Bacterial vaginosis (BV) is treated with prescription antibiotics, either taken by mouth or applied vaginally, with most courses lasting five to seven days. It’s the most common vaginal condition in women of reproductive age, and while it sometimes resolves on its own, treatment lowers the risk of serious complications and clears symptoms faster.
Recognizing Symptoms
BV happens when the balance of bacteria in the vagina shifts, with normally dominant lactobacilli replaced by an overgrowth of other organisms. The hallmark symptom is a thin, grayish-white discharge with a strong fishy odor, especially noticeable after sex. Some people also experience mild itching or burning during urination, though many have no symptoms at all.
BV is not the same as a yeast infection. Yeast infections typically cause thick, white, clumpy discharge and significant itching but little odor. If you’re unsure which you’re dealing with, a quick office visit or telehealth appointment can confirm the diagnosis with a vaginal swab. Getting the right diagnosis matters because the treatments are completely different.
Standard Antibiotic Treatment
The CDC recommends three first-line options, all considered equally effective:
- Oral metronidazole: 500 mg taken twice a day for 7 days
- Metronidazole vaginal gel (0.75%): one applicator inserted once daily for 5 days
- Clindamycin vaginal cream (2%): one applicator inserted at bedtime for 7 days
No studies have found one option to be clearly better than another, so the choice often comes down to personal preference and side effects. Oral metronidazole is convenient but can cause nausea, a metallic taste, and should not be combined with alcohol during treatment and for at least 24 hours after finishing. The vaginal options avoid those stomach-related side effects but require nightly application. Clindamycin cream can weaken latex condoms and diaphragms for up to 72 hours after use, so keep that in mind if you rely on barrier contraception.
Finishing the full course is important even if symptoms clear up in a day or two. Stopping early increases the chance that the bacterial imbalance returns.
What Happens If BV Goes Untreated
BV does resolve on its own in some cases, but leaving it untreated carries real risks. It increases susceptibility to HIV and other sexually transmitted infections like chlamydia and gonorrhea. Those infections, in turn, can lead to pelvic inflammatory disease, which can cause chronic pelvic pain and make it harder to get pregnant.
During pregnancy, the stakes are higher. BV raises the risk of preterm birth and low birth weight. If you’re pregnant and notice symptoms, getting treated promptly is especially worthwhile.
Dealing With Recurrent BV
Recurrence is one of the most frustrating aspects of BV. Up to half of those treated experience a return of symptoms within 12 months. If you’ve had three or more episodes in a year, your provider may suggest a longer or stepped approach: a standard treatment course followed by a maintenance regimen of vaginal metronidazole gel applied less frequently over several months to keep the bacterial balance stable.
Partner Treatment: A New Recommendation
For years, treating sexual partners wasn’t part of the standard approach because the evidence wasn’t strong enough. That changed in 2025 when the American College of Obstetricians and Gynecologists recommended, for the first time, that male sexual partners of people with recurrent BV receive concurrent antibiotic treatment. Growing evidence shows sexual activity plays a significant role in BV recurrence, and treating both partners appears to help break the cycle. The recommendation involves a combination of oral and topical antibiotics for the male partner.
Research on partner treatment in same-sex relationships and for people with multiple partners is still limited, so the recommendation currently applies most clearly to monogamous relationships with male partners.
Probiotics and Boric Acid
Probiotics are a popular complementary approach, and there is some clinical evidence behind specific strains. Trials using Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 taken orally for two months showed increased vaginal lactobacilli and reduced BV recurrence compared to placebo. Vaginal Lactobacillus acidophilus applied for 6 to 12 days also showed benefits in some studies. However, results are inconsistent. Other trials found no meaningful difference between probiotic use and placebo. Probiotics are unlikely to harm you, but they work best as a supplement to antibiotic treatment rather than a replacement.
Boric acid vaginal suppositories are another option that has gained attention, particularly for recurrent or antibiotic-resistant cases. Boric acid works by disrupting the protective biofilms that BV-associated bacteria form, making them more vulnerable to the body’s natural defenses. A review in Frontiers in Reproductive Health rated the clinical evidence as moderate quality, meaning it shows promise but isn’t definitive. Some providers recommend boric acid as an add-on after a standard antibiotic course, especially when BV keeps coming back.
Prevention Strategies That Actually Help
BV isn’t caused by poor hygiene, but certain habits do shift vaginal bacteria in the wrong direction. The most well-supported prevention strategies focus on protecting the vagina’s naturally acidic environment:
- Skip douching entirely. Douching washes out protective lactobacilli and is one of the strongest risk factors for BV.
- Use only water or a mild, unscented cleanser on the external vulva. Scented soaps, sprays, and washes disrupt the vaginal microbiome.
- Use condoms consistently. Semen is alkaline and temporarily raises vaginal pH, which can encourage BV-associated bacteria to flourish. Condoms also reduce the transfer of bacteria between partners.
- Avoid scented menstrual products. Unscented pads, tampons, or a menstrual cup are gentler on vaginal flora.
- Wear breathable cotton underwear and change out of wet swimwear or workout clothes promptly.
None of these steps guarantee you won’t get BV, but together they reduce the conditions that allow it to develop. If you’re someone who deals with frequent recurrences, combining these habits with a maintenance treatment plan from your provider gives you the best shot at staying symptom-free long term.