How to Test for Bacterial Vaginosis

Bacterial Vaginosis (BV) is a common vaginal infection caused by an imbalance of bacteria in the vagina. It's not a sexually transmitted infection but can be linked to sexual activity. In the following post, we’ll discuss common symptoms, risks, and the various methods one can test for BV.

Common Symptoms and Signs of BV

BV has several noticeable symptoms, though some women may not experience any signs. If you do have symptoms, you might notice:

  • Unusual discharge: BV often causes a thin, gray or white discharge.
  • Fishy odor: This smell is stronger after sex.
  • Burning sensation: You might feel this when you urinate.
  • Itching: This can occur around the outside of the vagina.

Causes and Risk Factors Associated with BV

BV happens when there is an imbalance between good and bad bacteria in the vagina. Several factors can increase your risk of developing BV:

  • Multiple sexual partners: Changing sexual partners often can disrupt the bacterial balance.
  • Douching: This can upset the natural balance of bacteria.
  • Lack of lactobacilli: Lactobacilli are good bacteria that help keep the vagina healthy. A lower amount can lead to BV.
  • Smoking: Smoking can affect your vaginal flora.

Why is it Important to Diagnose Bacterial Vaginosis?

Diagnosing Bacterial Vaginosis (BV) early is crucial for maintaining overall health and preventing complications. Here are several key reasons why timely diagnosis is important:

Health Implications of Untreated BV

Ignoring BV can lead to several health problems:

  • Pelvic Inflammatory Disease (PID): Untreated BV can spread to the uterus or fallopian tubes, causing PID. This condition can result in chronic pain and infertility.
  • Infections: BV increases the risk of other infections, including urinary tract infections (UTIs).

Impact on Pregnancy and Reproductive Health

For pregnant women, BV poses additional risks:

  • Preterm Birth: BV can lead to premature labor and birth, which can affect the baby's health.
  • Low Birth Weight: Babies born to mothers with untreated BV might have a lower birth weight, leading to further health issues.
  • Postpartum Endometritis: This is an infection of the uterine lining after childbirth, which BV can cause.

Increased Risk of Sexually Transmitted Infections (STIs)

BV can make you more susceptible to STIs:

  • HIV: Women with BV are at higher risk of contracting HIV if exposed.
  • Other STIs: The infection can increase the chances of getting STIs like chlamydia and gonorrhea.

Importance of Timely Treatment and Management

Treating BV promptly is essential:

  • Antibiotics: These can quickly restore the balance of bacteria in the vagina, easing symptoms and preventing complications.
  • Preventive Measures: Learning about BV and its causes can help you take steps to prevent recurrence, such as avoiding douching and managing sexual health responsibly.

Testing for BV

There are various ways to diagnose bacterial vaginosis in Canada:

  • Vaginal Swabs
  • Urine Test
  • At-Home Test Kits

Each method has its own advantages and limitations.

Vaginal Swabs

A sterile swab is used to collect a sample of vaginal discharge from the vaginal walls. Once the sample is collected, it undergoes laboratory testing. Types of tests include:

  • Microscopic Examination: The sample is placed on a slide and viewed under a microscope. The presence of "clue cells" (vaginal cells covered with bacteria) suggests BV.
  • Whiff Test: A solution called potassium hydroxide is added to the sample. A fishy smell indicates BV.
  • pH Test: The vaginal fluid's pH level is measured. A pH higher than 4.5 can indicate BV.

Doctors often use Amsel’s criteria to diagnose BV. These criteria require at least three of the following four conditions to be met:

  • Vaginal pH Greater than 4.5: Measured using pH paper or a specific pH stick.
  • Presence of Clue Cells: Identified through microscopic examination.
  • Homogeneous, Milky Discharge: Observed during the visual inspection.
  • Positive Whiff Test: A fishy odor detected after adding potassium hydroxide to the sample.

Urine Test

A sample of urine is collected to check for signs of BV but there are limitations:

  • Lower Accuracy: Urine tests are less accurate than vaginal swabs. They might miss the bacteria causing BV.
  • False Negatives: There's a higher chance of getting a false negative result, meaning the test shows no infection even if BV is present.
  • Less Detailed: Urine tests don't provide as much information as a vaginal swab. They might not detect specific bacteria types.

While urine tests offer a non-invasive option, they aren't as reliable or detailed as vaginal swabs and other methods. For the most accurate diagnosis, a combination of clinical criteria and laboratory tests using vaginal swabs is preferred.

