Executive summary
- Typical: thin grey/white discharge + fishy odour; usually minimal itch/soreness.
- Assess STI risk and pregnancy; consider testing if risk features or cervicitis/PID symptoms.
- First-line: metronidazole 400 mg BD for 5–7 days (including in pregnancy if symptomatic).
Diagnosis and differentials
- Thrush (itch/soreness, curdy discharge), trichomonas (frothy discharge), cervicitis/PID (pelvic pain, bleeding), foreign body.
- Speculum exam/pH testing can help if diagnosis unclear or recurrent.
Treatment and counselling
- Metronidazole 400 mg BD 5–7 days; advise common GI side effects and local alcohol advice.
- Partner treatment not routinely needed.
- Recurrence is common — reassess diagnosis and consider STI testing and triggers (douching/intra-vaginal products).
Safety-net and referral
- Urgent review if pelvic pain, fever, dyspareunia, intermenstrual/post-coital bleeding, pregnancy complications, or severe/recurrent symptoms.
- Consider sexual health referral for recurrent symptoms, STI risk, or diagnostic uncertainty.
Frequently asked questions
Is BV an STI?
Not classified as an STI, but it is associated with sexual activity and can coexist with STIs—test if risk factors or symptoms suggest cervicitis/PID.
Should my partner be treated?
Not routinely for BV.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.