Medically reviewed by Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket. Last reviewed: September 2026.
Bacterial vaginosis is something I see often in women on holiday, where heat, swimming, new partners and changes in routine can all upset the normal balance. It is not a sexually transmitted infection, but it can be uncomfortable and it tends to recur, so I always discuss prevention as well as treatment.
BV is one of the most common reasons women see us about vaginal symptoms on holiday, and it is often mistaken for thrush or an STI. A change of routine can tip the balance: a new partner, long hot days, perfumed hotel toiletries, bubble baths and a tendency to wash more when it is humid. Many women have had it before and recognise it straight away, while others worry it signals something more serious. Either way, a short examination and simple tests usually give a clear answer at one visit, and treatment can start the same day.
What changes in the vagina when BV develops
A healthy vagina is dominated by lactobacilli, bacteria that produce lactic acid and keep the environment acidic, with a pH of around 3.8 to 4.5. In BV, lactobacilli decline and a mix of other bacteria, including Gardnerella vaginalis and several anaerobes (bacteria that thrive without oxygen), overgrow. The pH rises above 4.5, and chemicals called amines give the typical fishy smell, which is often stronger after sex, because semen is alkaline, and around a period.
BV is not classed as a sexually transmitted infection, and it is not caused by poor hygiene. It is, however, more likely after a new partner or several partners, with a female partner who has BV, after douching or using perfumed washes, with a copper coil (IUD) and in smokers. Washing more often usually makes it worse rather than better.
Symptoms, and how BV differs from thrush and STIs
The classic picture is a thin, watery, grey or white discharge with a fishy smell, usually without itching or soreness. Many women with BV have no symptoms at all. Because several conditions affect the vagina in similar ways, the combination of discharge, smell and itching is a useful first guide.
| Condition | Discharge | Smell | Itch or soreness | Vaginal pH |
|---|---|---|---|---|
| Bacterial vaginosis | Thin, grey-white, watery | Fishy, worse after sex | Usually none | Above 4.5 |
| Thrush (candida) | Thick, white, curd-like | Little or none | Itching, soreness, redness | 4.5 or below |
| Trichomoniasis | Frothy, yellow-green | Often unpleasant | Soreness and itching | Above 4.5 |
| Chlamydia or gonorrhoea | Sometimes increased, often normal | Usually none | Burning on urination, bleeding after sex | Usually normal |
| Cystitis (UTI) | No change | Strong-smelling urine | Burning, frequency, urgency | Not relevant |
Burning and frequency point towards the bladder, where UTI treatment is needed instead. Bleeding after sex or pelvic pain should prompt a check for chlamydia, covered on our chlamydia treatment page.
How we diagnose BV
After a short, private conversation about symptoms, periods, contraception and recent partners, the doctor may examine you or ask you to take a vaginal swab yourself. Diagnosis usually uses the Amsel criteria, where three of four features confirm BV: a thin, even discharge; a vaginal pH above 4.5 on a test strip; a fishy smell when a drop of potassium hydroxide is added to the sample, called the whiff test; and clue cells, which are vaginal cells coated with bacteria, seen under the microscope. A laboratory Gram stain can also grade the balance of bacteria. If there is any chance of an STI, we test for chlamydia, gonorrhoea and trichomoniasis from the same visit, and our STD testing in Phuket page explains the wider options.
Treatment options, and the alcohol question
First-line treatment is metronidazole tablets twice a day for 7 days, which has good cure rates and fewer early recurrences than a single dose. Alternatives are metronidazole gel inserted into the vagina at night for 5 nights, or clindamycin cream inserted at night for 7 nights. A single large dose of metronidazole is sometimes used when a week of tablets is not practical, although BV returns more often afterwards. Symptoms usually improve within two to three days. Metronidazole can leave a metallic taste and mild nausea, which taking it with food reduces.
Alcohol is a practical issue on a Phuket holiday. UK guidance still advises avoiding alcohol during metronidazole and for 48 hours afterwards, because some people get flushing, nausea, vomiting and a racing heart; US guidance has relaxed this advice. If a week without drinks is unrealistic, tell us, because clindamycin cream avoids the issue. Clindamycin cream is oil-based and can weaken latex condoms and diaphragms during treatment and for several days afterwards, so use another method or avoid sex in that time.
Self-care while the treatment works
Wash the vulva, the outer skin, with plain water or an unperfumed emollient, and avoid douching, vaginal deodorants, scented soaps and bubble baths. Showers are better than baths while symptoms settle. Loose cotton underwear helps in the heat, and changing out of wet swimwear soon after a swim keeps the area comfortable, although swimming itself does not cause BV. Probiotic capsules and lactic acid gels are widely sold, but the evidence that they cure or prevent BV is limited; they are not harmful, but they are not a substitute for treatment.
When BV keeps coming back
BV returns often, sometimes within weeks or months of successful treatment. A repeat 7-day course is the usual first step, and for frequent recurrences a longer suppressive plan, such as metronidazole gel twice a week for several months, is recommended by some guidelines. It is also worth looking at possible triggers: douching, perfumed products, a copper coil, smoking or a partner. If BV seems to flare on every trip, the combination of heat, products and a change in sexual routine may be the pattern.
