The prevalence and complications of bacterial vaginosis are population dependent. In pregnancy, bacterial vaginosis is associated with late miscarriages and infection driven pre-term delivery. Regardless of the aetiology of pre-term delivery, surviving infants are at increased risk of subsequent neurodevelopmental handicap. Intervention studies in bacterial vaginosis positive pregnant women at high risk of pre-term delivery demonstrate the benefits of antibiotic treatment. Current evidence suggests that bacterial vaginosis may increase the efficiency of heterosexual HIV transmission. Metronidazole remains the mainstay of treatment of bacterial vaginosis. No treatment prevents relapse, which occurs in 20-30% of cases within 1 month. New approaches that are based on a better understanding of the pathophysiology of bacterial vaginosis are required to improve the clinical management of recurrent bacterial vaginosis.