Preparation Steps Before the Test

Preparing for a BV test helps ensure accurate results. Follow these steps:

  • Avoid Douching: Do not douche for at least 24 hours before the test.
  • No Vaginal Products: Avoid using tampons, creams, or vaginal medications.
  • Abstain from Intercourse: Do not have sex for at least 24 hours before your appointment.
  • Inform Your Provider: Tell your provider about any medications or supplements you are taking.

At-Home Vaginal pH Test Kits

At-home vaginal pH test kits allow you to check for BV from the comfort of your home. These kits typically include:

  • pH Paper Strips: Used to measure the acidity or alkalinity of your vaginal fluid.
  • Swabs: To collect a sample from the vaginal walls.
  • Color Chart: Helps you interpret the results.

These kits are available at most pharmacies and online stores.

Limitations of At-Home Testing

  • Accuracy: At-home tests may not be as accurate as laboratory tests.
  • Limited Information: These tests only measure pH levels and don't identify specific bacteria.
  • Need for Follow-Up: If the test indicates a high pH, you should still see a healthcare provider for a definitive diagnosis and treatment.

At-home BV testing kits offer a convenient first step in assessing vaginal health but should not replace professional medical advice and testing.


The cost of testing (whether swabs or urine) is usually covered for those with OHIP. For those without insurance, most labs charge $15 - $20 for a swab test. At TeleTest, you only pay for messaging with the doctor to discuss symptoms and if necessary, receive immediate treatment. For at-home test kits, the cost can range from $50 to $200.

Will Bacterial Vaginosis Go Away on Its Own?

Understanding the Self-Limiting Nature of BV in Asymptomatic Cases

Bacterial vaginosis (BV) sometimes resolves without treatment, especially in asymptomatic cases. This means that if you don't have symptoms, your body might correct the imbalance of bacteria naturally. However, this is not always the case.

Circumstances Under Which Treatment May Not Be Necessary

In certain scenarios, treatment for BV might not be required:

  • Asymptomatic Cases: If you have no symptoms, your doctor might decide to monitor the condition instead of prescribing medication.
  • Mild Symptoms: Sometimes, mild cases of BV improve on their own without antibiotics.

When to Seek Medical Advice Despite Mild Symptoms

Even if symptoms seem minor, seeking medical advice is crucial in some situations:

  • Persistent Symptoms: If symptoms continue for more than a week, consult your healthcare provider.
  • Pregnancy: If you're pregnant or planning to become pregnant, get checked for BV regardless of symptom severity.
  • Recurring BV: If you experience frequent BV episodes, medical evaluation is necessary to prevent complications.
  • Other Health Conditions: If you have other health concerns, such as a weakened immune system, don't ignore even mild symptoms.

How to Interpret BV Test Results

Explanation of Positive and Negative Test Results

When you get tested for bacterial vaginosis (BV), your results will come back as either positive or negative.

  • Positive Result: Indicates the presence of BV. This means that your vaginal fluid sample shows signs of an imbalance in the bacteria that typically live in the vagina.
  • Negative Result: Indicates no BV. Your vaginal fluid sample shows a normal balance of bacteria.

Next Steps if the Test is Positive for BV

If your BV test comes back positive, here’s what you should do next:

  1. Consult Your Healthcare Provider: Discuss treatment options with your doctor.
  2. Follow Treatment Plan: Typically, the doctor prescribes antibiotics, either oral or topical. Complete the entire course of medication.
  3. Avoid Certain Activities: While treating BV, avoid douching, using scented products, and engaging in unprotected sex, as these can worsen the condition or delay healing.

Follow-Up Treatments and Preventive Measures

After treating BV, follow these steps to prevent recurrence and ensure long-term health:

  • Follow-Up Visits: Schedule follow-up appointments to ensure the infection has cleared.
  • Probiotics: Consider taking probiotics, which may help maintain a healthy balance of bacteria in your vagina.
  • Good Hygiene Practices: Maintain good hygiene, but avoid over-cleaning, which can disrupt the natural balance of bacteria.
  • Safe Sexual Practices: Use condoms and limit the number of sexual partners to reduce the risk of BV and other infections.

By understanding your test results and taking the necessary steps, you can effectively manage and prevent bacterial vaginosis.

Disclaimer: This blog post is intended for educational purposes only and should not be taken as medical advice. Always consult your healthcare provider for personal health concerns.