Treatment for a vaginal infection depends entirely on which type you have, because the three most common infections require completely different medications. Using the wrong treatment won’t help and can make things worse. Bacterial vaginosis (BV) and trichomoniasis need prescription antibiotics, while yeast infections can often be treated with over-the-counter antifungal products.
Identifying Which Infection You Have
The discharge, smell, and sensation each infection produces are distinct enough to help you and your healthcare provider figure out what’s going on.
Bacterial vaginosis produces a thin white or gray discharge with a strong fishy odor, especially after sex. Many people with BV have no symptoms at all. It’s the most common vaginal infection and is not sexually transmitted. It happens when the balance of bacteria in the vagina shifts, allowing certain species to overgrow.
Yeast infections cause a thick, white discharge that can look like cottage cheese. There’s usually no odor, but the hallmark symptom is intense itching and redness of the vagina and vulva. Yeast infections are caused by fungal overgrowth, not bacteria, which is why antibiotics won’t treat them.
Trichomoniasis is a sexually transmitted infection caused by a parasite. It can produce a gray-green discharge that may smell bad, along with itching, burning, and soreness. Burning during urination is common. Like BV, trichomoniasis can also be symptom-free.
A healthy vagina has a pH between 3.8 and 4.5. Anything above 4.5 signals that something may be off and makes you more prone to infection. At-home pH test strips can flag an elevated reading, but they can’t tell you which infection you have. If you’re experiencing symptoms for the first time, or if your symptoms don’t match a straightforward yeast infection, getting tested is the fastest path to the right treatment.
Treating Bacterial Vaginosis
BV requires a prescription. The standard treatment is a 7-day course of oral antibiotics, taken twice daily. Your provider may instead prescribe an antibiotic vaginal gel applied once daily for 5 days, or an antibiotic vaginal cream used at bedtime for 7 days. Shorter alternative courses lasting 2 to 5 days are sometimes used.
BV has a frustrating tendency to come back. About half of people treated for BV experience a recurrence within 12 months. If yours keeps returning, your provider may recommend a longer or repeated treatment course. Boric acid vaginal suppositories are sometimes used as an add-on therapy for recurrent BV, helping restore the vagina’s natural acidity. These should be used under medical guidance, not as a first-line fix.
Treating Yeast Infections
Most uncomplicated yeast infections respond well to over-the-counter antifungal creams or suppositories, available in 1-day, 3-day, and 7-day formulations. The 7-day options tend to cause less irritation. You insert them vaginally, typically at bedtime, and symptoms usually start improving within a couple of days.
If you prefer a pill, a single dose of a prescription oral antifungal clears most uncomplicated yeast infections. For more stubborn cases, your provider might prescribe three doses spaced 72 hours apart. Recurrent yeast infections, defined as four or more episodes in a year, call for a longer approach: a 10- to 14-day initial treatment followed by a once-weekly maintenance dose for up to six months.
One important note: if you’ve never had a yeast infection before, it’s worth getting a proper diagnosis rather than reaching for an OTC product. What feels like a yeast infection can sometimes be BV or another condition entirely.
Treating Trichomoniasis
Trichomoniasis is a sexually transmitted infection, which changes how treatment works. The recommended regimen for women is a 7-day course of oral antibiotics taken twice daily. Men receive a single, higher dose of the same medication. An alternative single-dose option exists for both.
The critical part of trichomoniasis treatment is that all current sexual partners need to be treated at the same time, even if they have no symptoms. Without concurrent treatment, reinfection is almost guaranteed. Both you and your partners should avoid sex until everyone has finished treatment and symptoms have fully resolved.
Vaginal Dryness and Irritation After Menopause
Not every vaginal irritation is an infection. After menopause, declining estrogen levels cause vaginal tissues to thin, dry out, and become more vulnerable to irritation. This condition, called vaginal atrophy, can mimic infection symptoms with burning, itching, and pain during sex.
First-line treatment is straightforward: vaginal moisturizers used regularly (not just during sex) help restore moisture to the tissues. For sex, water-based or silicone-based lubricants reduce friction and pain. Avoid products with glycerin or warming ingredients like capsaicin, which can irritate sensitive tissue. If you use latex condoms, skip petroleum jelly and oil-based lubricants, as they break down latex.
When moisturizers and lubricants aren’t enough, topical estrogen applied directly to the vagina is the most effective option. It comes as a cream, tablet, or ring and works at much lower doses than oral hormone therapy, with minimal estrogen reaching the bloodstream. For those who can’t use estrogen, such as people with a history of estrogen-dependent breast cancer, prescription alternatives include a daily pill that eases painful sex symptoms or vaginal inserts containing a hormone precursor that the body converts locally. Vaginal dilators, which gently stretch and stimulate vaginal tissues, are another non-hormonal option.
Preventing Recurrent Infections
Your vagina is a self-cleaning system, and most infections start when something disrupts its natural balance. A few habits lower your risk significantly.
- Skip douching entirely. It washes away protective bacteria and raises vaginal pH, creating the exact conditions infections thrive in.
- Wear cotton underwear. White cotton is the healthiest option. Avoid thongs, tight-fitting nightwear, and synthetic fabrics that trap moisture. Sleeping without underwear helps keep the area dry.
- Urinate after sex. This helps flush bacteria away from the urethra and surrounding area.
- Avoid scented products. Vaginal sprays, scented tampons, and perfumed soaps can irritate vaginal tissue and disrupt the microbiome. Warm water alone is sufficient for external cleaning.
- Wear loose clothing when possible. Tight pants and pantyhose create warm, moist environments where yeast and bacteria flourish.
Why Treatment Matters During Pregnancy
Vaginal infections during pregnancy carry real risks beyond discomfort. Untreated infections can lead to preterm birth, low birth weight, and in some cases serious illness or birth defects in the baby. Some infections can also cause lifelong disabilities like hearing loss or learning problems. If you’re pregnant and notice any unusual discharge, odor, or irritation, getting tested and treated promptly protects both you and your baby. Many of the standard treatments are safe during pregnancy, though your provider may adjust which medications or routes they recommend.