Bacterial vaginosis (BV) is treated with prescription antibiotics, either taken by mouth or applied vaginally. Most cases clear up within a week of starting treatment, but BV has one of the highest recurrence rates of any vaginal condition, with about 58% of women experiencing it again within 12 months. Getting rid of it for good often requires a combination of the right medication, lifestyle adjustments, and sometimes a plan for preventing repeat episodes.
How to Know It’s BV and Not a Yeast Infection
BV and yeast infections are easy to confuse, but they feel and look quite different. BV produces a thin, grayish discharge that’s often heavy in volume and has a noticeable fishy smell, especially after your period or after sex. It can cause some irritation, but it typically doesn’t cause pain.
A yeast infection, on the other hand, produces a thick, cottage cheese-like discharge without much odor. Yeast infections are more likely to cause significant itching, burning, and pain, particularly after intercourse. This distinction matters because over-the-counter yeast treatments won’t work on BV, and using the wrong product can delay proper treatment and let the imbalance worsen. If you’re unsure which you’re dealing with, a healthcare provider can confirm BV quickly with a simple vaginal swab.
Prescription Antibiotic Treatment
The standard first-line treatment is a course of antibiotics, most commonly metronidazole or clindamycin. These are available as oral tablets or as a vaginal gel or cream. A typical oral course runs seven days, while vaginal gel is often used for five to seven days. Both approaches are effective for the initial infection, with most women seeing symptoms resolve within a few days of starting.
If you’re prescribed oral metronidazole, you’ll need to avoid alcohol completely during treatment and for two full days after your last dose. The combination can cause nausea, vomiting, stomach pain, flushing, a pounding heartbeat, and headaches. The vaginal gel version absorbs less into your body, so this reaction is less common with it, but it can still happen. If you notice those symptoms while using the gel, stop drinking until treatment is finished.
Why BV Keeps Coming Back
Recurrence is the central frustration with BV. Research published in The Journal of Infectious Diseases found that 23% of women had a recurrence just one month after completing oral antibiotic treatment. By three months, that number climbed to 43%. By 12 months, 58% of women had experienced at least one recurrence. These aren’t small numbers, and they help explain why so many people feel like they can’t fully shake it.
BV happens when the balance of bacteria in the vagina shifts. Healthy vaginal flora is dominated by protective bacteria that keep the environment slightly acidic. When other types of bacteria overgrow, the pH rises and symptoms appear. Antibiotics kill off the overgrown bacteria, but they don’t always fully restore the protective bacteria that keep things balanced. That gap is what allows BV to return.
Treating Recurrent BV
For women dealing with multiple recurrences, treatment gets more aggressive and layered. The CDC outlines a protocol that starts with a seven-day course of oral antibiotics, followed by vaginal boric acid suppositories (600 mg daily) for 21 days, and then a suppressive course of vaginal antibiotic gel used twice weekly for four to six months. This extended approach aims to not just clear the infection but prevent the bacterial imbalance from re-establishing itself.
Boric acid suppositories are available over the counter and work by helping restore the vagina’s natural acidity. They’re not a standalone cure for BV, but they play a meaningful role in the multi-step approach to recurrence prevention. They should never be taken orally, as boric acid is toxic when swallowed.
Partner Treatment: A Shift in Recommendations
For years, treating male sexual partners wasn’t recommended because the evidence wasn’t strong enough. That changed in 2025. The American College of Obstetricians and Gynecologists now recommends considering concurrent treatment of male sexual partners with a combination of oral and topical antimicrobial agents when a woman has recurrent, symptomatic BV. This followed growing evidence that sexual activity is a risk factor and that BV-associated bacteria can be carried and transmitted by male partners. If you’re in a sexual relationship and dealing with repeated BV, this is worth discussing with your provider.
Probiotics for Prevention
Probiotics are a promising tool for reducing recurrence, though they work best as an add-on after antibiotic treatment rather than a replacement for it. A study covered by Harvard Health Publishing found that women who used a vaginal probiotic containing Lactobacillus crispatus (a strain naturally found in healthy vaginal flora) twice per week after standard antibiotic treatment had notably better outcomes. Only 30% of women using the probiotic had a recurrence by week 12, compared with 45% of women who received a placebo. That’s a meaningful difference, though it still shows that even with probiotics, recurrence remains common.
The specific strain matters. Not every probiotic supplement or yogurt contains strains that colonize the vagina effectively. Lactobacillus crispatus has the strongest evidence behind it for vaginal health specifically. Oral probiotics containing vaginal-relevant strains exist, but vaginal application appears to deliver bacteria more directly where they’re needed.
Habits That Help Prevent BV
What you do between episodes can make a real difference in whether BV returns. The vagina is self-cleaning, and many common hygiene products do more harm than good.
- Skip the douche entirely. Washing inside the vaginal canal disrupts the natural bacterial balance and is directly linked to BV. Research shows a clear connection between frequent use of feminine hygiene products and BV rates.
- Use minimal soap on the vulva. Warm water alone is sufficient for most people. If you prefer soap, use a small amount of an unscented, gentle bar. Fragranced body washes, feminine sprays, and scented wipes introduce chemicals that can alter vaginal pH and irritate tissue.
- Avoid scented period products. Scented pads, tampons, and liners contain fragrances your body doesn’t need exposure to.
- Use condoms consistently. Since sexual activity is a recognized risk factor, barrier methods can help reduce the transfer of bacteria that contribute to BV.
These changes won’t cure an active infection, but they reduce the environmental triggers that allow BV-associated bacteria to gain a foothold. For women prone to recurrence, combining antibiotic treatment with these habit changes and probiotic use gives the best shot at long-term relief.