Bacterial Vaginosis Diagnosis and Symptoms

Primary Clinical Presentation of BV

The Centers for Disease Control and Prevention recommends that bacterial vaginosis be diagnosed based on a homogeneous, white, noninflammatory discharge that smoothly coats the vaginal walls, fishy vaginal odor, vaginal pH >4.5, and absence of significant vulvar inflammation, with a strength of evidence level of II 2, 3
The American College of Obstetricians and Gynecologists notes that the absence of significant vulvar inflammation distinguishes BV from other causes of vaginitis, with a strength of evidence level of II 2

The Centers for Disease Control and Prevention suggests measuring vaginal pH, with normal (3.8-4.5) suggesting candidiasis and elevated (>4.5) suggesting BV or trichomoniasis, with a strength of evidence level of II 4, 5
The American College of Obstetricians and Gynecologists recommends performing wet mount microscopy to look for yeast/pseudohyphae (candidiasis), motile trichomonads (trichomoniasis), or clue cells (BV), with a strength of evidence level of II 2, 3
The Centers for Disease Control and Prevention advises conducting a whiff test, with fishy odor with KOH indicating BV or trichomoniasis, with a strength of evidence level of II 2, 3
The American College of Obstetricians and Gynecologists notes that assessing discharge characteristics, such as thin white (BV), thick white curdy (candidiasis), or frothy yellow-green (trichomoniasis), can aid in diagnosis, with a strength of evidence level of II 1

The Centers for Disease Control and Prevention states that trichomoniasis causes a frothy greenish discharge with itching and vulvar irritation, with a strength of evidence level of II 1
The American College of Obstetricians and Gynecologists notes that mechanical or chemical irritation should be suspected when objective signs of vulvar inflammation exist with minimal discharge and no identifiable pathogens, with a strength of evidence level of II 2, 3