Bacterial vaginosis FAQs

BV is a disruption in the bacteria that are present in the vagina, where the healthy bacteria are replaced with ‘bad’ or non-optimal BV-bacteria. 

While the general view had been that BV is not a sexually transmitted infection, it has been known for many years that BV is only detected after people become sexually active, and that condoms appear to provide protection against BV. Now a recent clinical trial has shown that treating people with a penis at the same time as their partner greatly improves BV cure for people with a vagina. This new evidence supports other research that has shown that the bacteria that cause BV (BV-bacteria) can be sexually transmitted between individuals.  

Melbourne Sexual Health Centre is now offering treatment for people with a penis who have a regular sexual partner being treated for BV, as part of routine care. A trial is underway to determine if partner treatment is effective in couples across the LGBTQIA+ community. 

The range of symptoms and severity can vary. The following quotes were provided in interviews by people involved in the BV partner treatment clinical trial. 

“I kind of had recurrent BV without actually even really realising it...I was just kind of having a bit of like thick discharge that had a bit of a smell to it, but I’d had it kind of for so long that I had just perceived that to be my normal.” (Chloe) 

“My partner found it, probably more than the physical discomfort, she found it really stressful and frustrating.” (Mitchell) 

“(My partner) complained a few times, being like, “I feel like we don’t have enough sex” or “I feel like I want to have more sex with you.”  I think it makes him feel like I’m not attracted to him or whatever.  But it’s like, “That’s not the case at all.  I’m so attracted to you, but I just feel shit about myself because of this.” (Taylor) 

“The first time I got the BV – I, maybe, got the BV once or twice treated by the GP but, obviously, that cycle kept repeating and it was just like unsatisfactory to me. . . . Kind of going, well, we're doing the same thing. I'm actually not feeling great about this, on many levels. And, yeah, we're not actually changing what’s happening.” (Ana) 

There are two reasons why people experience a repeat BV infection after finishing antibiotics. 

1. BV is cured but returns after antibiotics, and we call this BV recurrence. 

2. BV is not completely cleared by antibiotics, and we call this BV persistence. 

BV recurrence is due to reinfection with BV-bacteria from the untreated partner. If you are having unprotected sex with a partner, it is possible you have been reinfected with BV, so it is important to discuss this with your doctor. Partner treatment for BV is now available for couples to reduce the risk of reinfection.

BV persistence can be hard to distinguish from BV recurrence but is most obvious in a person without an ongoing partner. For individuals where reinfection is unlikely, a longer course of vaginal antibiotics, or a combination of oral and vaginal antibiotics, or the addition of boric acid suppositories can be used as treatment strategies.  

Otherwise, sometimes people mistake thrush (candida) for BV as it often follows antibiotics. If you are experiencing a thick vaginal discharge and/or itch or vulval burning, it is important to consider thrush and to see your doctor. 

The healthcare provider will help to determine the cause of the return of symptoms. If your BV symptoms come back after treatment, see your doctor to discuss your options. 

It is recommended that you avoid all sexual contact until you have completed the antibiotic treatment. Sex with ongoing untreated partners increases the chance of BV coming back again after treatment. If you do have sex, barrier methods, like condoms, should be always used. However, please by aware that recently applied clindamycin cream may weaken latex. 

If a dose is missed, continue taking the medication at the correct time until all the antibiotics are finished (i.e. add that missed dose on to the end of your treatment). 

If you have been given antibiotics, make sure you use the full course as directed by your healthcare provider, even if the symptoms experienced by you (and/or your partner if taking partner treatment) clear up quickly. This is important for ensuring the antibiotics are most effective.

In interviews with partner treatment clinical trial participants, partners highlighted that the inconvenience of treatment, including avoiding sex and alcohol and using the medications, was worth it to achieve their goals for the treatment. Most participants reported finding treatment was easy, though some admitted to having initial concerns. 

“Initially I probably thought, "Oh yeah, that sounds like a bit of a pain to have to do that twice a day, and maybe it'd be uncomfortable." but then it was like, "Oh, that's not a problem." That takes two minutes.” (Kurt)  

“We were getting desperate, in the end, and I hated seeing her in...discomfort, so when that was suggested I straight away said, "Yes."” (Lachlan) 

“Reading through what was required of me, it didn't seem to take a lot of effort on my part. So, I was more than happy.” (Samuel) 

Couples should avoid all sexual contact until both partners have finished their antibiotic regimen. If couples do have sex while on antibiotics, they should always use a barrier method, like a condom, to reduce the transmission of BV-bacteria. Couples must also be aware that the clindamycin cream, if recently applied, may weaken latex. 

For this treatment to work it is important that couples try to take their medication over the same 7-day period. Where this is not possible, couples should avoid all sexual contact until both partners have completed their antibiotics. 

The success of this treatment relies on the use of the cream and the oral tablets together at the same time. This is because the tablets target the BV-bacteria that are present inside the urethra (the tube that passes urine) and the cream targets the BV-bacteria present on the surface of the skin. It is very important to take all of the medication as missing doses makes the treatment less effective.  

If individuals have more than one ongoing partner, consider treating everyone involved to reduce the risk of reinfection by untreated sex partners who may be carriers or infected. Please speak to your GP about the options and risks.