How you treat vaginitis depends entirely on which type you have, because the three most common forms, bacterial vaginosis, yeast infections, and trichomoniasis, each require different medications. Using the wrong treatment won’t help and can make things worse. Here’s how to figure out what you’re dealing with and what works for each one.
Identifying Which Type You Have
The discharge, smell, and sensation each type produces are distinct enough to narrow things down before you ever see a provider. Bacterial vaginosis (BV) causes a thin, grayish-white discharge with a fishy smell that often gets stronger after sex. There’s usually no itching or visible redness. A yeast infection is almost the opposite: thick, white, cottage-cheese-like discharge with intense itching or burning, but little to no odor. Trichomoniasis produces a frothy, yellow-green discharge with a foul smell, along with pain during sex or urination.
Vaginal pH offers another useful clue. A normal vagina sits around pH 4 to 4.5. BV pushes the pH above 4.5, and trichomoniasis raises it even higher, often above 5.4. Yeast infections typically leave pH unchanged. Over-the-counter pH test kits are available at most pharmacies and show roughly 88% accuracy when used correctly. They can help you decide whether an antifungal cream is appropriate or whether you need a provider visit for antibiotics.
That said, pH alone can’t distinguish BV from trichomoniasis since both raise it. If your discharge is frothy or greenish, or you have a new sexual partner, testing for trichomoniasis specifically is important because it’s a sexually transmitted infection that requires partner treatment too.
Treating Bacterial Vaginosis
BV is caused by an overgrowth of certain bacteria that displace the healthy lactobacilli in your vagina. It requires prescription antibiotics. The standard regimen is oral metronidazole taken twice daily for seven days. Alternatively, your provider may prescribe metronidazole vaginal gel applied once daily for five days, or clindamycin vaginal cream used at bedtime for seven days. The topical options cause fewer side effects like nausea but require consistent nightly application.
The biggest challenge with BV is that it comes back. About 60% of women experience a recurrence within one year of antibiotic treatment. If you’ve had repeated episodes, taking a probiotic supplement after completing antibiotics may help. Clinical data shows that women who used a combination of Lactobacillus strains (including L. crispatus and L. acidophilus) after metronidazole treatment had a recurrence rate of 18% compared to 32% in those who didn’t. Look for products containing at least 10 billion CFUs per capsule and plan on taking them daily for four to six weeks.
Treating Yeast Infections
Yeast infections are the one type of vaginitis you can often treat without a prescription. Over-the-counter antifungal creams and suppositories based on miconazole come in several formats: a seven-day course with a lower-strength cream, a three-day course with a higher-strength version, or a single-day high-dose suppository. All are comparably effective; the shorter courses just use a more concentrated dose.
If you’d rather skip the cream, a single oral antifungal pill (fluconazole, 150 mg) clears most uncomplicated yeast infections and requires a prescription. For severe infections with significant redness or swelling, a second dose 72 hours after the first is the standard approach.
One important caveat: only self-treat with OTC products if you’ve had a yeast infection diagnosed before and you’re confident that’s what’s happening again. Studies consistently show that women who self-diagnose are wrong about half the time, often confusing BV or other conditions for yeast. If your symptoms don’t improve within a few days of starting an antifungal, stop using it and get tested.
Recurrent Yeast Infections
If you get four or more yeast infections in a year, the treatment strategy shifts. An initial course of oral fluconazole is given on days one, four, and seven, followed by a weekly maintenance dose for six months. This extended approach significantly reduces the cycle of reinfection. Probiotics containing L. rhamnosus GR-1 and L. reuteri RC-14, taken daily at 10 billion CFUs for four to six weeks after antifungal treatment, also show promise for keeping yeast in check.
Treating Trichomoniasis
Trichomoniasis is caused by a parasite, not bacteria or yeast, and it’s sexually transmitted. The treatment is oral metronidazole, 500 mg twice daily for seven days. This is the same antibiotic used for BV, but the context is different: your sexual partner must be treated at the same time, or reinfection is virtually guaranteed. Male partners receive a single larger dose.
Both you and your partner should avoid sex until treatment is finished and symptoms have resolved. All current sexual partners need to be notified and treated presumptively, even if they have no symptoms. Because trichomoniasis increases vulnerability to other sexually transmitted infections, your provider will likely screen for those as well.
Treatment During Pregnancy
Pregnancy changes the equation for several treatments. Oral metronidazole for seven days remains the preferred option for both BV and trichomoniasis and is considered safe starting in the first trimester. However, oral antifungal pills are not approved for use during pregnancy. If you develop a yeast infection while pregnant, the treatment is a vaginal antifungal cream (such as miconazole or clotrimazole) applied for seven days. The longer course is used because pregnancy alters the vaginal environment in ways that make shorter regimens less reliable.
Post-Menopausal Vaginitis
Not all vaginitis is caused by infection. After menopause, declining estrogen thins the vaginal lining, causing dryness, burning, and irritation that can mimic an infection. This is called atrophic vaginitis, and antibiotics or antifungals won’t help.
For mild symptoms, vaginal moisturizers used regularly (not just during sex) can restore moisture to the tissue. Products like Replens or Sliquid are applied several times a week as ongoing maintenance. During sex, a water-based or silicone-based lubricant reduces friction and pain. Avoid lubricants with glycerin or warming ingredients, which can irritate already-sensitive tissue. If moisturizers aren’t enough, prescription vaginal estrogen therapy is the most effective option and delivers hormones locally rather than throughout your body.
Habits That Reduce Your Risk
Several everyday behaviors have a measurable effect on whether vaginitis develops or comes back. Douching is the single biggest risk factor you can control. Women who use douching products are up to six times more likely to develop BV. Antiseptic solutions applied to the vulva or vagina triple the risk. Even bubble bath doubles the likelihood of BV compared to avoiding it.
Beyond avoiding those products, the following practices are supported by clinical guidelines:
- Clean gently, once daily. Shower rather than bathe. Use your hand rather than a sponge. Avoid soap, shower gel, or any fragranced product on the vulva. A mild, pH-balanced wash (around pH 4) is the safest option. Washing with plain water alone can actually dry the skin and increase irritation.
- Wear breathable fabrics. Loose-fitting cotton or silk underwear allows airflow. Avoid tight clothing and synthetic fabrics that trap heat and moisture. Sleep without underwear when possible.
- Be strategic about laundry. Wash underwear separately using a fragrance-free, non-biological detergent. Skip fabric softener. Light-colored underwear is less likely to contain irritating textile dyes.
- Practice front-to-back hygiene. This applies to wiping, cleansing before and after sex, and any genital contact.
- Change period products frequently. Prolonged contact with blood shifts vaginal pH upward, creating conditions that favor BV and other infections.
These habits won’t cure an active infection, but they meaningfully lower the chance of one starting or returning, especially for women who’ve already dealt with recurrent BV or yeast infections.