Bacterial vaginosis (BV) is treated with prescription antibiotics, and they work well. Cure rates range from about 70% to 85% depending on the medication. There’s no reliable over-the-counter cure, but a few supplements can support treatment or help prevent BV from coming back.
Prescription Antibiotics: The First-Line Options
Two antibiotics are the standard treatments for BV: metronidazole and clindamycin. Both come in oral (pill) and vaginal (gel or cream) forms, and clinical data shows no clear winner between taking a pill versus using a topical version. What matters most is completing the full course.
Metronidazole is the most commonly prescribed option. The typical oral regimen is a 500 mg pill taken twice a day for seven days. In clinical trials, this achieves cure rates around 70%. The vaginal gel version uses a lower concentration applied for five days and performs similarly. The main downside of oral metronidazole is stomach-related side effects: nausea, metallic taste, and digestive discomfort affect roughly half of people who take it. You also need to avoid alcohol during treatment and for at least 24 hours after finishing, because the combination can cause severe nausea and vomiting.
Clindamycin is the main alternative. Taken orally at 300 mg twice daily for seven days, one trial showed a cure rate of 85%. It’s also available as a vaginal cream. Clindamycin tends to be easier on the stomach than metronidazole, which makes it a good choice if you’ve had GI problems with metronidazole before. One thing to know: clindamycin cream can weaken latex condoms for up to five days after use.
A newer option is secnidazole, which works as a single-dose oral treatment. You take one packet of granules mixed into food, and the treatment is done. For people who struggle with a seven-day course of pills, this can be a practical alternative.
What About Over-the-Counter Products?
No over-the-counter product is proven to cure BV on its own. However, boric acid vaginal suppositories have a specific role, particularly for recurrent infections. Boric acid is available without a prescription and is typically used at a dose of 600 mg inserted vaginally once daily. For recurrent BV, courses of up to 21 days are sometimes recommended. Boric acid isn’t a replacement for antibiotics during an active first infection, but it can be a useful add-on for people dealing with repeat episodes.
You may have also seen hydrogen peroxide douches suggested online. A randomized trial directly compared a single hydrogen peroxide douche (3% solution) against a single oral dose of metronidazole. The hydrogen peroxide group had a significantly lower cure rate: 62.5% versus 78.6% for metronidazole. Hydrogen peroxide did cause far fewer side effects (about 14% reported GI symptoms compared to nearly 49% with metronidazole), but the trade-off in effectiveness is real. More importantly, douching of any kind can further disrupt vaginal bacteria and is generally discouraged as a regular practice.
Do Probiotics Help?
Probiotics won’t cure an active BV infection, but growing evidence suggests they can reduce the chance of it coming back after antibiotic treatment. The key is using strains that have actually been studied for vaginal health, not just any yogurt-based supplement off the shelf.
The most promising research involves a strain called L. crispatus CTV-05 (sold under the name Lactin-V). In a phase IIb clinical trial, using this probiotic vaginally after completing metronidazole treatment significantly lowered BV recurrence compared to placebo. Two other well-studied strains, L. rhamnosus GR-1 and L. reuteri RC-14, are available as oral supplements and have been evaluated in multiple populations. Several clinical studies have found that lactobacillus-based probiotics, whether taken orally or inserted vaginally, can improve outcomes when used alongside antibiotics.
If you’re considering probiotics, look for products that list specific strain names (not just the species) on the label. Generic “women’s health” probiotics without identified strains haven’t been tested in the same way.
Why BV Keeps Coming Back
Recurrence is the most frustrating part of BV. Even after successful treatment, many people experience repeat infections within months. Several factors contribute to this.
BV-causing bacteria form a protective layer called a biofilm on the vaginal walls. Antibiotics kill the free-floating bacteria effectively, but the biofilm can survive treatment and reseed the infection once antibiotics stop. This is one reason maintenance therapy exists: after clearing an active infection, some providers prescribe a vaginal gel used twice weekly for several months to suppress regrowth.
Sexual partners also play a role. In 2025, the American College of Obstetricians and Gynecologists recommended for the first time that sexual partners of people with recurrent BV be treated concurrently. The recommendation applies to both opposite-sex and same-sex partners. If your BV keeps returning, this is a conversation worth having with your provider.
Habits That Protect Your Vaginal Flora
The vagina maintains a naturally acidic environment dominated by beneficial lactobacillus bacteria. BV happens when that balance tips in favor of other organisms. Several everyday habits can push things in the wrong direction.
Lubricants are a common overlooked trigger. Products with high osmolality (a measure of how concentrated they are) can irritate vaginal tissue and disrupt the bacterial balance. Many popular water-based lubricants contain glycerin, parabens, or propylene glycol, all of which increase osmolality. Hyper-osmotic lubricants, which range from about 1,500 to nearly 6,000 mOsm/kg, are associated with mild to severe mucosal irritation. Look for lubricants labeled “iso-osmotic” or those specifically formulated without glycerin and parabens.
Other protective habits are straightforward: avoid douching entirely, use unscented soap only on the external vulva (not inside the vaginal canal), and wear breathable cotton underwear. Smoking is also linked to higher BV rates, though the exact mechanism isn’t fully understood.
What to Expect During Treatment
Most people notice improvement in discharge and odor within the first two to three days of starting antibiotics. Full resolution typically takes the entire course of treatment. Even if symptoms clear up early, finishing all seven days of medication matters. Stopping early increases the chance that the biofilm survives and the infection returns.
If you’ve completed a full course of antibiotics and symptoms persist or return within a few weeks, that’s recurrent BV, and the approach shifts. Your provider may try a different antibiotic, add boric acid suppositories, recommend maintenance therapy, or suggest concurrent partner treatment. Recurrent BV isn’t a sign that you did something wrong. It’s a reflection of how resilient these bacterial communities can be.