An indeterminate result for bacterial vaginosis (BV) means your vaginal sample didn’t clearly fall into the “positive” or “negative” category. It lands in a middle zone, sometimes called “intermediate flora,” where your bacterial balance is shifting but hasn’t tipped fully toward infection. This is not a diagnosis of BV, and it doesn’t necessarily mean you’ll develop it.
What the Scoring System Actually Measures
Most BV diagnoses rely on a lab method called the Nugent score. A technician examines your vaginal sample under a microscope and counts three types of bacteria: protective Lactobacillus, Gardnerella (a key BV-associated organism), and curved rod-shaped bacteria. Each type gets a score based on how many are present, and the numbers are combined into a total between 0 and 10.
A score of 0 to 3 means your vaginal flora is normal, dominated by healthy Lactobacillus. A score of 7 to 10 means BV is present. A score of 4 to 6 is the intermediate or indeterminate range. At this level, the lab sees that Gardnerella is starting to emerge, but Lactobacillus hasn’t disappeared. Your bacterial environment is somewhere between healthy and infected.
Why Your Result Fell in the Middle
The vaginal microbiome isn’t static. It shifts in response to your menstrual cycle, sexual activity, douching, new hygiene products, and hormonal changes. An indeterminate result often captures that shift in progress. You may be in a transitional state where BV-associated bacteria are gaining a foothold but haven’t yet overtaken the protective bacteria, or where your flora was disrupted and is in the process of recovering back to normal.
There’s no single cause for landing in this zone. It simply reflects a bacterial balance that doesn’t fit neatly into either diagnostic box.
Indeterminate Doesn’t Always Mean BV Is Coming
An indeterminate result has the potential to progress toward full BV, but that’s not a certainty. The flora can also shift back to a healthy, Lactobacillus-dominant state on its own. Research shows that intermediate flora is a transitional category, and it can go in either direction.
When researchers have tested intermediate Nugent samples with more precise molecular methods (quantitative PCR), the results split. In one study published in the Journal of Clinical Microbiology, nine samples scored as intermediate by Nugent were retested with PCR. Five of them turned out to be BV-positive by the higher-resolution method, while four were actually BV-negative but had other conditions, like yeast infections or altered flora from a different cause, explaining the unusual microscopy findings. This highlights that “indeterminate” is genuinely ambiguous, not a soft positive.
Symptoms You Might Notice
Many people with intermediate flora have no symptoms at all. Research comparing women across all three Nugent categories found no significant differences in self-reported discharge, abnormal odor, or itching. About 18% of women with intermediate scores reported discharge in the prior week, compared to 14% of women with normal scores and 16% of women with confirmed BV. The differences were not statistically meaningful.
If you do have noticeable symptoms like a fishy smell or thin grayish discharge, those details matter more than the score alone. Your provider may use clinical criteria (checking your discharge pH, performing a “whiff test,” and looking at cells under a microscope) to decide whether BV treatment is warranted regardless of where you fall on the Nugent scale.
What Happens Next
CDC guidelines recommend treating BV only in women who have symptoms. An indeterminate result without symptoms does not call for antibiotics. If you’re not experiencing discharge, odor, or discomfort, the typical approach is to retest after a few weeks to see if the balance resolves on its own or shifts in one direction.
If you are pregnant, you may wonder whether intermediate flora poses a risk. A study examining pregnancy outcomes found that intermediate vaginal flora was not significantly associated with preterm birth or other adverse outcomes. Routine screening and treatment of asymptomatic BV (or intermediate flora) in pregnancy is not currently recommended by the CDC for preventing preterm delivery.
If your symptoms are bothersome or your provider suspects the intermediate result is masking early BV, they may recommend treatment or additional testing. Some clinics now use molecular panels that can detect specific bacterial DNA and provide a clearer positive or negative answer than microscopy alone. If your result feels inconclusive and you’re symptomatic, asking about molecular testing is reasonable.
What You Can Do in the Meantime
While waiting to retest or for your flora to stabilize, a few practical steps can support the return of healthy bacteria. Avoid douching, which strips Lactobacillus and pushes the balance toward BV-associated organisms. Use unscented soap around the vulva only, not internally. If you use condoms, they may help by reducing exposure to semen, which temporarily raises vaginal pH and can encourage BV-associated bacteria.
An indeterminate BV result is genuinely uncertain, not a diagnosis you need to act on urgently. It means your bacterial balance is in flux, and the most useful next step is usually a follow-up test to see where things land.