Bacterial vaginosis (BV) is treated with prescription antibiotics, typically a seven-day course that clears the infection in most cases. But treatment is only part of the picture. Between 50% and 80% of women experience a recurrence within a year, which means what you do after treatment matters just as much as the prescription itself.
How BV Is Diagnosed
BV causes a thin, grayish-white discharge with a noticeable fishy smell, especially after sex. Some women also experience mild itching or burning during urination, though many have no symptoms at all. A healthcare provider can confirm the diagnosis with a quick in-office exam, checking the discharge under a microscope for specific bacterial markers and testing vaginal pH, which runs higher than normal in BV.
Getting a proper diagnosis matters because BV symptoms overlap with yeast infections and some sexually transmitted infections. Treating the wrong condition wastes time and can make the actual problem worse.
Prescription Treatment Options
The standard first-line treatment is oral metronidazole, taken twice daily for seven days. There’s also a vaginal gel version of the same medication, and a vaginal cream alternative for women who can’t tolerate metronidazole. Both oral and topical options work well for a first episode.
If you want something faster, a single-dose oral treatment called secnidazole is available. You take one packet of granules mixed into food, and you’re done. In clinical trials, it performed comparably to the seven-day metronidazole regimen. The tradeoff: only about 50% of women see full clinical resolution at the follow-up visit, which is roughly in line with what you’d expect from any BV treatment given how commonly this infection returns.
Avoid alcohol during treatment with metronidazole or secnidazole, as the combination causes nausea and vomiting. Your provider will tell you how long to wait after finishing treatment before drinking.
What to Do About Recurring BV
Recurrence is the single most frustrating aspect of BV. Half to four-fifths of women who complete a full course of antibiotics will have the infection come back within six to twelve months. This isn’t because the antibiotics failed. It’s because the underlying vaginal microbiome hasn’t fully shifted back to a protective state dominated by healthy bacteria.
For women with multiple recurrences, CDC guidelines outline a longer protocol: a seven-day course of oral antibiotics, followed by intravaginal boric acid suppositories (600 mg daily) for 21 days, then a suppressive course of metronidazole vaginal gel used twice weekly for four to six months. This extended approach aims to reset the vaginal environment and keep BV from bouncing back. Boric acid is available over the counter as vaginal suppositories and helps restore normal acidity, but it should not be taken orally, as it’s toxic when swallowed.
Should Your Partner Be Treated?
BV has traditionally been considered a non-sexually-transmitted condition, but recent research has shifted that thinking. The California Department of Public Health now recommends that clinicians consider treating male sexual partners of women with recurrent BV, particularly in ongoing monogamous relationships. The suggested regimen is a combination of oral antibiotics and a topical penile cream, both taken for seven days at the same time the female partner is being treated. Both partners should avoid sexual contact during the treatment period.
This is a newer recommendation, and not every provider will bring it up. If your BV keeps coming back and you have a regular male partner, it’s worth raising the question yourself.
Probiotics and Vaginal Flora
A healthy vagina is dominated by Lactobacillus bacteria, which produce lactic acid and hydrogen peroxide to keep harmful bacteria in check. In BV, these protective bacteria are displaced by an overgrowth of other organisms. Probiotics aim to tip the balance back.
Clinical trials have found that certain Lactobacillus strains, taken either orally for about two months or used as vaginal suppositories for six to twelve days, can help restore normal vaginal bacteria and reduce BV recurrences compared to placebo. The strains with the most evidence behind them include L. acidophilus, L. rhamnosus GR-1, and L. fermentum RC-14. These are available in supplement form at most pharmacies. Probiotics aren’t a replacement for antibiotics during an active infection, but they may help keep BV from returning after treatment.
Habits That Protect Your Vaginal pH
Your vagina maintains a naturally acidic environment that discourages the bacteria responsible for BV. Several everyday habits can disrupt that acidity and set the stage for infection.
- Don’t douche. Douching flushes out protective bacteria and directly raises vaginal pH. Wash your vulva with warm water only. You don’t need to put any soap or product inside your vagina.
- Skip scented products. Scented pads, tampons, sprays, and soaps contain chemicals that alter vaginal pH. Switch to unscented versions.
- Change tampons and pads every few hours. Leaving them in too long creates an environment that favors harmful bacteria.
- Use condoms or dental dams. Semen is alkaline and temporarily raises vaginal pH after unprotected sex. Lubricants and even dirty sex toys can introduce bacteria that shift the balance.
- Change out of wet or sweaty clothes promptly. Moisture trapped against the skin encourages bacterial overgrowth.
None of these habits will cure an active case of BV, but they reduce the chances of developing one in the first place or triggering a recurrence after treatment.
Why You Shouldn’t Ignore BV
BV sometimes resolves on its own, but leaving it untreated carries real risks. Women with BV have higher susceptibility to sexually transmitted infections, including HIV, chlamydia, and gonorrhea. The disrupted vaginal environment makes it easier for these infections to take hold.
During pregnancy, the stakes are higher. A meta-analysis of maternal outcomes found that BV increases the odds of preterm birth by 76% and low birth weight by 73%. Pregnant women with symptoms should be treated promptly.
Even outside of pregnancy, the persistent discharge, odor, and discomfort of untreated BV can significantly affect quality of life and sexual confidence. Treatment is straightforward, and there’s no reason to wait it out when effective options exist.