Bacterial vaginosis (BV) is treated with prescription antibiotics, and most cases clear up within a week of starting medication. The catch: 50 to 80 percent of women experience a recurrence within a year, making prevention just as important as the initial treatment. Here’s what works, what doesn’t, and how to keep BV from coming back.
What BV Actually Is
BV happens when the balance of bacteria in the vagina shifts. Normally, beneficial bacteria keep the vaginal environment slightly acidic (a pH below 4.5), which prevents harmful organisms from gaining a foothold. When that balance tips, other bacteria overgrow, raising the pH and causing symptoms: a thin, milky discharge, a noticeable fishy odor, and sometimes mild itching or irritation.
BV isn’t a sexually transmitted infection, though sexual activity can increase the risk. It’s the most common vaginal infection in women of reproductive age, and many people get it more than once. Some women with BV have no symptoms at all, discovering it only during a routine exam.
Prescription Antibiotics: The First-Line Fix
Antibiotics are the standard treatment and the only approach with strong evidence behind it. Your provider will typically prescribe one of two options: metronidazole (taken as a pill or applied as a vaginal gel) or clindamycin (usually a vaginal cream). Both work by targeting the overgrown bacteria and allowing your natural flora to recover. A typical course runs five to seven days.
Cure rates with antibiotics are high in the short term. In clinical trials, over 90 percent of women see their symptoms resolve after a full course. The problem is what happens next. Within six to twelve months of finishing treatment, somewhere between half and four out of five women will have BV again. That recurrence rate is why BV can feel so frustrating, and why the steps you take after treatment matter enormously.
If you’ve had multiple recurrences, your provider may suggest a longer course of antibiotics or a maintenance regimen, using a lower dose over several months to keep the bacteria in check while your vaginal flora stabilizes.
What About Boric Acid?
Boric acid vaginal suppositories have gained popularity online, but the evidence is limited. Boric acid isn’t well regulated or thoroughly studied, and commercially available products haven’t been proven to deliver on their claims. It may be helpful for resistant or recurrent vaginal infections when combined with a prescription antibiotic, but it’s rarely a first-line treatment.
There are real safety concerns. Boric acid is highly toxic if swallowed, and even a single pill taken by mouth can be fatal. Vaginal use can cause significant irritation, potentially even chemical burns. Sexual partners may also experience skin irritation after contact. Boric acid is not recommended during pregnancy or for anyone trying to conceive. If you’re considering it, talk to your provider rather than self-treating based on internet advice.
Do Probiotics Help?
The idea behind probiotics is straightforward: replenish the beneficial bacteria that BV depletes. In practice, the results have been disappointing. A controlled trial testing oral probiotics as an add-on to standard antibiotics found that they did not increase the cure rate compared to antibiotics alone. The probiotic species were rarely even detected in the vaginal or gut microbiome after women took them, suggesting the supplements simply weren’t reaching the right place in meaningful numbers.
That doesn’t mean all probiotic approaches are useless forever, but right now there isn’t solid clinical evidence that any specific supplement will help clear BV or prevent it from returning. Eating fermented foods and maintaining a varied diet supports general health, but don’t count on yogurt or a pill to fix an active infection.
Non-Antibiotic Treatments in Development
One promising alternative is an antiseptic vaginal tablet that has been used in Europe for decades. In a randomized trial, this treatment achieved a clinical cure rate of about 93 percent, essentially matching standard antibiotics. At a follow-up visit 20 to 40 days later, both groups saw some recurrence, but the antiseptic remained comparable to antibiotics. This option is recommended in European guidelines but is not yet approved in the United States. It’s worth knowing about, especially if you struggle with antibiotic side effects or repeated courses of treatment.
Why BV Keeps Coming Back
Recurrence is the defining frustration of BV. The bacteria responsible for the infection can form a protective layer, called a biofilm, on the vaginal walls. Antibiotics kill the free-floating bacteria but may not fully penetrate this biofilm, leaving behind a reservoir that can re-establish the infection once treatment stops.
Sexual activity can reintroduce disruptive bacteria. Some research suggests that untreated sexual partners may carry the organisms associated with BV and pass them back. Having a new partner or multiple partners increases the likelihood of recurrence. Using condoms consistently has been associated with lower recurrence rates in some studies, likely because they reduce the exchange of bacteria that can shift vaginal pH.
Preventing BV: What You Can Control
The most impactful thing you can do is stop disrupting your vaginal environment. That starts with never douching. Douching removes the good bacteria and healthy flora naturally present in the vagina. When your body tries to repopulate those bacteria, it can overproduce, triggering an infection. Even douching with plain water is not recommended, because the act itself causes irritation, removes beneficial organisms, and disrupts pH balance.
Beyond douching, a few specific habits make a difference:
- Skip scented products. Scented body wash, feminine hygiene sprays, powders, and wipes can worsen symptoms or irritate sensitive tissue. Wash the external genital area with warm water only, or a mild, unscented soap on the outer skin.
- Don’t over-clean. Washing your genitals multiple times a day strips away protective bacteria. Once daily is enough.
- Wear breathable underwear. Cotton underwear and loose-fitting clothing reduce moisture buildup, which creates a less hospitable environment for harmful bacteria.
- Use condoms. Barrier protection during sex reduces the introduction of bacteria that can shift vaginal pH.
Why Treatment Matters
BV sometimes resolves on its own, but leaving it untreated carries risks. It increases susceptibility to sexually transmitted infections, including HIV, by disrupting the vaginal lining’s natural defenses. During pregnancy, BV has been linked to a higher chance of preterm delivery (before 37 weeks), which is associated with serious complications for the baby, including breathing problems and neurological issues.
Even outside of pregnancy, untreated BV can cause persistent discomfort and may increase the risk of infection after gynecological procedures. If you recognize the symptoms, getting tested and treated is straightforward and worth the effort, even if it feels like a cycle you’ve been through before.
Getting Diagnosed
BV shares symptoms with yeast infections and other conditions, so self-diagnosing based on discharge alone is unreliable. A provider can diagnose BV during a quick office visit by checking for a few key signs: thin, milky discharge that coats the vaginal walls, a pH above 4.5, a fishy odor, and the presence of certain cells visible under a microscope. At least three of these four markers need to be present for a BV diagnosis. Some clinics also use a lab-based scoring system on a vaginal swab, which is considered the gold standard.
If you’ve treated what you assumed was BV with over-the-counter products and it keeps returning, getting an actual diagnosis ensures you’re treating the right condition. Yeast infections, trichomoniasis, and other issues can look similar but require completely different treatment.