Bacterial vaginosis is a common vulvo-vaginal infection that is caused by anaerobic microorganisms, mainly representatives of the species Gardnerella vaginalis. Although less common, causative agents of bacterial vaginosis can also be anaerobes of the genus Peptostreptococcus, Bacteroides, Mobiluncus, Fusobacterium, etc. It is characteristic of bacterial vaginosis that the normal flora in the vagina is disturbed, which is acidic, with a pH of 3.5-4.2, and is represented by anaerobes and aerobes – beneficial lactobacilli. In bacterial vaginosis, anaerobic microorganisms multiply their number and the ratio of anaerobes: aerobes becomes 100-1000:1, with a norm of 2-5:1. Anaerobes cause the formation of a biofilm, which destroys the beneficial Döderlein bacteria and the environment in the vagina becomes alkaline. Predisposing factors for the development of bacterial vaginosis are the use of vaginal douches, intimate cosmetics containing perfume substances, long-term use of antibiotics, multiple sexual partners, failure to use contraceptives during sex. How do we know if the symptoms we have could be due to a Gardnerella vaginalis infection? Usually, infections of the genital tract in women are manifested by general symptoms, which include the appearance of an unusual vaginal discharge, pain, redness and itching in the area of ​​​​inflammation, pain and burning during urination, pain during intercourse, general malaise. However, there are specific characteristics of these symptoms, thanks to which we can distinguish diseases of the genital system from one another. Bacterial vaginosis is characterized by the appearance of a homogeneous, grayish vaginal discharge. Vaginal discharge has a characteristic smell of rotten fish, which is due to specific amines – cadaverine and putrescine. It has been found that the smell of rotten fish appears more often after intercourse, because the seminal fluid with its alkaline reaction causes the release of these amines. This symptom is confirmed by an amine test with 10% KOH. Another hallmark of bacterial vaginosis is an increase in vaginal pH above 4.5. Rapid pH tests are available to measure vaginal pH. Generally, these tests are not intended for general use and are mainly applied by specialists. For general use, they are mainly used by pregnant women, in which the prevention of vaginal infections is very important and the untimely detection of such can cause premature birth, birth of a child with a low weight. A histological finding in bacterial vaginosis are the so-called clue cells – characteristic epithelial cells colonized by Gardnerella vaginalis and other anaerobes. In addition to these more specific symptoms, bacterial vaginosis is characterized by dysuria and dyspareunia. The disease is very persistent and often recurs. Bacterial vaginosis is treated with metronidazole, orally, in combination with a topical cream for 10 days, or the antibiotic streptomycin for 10-14 days.In case of recurrent infection, the drug can be changed to another. A recent May 13 study published in the New England Journal of Medicine found that microbiome therapy reduced the risk of recurrent bacterial vaginosis. The publication presents results from Phase IIB of a randomized, placebo-controlled, double-blind study conducted at the University of Chicago Medical Center and at Washington University in St. Louis. The researchers administered a preparation containing beneficial lactobacilli and found that the administration of such an agent reduced the recurrence of bacterial vaginosis by 30% compared to the recurrence in women on placebo and antibiotic therapy, which was 45%. Bacterial vaginosis is a persistent infection, the complete cure of which requires a combined approach of antibiotic therapy, therapy of the sexual partner, restriction of vaginal douching and intake of pro- and prebiotics to restore the vaginal flora.