Key Points:

• Bacterial vaginosis (BV) is a very common condition that can cause an unpleasant fishy odor and thin, milky vaginal discharge. It’s caused by an imbalance of “good” and “bad” bacteria in the vagina.
• Bacterial vaginosis is treated with antibiotics. However, BV comes back in more than half of all cases within a year. 
• Repeat cases of BV can be treated with another round of antibiotics or with other therapies in combination with antibiotics. Preventive measures, like practicing safe sex and not douching, can also help.

Bacterial vaginosis (BV) is caused by an imbalance of bacteria in the vagina. BV can cause symptoms like a strong, fishy odor and milky discharge from the vagina. As if BV isn’t bad enough, some people experience something known as recurrent BV. This is when BV keeps coming back, even after treatment.

Bacterial vaginosis is treated with antibiotics. However, more than 50% of cases come back within 3-5 months. Sometimes, the same infection keeps coming back. Other times, it’s a new infection.

There are treatment options for people with recurrent BV, including additional antibiotics as well as new and emerging treatments like probiotics and boric acid suppositories. Prevention measures can also help, including practicing safe sex and avoiding irritating products.

What causes bacterial vaginosis?

Bacterial vaginosis is caused by an imbalance of “good” and “bad” bacteria in the vagina. This imbalance can happen after any activity that disrupts the natural balance of bacteria in the vagina.

Bacterial vaginosis is not a sexually transmitted infection (STI). It’s not contagious, and it can't spread from person to person. However, having sex does increase the risk of developing bacterial vaginosis. This risk goes up if you have multiple sex partners or have sex with women.

The risk of developing bacterial vaginosis increases if you:

• Are pregnant
• Have unprotected sex
• Have an intrauterine device (IUD)
• Have multiple sex partners or a new sex partner
• Have sex with women
• Douche or use other potentially irritating products in the vagina, including sprays, deodorants or scented hygiene products
• Are using antibiotics
• Smoke cigarettes 

BV usually gets better after a few days of treatment with antibiotics. Since BV doesn’t always cause symptoms, the only way to know the infection is gone is to have a repeat vaginal culture about two weeks after finishing treatment.

Why you keep getting bacterial vaginosis

Antibiotics are the first choice for treating bacterial vaginosis. These usually work well, but about 10-15% of people need a second course of treatment. Research also shows that even when treatment is successful, BV comes back for more than half of people after just a few months.

The reason bacterial vaginosis keeps coming back isn’t entirely clear. Antibiotics can clear out the bacteria that cause BV, but it’s possible that “bad” bacteria can regrow if it’s re-introduced from sex or other irritants.

There is also something called a “biofilm” – a group of bacteria that stick together and make it hard for antibiotics to reach them. Some researchers think that “bad” bacteria hide out in biofilms where antibiotics can’t reach them.

If you keep getting bacterial vaginosis with the same partner, there may be something about your partner’s genital chemistry that irritates your own vaginal flora. It might be worthwhile for your partner to be tested and possibly treated for BV.  It’s also important to finish the full course of your treatment to make sure the infection has cleared up before having sex again.

People who get bacterial vaginosis over and over might need long-term antibiotics to help permanently clear up the infection along with lifestyle changes, like using latex condoms and limiting sex partners.

Boric acid suppositories may be another option, especially when combined with antibiotics. Boric acid has antifungal and antibacterial properties and can lower the pH of the vagina.

Boric acid suppositories should only be used under the direction of a medical provider since this treatment isn’t right for every condition. Additionally, over-the-counter suppositories aren’t regulated by the U.S. Food and Drug Administration, making it impossible to know whether an individual product is safe. Note: If you do have boric acid suppositories in the house, keep them out of the reach of children and pets since boric acid is toxic if swallowed.

Chronic BV can be really frustrating, but a medical provider can help you find ways to treat it and prevent it from coming back.

How to prevent getting bacterial vaginosis again

You can support a good balance of bacteria in the vagina by practicing safe sex and avoiding irritating products in the vagina. There is also some evidence that probiotic supplements or eating foods with “good” bacteria like Lactobacillus can help as well.

You can help prevent bacterial vaginosis by following these steps:

• Don’t douche: There’s no need to use special products or cleansers in the vagina. In fact, douching can disrupt the normal balance of bacteria in the vagina. This makes it more likely for bacterial vaginosis to occur.
• Use non-irritating hygiene products: Vaginal deodorants or sprays and scented tampons or pads can irritate the vagina and disrupt the normal bacteria balance.
• Practice safe sex: The risk of bacterial vaginosis goes up if you have multiple sex partners. Additionally, unprotected sex increases the risk of developing bacterial vaginosis as well as sexually transmitted infections. Latex condoms or dental dams can reduce your risk. It’s also important to wash all sex toys before and after use to avoid spreading harmful bacteria.
• Don’t smoke: Smoking changes the way your body fights off infection and is linked to higher rates of BV as well as STIs.
• Wear breathable underwear made of cotton: Bacteria are more likely to grow in warm, moist places. Nylon and other fabrics can trap warmth and moisture, while cotton is more breathable.
• Consider a probiotic supplement or eating foods with Lactobacillus (like yogurt): Research is still emerging in this area, so talk to your medical provider before starting any new supplement.

Online treatment for recurrent bacterial vaginosis 

If you struggle with repeat cases of BV, you’re not alone. In fact, bacterial vaginosis is the most common vaginal condition in people assigned female at birth who are between the ages of 15-44.

If you keep getting BV, remember you haven’t done anything “wrong.” The truth is that recurrent BV can be difficult and frustrating to treat.

For questions about BV, or if you are dealing with a repeat case, talk to a medical provider who can help you find a treatment that can clear it up for good. A medical professional can also help you review your current hygiene and sex habits to make sure you’re doing everything possible to reduce your risk.

Need help finding the right treatment option for BV? Dr. B can help.

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