed review of your history, symptom patterns and microbiome factors may help clarify what could be contributing.

Yes. Many women who consult with me have already seen one or more healthcare professionals and have undergone repeated treatment. My role is not to replace appropriate specialist care, but to review your history, previous investigations and treatment responses, and consider whether there are any additional factors that may be contributing to your recurrent symptoms.

Not necessarily. Microbiome testing is one tool that may be useful for some women — particularly when symptoms are persistent and conventional investigations have not provided a clear answer. Whether testing is appropriate depends on your individual history and previous results, and is something we can discuss during a consultation.

Yes. Hormonal changes including those associated with the menstrual cycle, pregnancy, perimenopause, menopause and certain forms of contraception can influence vaginal microbiome balance and may contribute to BV recurrence in some women. This is one reason why BV can follow a cyclical pattern in some cases.

BV is caused by a shift in vaginal bacteria (dysbiosis), whereas thrush (vulvovaginal candidiasis) is caused by an overgrowth of Candida yeast. BV typically produces a thin grey or white discharge with an unusual odour, while thrush more commonly causes thick white discharge, itching and vulval irritation without a strong odour. Both conditions can coexist, and accurate diagnosis is important as the treatments are different.

Research suggests that BV and vaginal dysbiosis may be associated with a range of broader vaginal and reproductive health outcomes, including increased susceptibility to certain sexually transmitted infections. Maintaining a healthy vaginal microbiome is increasingly recognised as important for overall vaginal and reproductive health.

You should seek medical review if symptoms continue to return despite treatment, symptoms are affecting your quality of life, you are unsure whether your symptoms are due to BV, or you have been treated multiple times without lasting relief. Recurrent BV is not something you should simply manage repeatedly without a more thorough assessment.

No. You do not need a GP referral to book a consultation with Kylie Sayce NP. You can book directly online.

Yes. As an Endorsed Nurse Practitioner, Kylie has prescribing authority and can prescribe medications where clinically appropriate, including treatments relevant to BV and vaginal health.

Consultations are conducted via secure video or phone telehealth from anywhere in Australia. A consultation typically covers your symptom history and recurrence patterns, previous treatments and how you responded, vaginal microbiome health, hormonal influences, and other contributing factors. The aim is to understand what is driving your recurrence and develop a personalised management plan, not just another prescription.

Telehealth is suitable for many women with recurrent vaginal symptoms, and most consultations can be completed without an in-person visit. However, some presentations require physical or gynaecological examination, specialist review, or investigations that cannot be appropriately assessed remotely. Where this applies, I will recommend appropriate face-to-face care or referral — your safety and a thorough assessment always take priority.