What’s the most common gynecological infection? It’s not yeast. It’s not viral vaginitis. It’s bacterial vaginosis, and it affects approximately 21 million U.S. women—or more than one in 10 of us—each year. Or that’s experts’ best guess; no major health organization has collected information on BV’s preva­lence in the U.S. since 2004. Thankfully, the majority of the women who contract BV won’t experience symptoms, but for the 16 percent that do, it can make life suck. And lately—if health message boards are any indication—more women who have unidentified vaginal symptoms are wondering whether BV could be the culprit. Here’s what to know before you start googling.

First, BV Is Tricky to Categorize

Its symptoms include a grayish discharge, pain, itching, and a foul, fishy smell. But let’s be clear: BV is not a hygiene problem. It happens when bacteria in your vagina get out of whack, and lactobacillus, which keep that area healthy, are overtaken by more hostile bacteria. BV is also not a sexually transmitted infection (though the fact that the CDC’s website still lists BV under the STIs umbrella may contribute to some of the confusion—it’s categorized there since it’s so similar to STIs, though the CDC acknowledged to Glamour that it isn’t one). “Lots of sex does increase your risk,” explains Caroline Mitchell, M.D., of Massachusetts General Hospital, “but that’s not how you contract the bacteria.” Studies have found the more partners you’ve had, the more likely you are to get BV, and that condom use lowers your risk. “Basically, anything that disturbs the balance between healthy and unhealthy bacteria—including sexual intercourse, improperly cleaned sex toys, douching, and soap—can make a BV infection more likely to occur,” says Ingrid Cherrytree, M.D., an ob-gyn at Providence Women’s Clinic in Portland, Oregon.

It Affects All Women Differently

Experts aren’t sure exactly why, but African American women have double the risk of BV that white women do; Mexican American women are about 1.5 times more likely to get it than white women. (The CDC doesn’t have data on other groups.) Some women get the infection once and never get it again, while others experience recurrences. And as we mentioned, not everyone will get symptoms. But here’s what we all should know: Some data suggests that untreated BV can make STIs easier to contract, and if you’re pregnant, it may increase the risk of preterm labor. So if you have any symptoms—especially if you’re pregnant or having unprotected sex—call your gyno. Docs can test for BV several ways, but they might not if you don’t ask.

You Can’t Treat It Yourself
OK, you have odor and discharge. Before you assume the best treatment is an over-the-counter yeast infection treatment, know that one study found that 66 percent of women buying these meds didn’t have a yeast infection; nearly 20 percent actually had BV (others had things like mixed vaginitis, or nothing at all). “It’s hard even for doctors to describe what bacterial vaginosis is—of course women are confused,” says Dr. Mitchell. (She also warns against trying “cures” you find from googling, like tea tree oil, which have no scientific backing.) While there’s no harm in trying an OTC yeast treatment (besides being out $20), if that doesn’t solve your symptoms, get to the gyno ASAP. Fewer than 20 percent of women with BV see a doc, and antibiotics are the only treatment; otherwise the discharge and itch will only continue. And no one should have to live with that.

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