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Bacterial vaginosis - Management
When and how should I test a non-pregnant woman for bacterial vaginosis?

  • Examination and further tests may be omitted and empirical treatment for bacterial vaginosis (BV) started in women with characteristic symptoms of BV if all the following apply:
    • The woman is not at high risk of a sexually transmitted infection (STI).
      • Women are at increased risk of an STI if they are younger than 25 years of age, or have had a new sexual partner in the last 12 months, or more than one sexual partner in the last 12 months.
    • The woman does not have symptoms of other conditions causing vaginal discharge (for example itch, abdominal pain, abnormal bleeding, dyspareunia, or fever).
    • The woman is not post-natal, post-miscarriage, or post-termination.
    • Symptoms have not developed after a gynaecological procedure.
    • Symptoms have not recurred soon after treatment for BV or persisted following treatment for BV.
    • The woman is not pregnant (see When and how to test pregnant women).
  • If empirical treatment is not considered appropriate, or if the diagnosis is uncertain:
    • Perform a speculum examination.
    • If pH paper is available, test the pH of the vaginal fluid.
    • Take a high vaginal swab (or use a self-taken low vaginal swab) for Gram staining and to exclude other causes of vaginal discharge.
      • Samples should be placed in transport media (such as Amie's or Stuart's medium). A Gram stain for mixed flora suggestive of BV and a trichomoniasis culture should be requested from the laboratory.
      • If there is a delay in transportation, the swab should be refrigerated at 4°C for no longer than 48 hours.
    • If the woman is at high risk of an STI, specimens for chlamydia and gonorrhoea should also be sent, according to local laboratory procedures.
  • For further information, see the CKS topic on Vaginal discharge.

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