Can Bacterial Vaginosis Cause Vulvovaginal Itching?
Yes, bacterial vaginosis can cause vulvovaginal itching, though this is not its most characteristic symptom—BV primarily presents with malodorous discharge rather than prominent itching. 1, 2
Primary Clinical Presentation of BV
The classic presentation of bacterial vaginosis centers on:
- A homogeneous, white, noninflammatory discharge that smoothly coats the vaginal walls 3
- Fishy vaginal odor (the hallmark symptom), particularly after intercourse or with alkaline exposure 3
- Vaginal pH >4.5 3
- Absence of significant vulvar inflammation, which distinguishes BV from other causes of vaginitis 3, 1
When BV Does Cause Itching
While itching is not the predominant symptom, approximately 50% of women with BV are symptomatic and can experience:
- Vaginal itching as a secondary symptom 2
- Vaginal burning on occasion 4
- Vaginal discharge and malodor remain the primary complaints 2, 4
Critical Diagnostic Distinction
The presence of prominent vulvovaginal itching should prompt consideration of alternative diagnoses:
- Vulvovaginal candidiasis is the primary cause of vulvovaginal itching, presenting with itching, burning, white discharge, and vulvar/vaginal erythema 5, 6
- Trichomoniasis causes a frothy greenish discharge with itching and vulvar irritation 1, 5
- Mechanical or chemical irritation should be suspected when objective signs of vulvar inflammation exist with minimal discharge and no identifiable pathogens 3
Diagnostic Algorithm When Itching Is Present
When a patient presents with vulvovaginal itching:
- Measure vaginal pH: Normal (3.8-4.5) suggests candidiasis; elevated (>4.5) suggests BV or trichomoniasis 7, 8
- Perform wet mount microscopy: Look for yeast/pseudohyphae (candidiasis), motile trichomonads (trichomoniasis), or clue cells (BV) 3
- Conduct whiff test: Fishy odor with KOH indicates BV or trichomoniasis 3
- Assess discharge characteristics: Thin white (BV), thick white curdy (candidiasis), or frothy yellow-green (trichomoniasis) 1, 5
Common Pitfall to Avoid
Do not assume itching automatically excludes BV—while itching is more characteristic of candidiasis or trichomoniasis, BV can present with itching as a secondary symptom in symptomatic women. 2, 4 The key is that BV lacks the prominent vulvar inflammation typically seen with candidal infections. 3, 1