Bacterial vaginosis (BV) is treated with prescription antibiotics, either taken by mouth or applied inside the vagina. Most cases clear up within five to seven days of starting treatment. BV is the most common vaginal infection in women ages 15 to 44, and while it sometimes resolves on its own, antibiotics are the fastest and most reliable way to get rid of it.
What BV Is and Why It Happens
BV isn’t a traditional infection you “catch” from somewhere. It’s a shift in the balance of bacteria that naturally live in the vagina. A healthy vagina is dominated by beneficial bacteria (mainly Lactobacillus species) that keep the environment slightly acidic. When those protective bacteria get outnumbered by other organisms, the pH rises and symptoms develop: a thin grayish-white discharge, a strong fishy odor (especially after sex), and sometimes mild itching or burning.
Several things can tip that balance. Douching, having new or multiple sex partners, and not using condoms all increase the risk. Women who douche weekly are five times more likely to develop BV than women who don’t. BV can also spread between female sex partners, though there’s currently no evidence that treating a male sex partner affects whether BV comes back.
Prescription Treatments That Work
A doctor or clinic can diagnose BV with a simple exam and prescribe one of several antibiotic options. The CDC lists three first-line treatments:
- Oral metronidazole: a pill taken twice a day for seven days
- Metronidazole vaginal gel: applied once a day for five days
- Clindamycin vaginal cream: applied at bedtime for seven days
If those don’t work or aren’t a good fit, alternatives include oral clindamycin for seven days, clindamycin vaginal suppositories for three days, or tinidazole (a related antibiotic) taken orally for two to five days depending on the dose. Your provider will choose based on your history, preferences, and whether you’re pregnant.
Oral and vaginal treatments are similarly effective. Some people prefer the vaginal option because it causes fewer side effects like nausea. Others prefer a pill for convenience. If you’re prescribed metronidazole by mouth, avoid alcohol during treatment and for at least 24 hours afterward, since the combination can cause severe nausea and vomiting.
Why BV Keeps Coming Back
Recurrence is the most frustrating part of BV. Up to half of women who are successfully treated see symptoms return within a year. One reason is that the bacteria responsible, particularly Gardnerella vaginalis, form a protective coating called a biofilm on the vaginal lining. Research published in the American Journal of Obstetrics & Gynecology found that bacteria in this biofilm tolerate four to eight times higher concentrations of the natural acids produced by healthy vaginal bacteria compared to free-floating bacteria. That means even after antibiotics knock the infection down, small pockets of resistant bacteria can survive and regrow once treatment ends.
For women dealing with repeated episodes, providers sometimes recommend extended or maintenance therapy. This typically involves completing a standard course of antibiotics, then continuing with a lower-frequency regimen (such as vaginal metronidazole gel applied a couple of times per week) for several months to keep the bacteria suppressed while the vaginal ecosystem recovers.
What About Home Remedies?
If you’ve searched online, you’ve probably seen suggestions for apple cider vinegar, tea tree oil, hydrogen peroxide, or yogurt. None of these have strong clinical evidence behind them for treating BV, and some carry real risks.
Douching with vinegar or any other solution is one of the worst things you can do. The Office on Women’s Health is clear on this: douching disrupts vaginal bacteria, can push existing infection deeper into the uterus and fallopian tubes, and only covers up odor temporarily while making the underlying problem worse. If you’re planning to see a provider, don’t douche beforehand, as it can interfere with test results.
Boric acid vaginal suppositories (typically 600 mg) are sometimes used as an add-on therapy, particularly for recurrent BV. Some providers recommend them alongside or after standard antibiotics. Clinical trials have studied this approach, but the evidence is still limited, and boric acid should never be taken by mouth, as it’s toxic when swallowed. If you’re curious about trying it, talk to your provider first.
The Role of Probiotics
Since BV is fundamentally a problem of missing beneficial bacteria, it makes sense to wonder whether probiotics could help restore them. Several strains are being studied, including Lactobacillus crispatus, Lactobacillus gasseri, and Lactobacillus acidophilus, delivered as vaginal suppositories. The idea is to reintroduce the bacteria that keep the vaginal pH low and crowd out harmful organisms.
The results so far are promising but inconsistent. Probiotics are not a standalone replacement for antibiotics in active BV. Where they may have a role is after antibiotic treatment, helping to re-establish a healthy bacterial community and potentially reducing the chance of recurrence. Over-the-counter probiotic supplements vary widely in quality and strain composition, so what you pick up at a pharmacy may not contain the specific strains being tested in clinical research.
Habits That Lower Your Risk
Whether you’re trying to prevent a first episode or break the cycle of recurrence, a few practical changes can make a difference. Using condoms consistently reduces the introduction of bacteria that disrupt vaginal balance. Limiting your number of sexual partners has the same effect. And stopping douching entirely, if you haven’t already, removes one of the strongest known risk factors.
Beyond that, the basics of vaginal care apply: wash the external area with plain water or a mild, unscented soap, avoid scented sprays or wipes inside or around the vagina, and wear breathable cotton underwear. The vagina is self-cleaning, and most products marketed for “freshness” do more harm than good.
If you notice that fishy odor, unusual discharge, or irritation, getting tested sooner rather than later leads to faster treatment and a lower chance of complications. BV that goes untreated can increase susceptibility to sexually transmitted infections and, during pregnancy, raise the risk of preterm delivery.