When to see a doctor
A first episode of unusual discharge deserves a proper diagnosis rather than guessing, and so does any symptom during pregnancy, because BV in pregnancy is linked to premature birth and needs treatment. Seek care promptly if symptoms follow a recent miscarriage, termination, coil fitting or gynaecological procedure, because infection can spread into the womb. Lower abdominal pain, fever, pain during sex or bleeding between periods suggest pelvic inflammatory disease rather than simple BV.
Prevention and early detection
The most effective prevention is leaving the vagina’s natural balance alone. Avoid douching and perfumed products, wash with water, and choose showers over long hot baths. Condoms reduce the risk of BV with male partners, and washing sex toys between uses and partners helps. Stopping smoking lowers the risk too. Knowing your normal discharge makes it easier to spot changes early, and screening for STIs with each new partner separates BV from infections that need different treatment.
Getting BV treated at Takecare Clinic
BV is simple to sort out in one visit, and you can come at whatever hour suits you, because our clinics are open 24 hours every day. Choose the Bangtao (Cherngtalay) clinic, the Kata-Karon clinic on Kedkwan Road, or the Patong clinic. WhatsApp us if you have a quick question, or call the clinic on +66 81 718 9080. Our walk-in doctor in Phuket service means you are usually seen within minutes, with treatment dispensed from the on-site pharmacy.
If you would rather not leave your room, a doctor hotel visit in Phuket can be arranged at any hour, including a private consultation and self-taken swab. We confirm the price on WhatsApp before your visit. Symptomatic BV is usually treated as a new medical problem by travel insurers, many of which we can bill directly, and we give you an invoice and a short medical report for anything you claim yourself.
Related services and treatments
BV makes the vagina more vulnerable to other infections, including HIV, so it is worth thinking about wider sexual health. After condomless sex in the last 72 hours, PEP treatment in Phuket is the urgent step; an HIV test in Phuket at the right time and our PrEP clinic in Phuket cover testing and prevention. Genital sores are not a feature of BV and are covered under herpes treatment. A partner’s cold sore can pass HSV-1 to the genitals during oral sex, as our cold sore treatment page explains. See the full list of conditions we treat for other concerns.
Summary
BV is a common imbalance of vaginal bacteria, not an STI, and it is easy to treat. A thin grey discharge with a fishy smell and no itching is the typical sign, and a pH strip, whiff test and microscopy confirm it. Metronidazole for 7 days is first line, with gel or clindamycin cream as alternatives. Think about alcohol and condoms when choosing, skip perfumed products, and get checked promptly in pregnancy or with pelvic pain.
“Avoid douching and perfumed washes, which make BV more likely. If it keeps coming back, tell us, because there are longer treatment plans that help.”
Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket
Frequently asked questions
Can I drink alcohol while taking metronidazole on holiday?
UK guidance advises avoiding alcohol during metronidazole and for 48 hours after the last dose, because it can cause flushing, nausea and palpitations in some people. US guidance no longer insists on this, but the reaction is unpleasant when it happens. If you do not want to stop drinking, clindamycin cream is an effective alternative with no alcohol restriction, so mention it during your visit.
How quickly does BV treatment work?
Most women notice the smell and discharge improving within two to three days of starting treatment. Finish the full course even when symptoms have gone, because stopping early makes a quick return more likely. If there is no improvement after a week, come back, as the cause may be something else, such as trichomoniasis or thrush.
Do I need an appointment to be seen for BV?
No appointment is needed at any of our three clinics, at any hour. Walk in and you will usually be seen within minutes, and the consultation and examination happen in a private room. If you are on your period, you can still be seen, though mentioning it helps the doctor interpret the tests.
Can a doctor treat BV at my hotel?
Yes. A home-visit doctor can see you privately in your hotel room or villa, day or night, and you can take a vaginal swab yourself in your own bathroom. In most cases treatment can start during the same visit. Send us a WhatsApp message to arrange a time that suits you.
Is BV treatment covered by travel insurance?
Many travel policies cover a symptomatic vaginal infection as a new medical problem, including the consultation, tests and medicine, and we can bill many insurers directly. Policies differ, especially for recurrent conditions you had before travelling. We confirm the price on WhatsApp before your visit and provide the invoice and report you need for a claim.
Does my partner need treatment too?
Current guidelines do not routinely treat male partners, because BV is not an STI in the usual sense. A trial published in 2025 found that treating a regular male partner reduced recurrences, so this advice may change, and it is worth discussing if BV keeps coming back. Female partners with symptoms should be checked, as BV can pass between women.
Sources
The NHS page on bacterial vaginosis covers symptoms, causes and treatment. The World Health Organization fact sheet on BV summarises causes, risks and treatment worldwide. The CDC bacterial vaginosis treatment guideline sets out metronidazole and clindamycin regimens.
Bacterial vaginosis, BV, vaginal dysbiosis, Gardnerella vaginalis, lactobacilli, vaginal pH, Amsel criteria, clue cells, whiff test, Gram stain, metronidazole, metronidazole vaginal gel, clindamycin cream, thrush, candida, trichomoniasis, pelvic inflammatory disease, NHS, CDC, WHO, Bangtao, Cherngtalay, Kata, Karon, Patong, Phuket, Takecare Clinic Phuket, Dr. Ponlawat Pitsuwan
This page is general health information and not a substitute for a medical consultation.