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 because up to 66% of women experience a recurrence within a year, managing BV often means combining medication with longer-term strategies to keep the vaginal microbiome balanced.
Prescription Antibiotics
Antibiotics are the first-line treatment and the only proven way to fully resolve an active BV infection. The CDC recommends several options, all typically lasting five to seven days. The most commonly prescribed is metronidazole, available as an oral pill taken twice daily for seven days or as a vaginal gel applied once daily for five days. Clindamycin is the main alternative, also available in oral and vaginal forms. A vaginal cream version is applied at bedtime for seven days, while a shorter-course ovule form takes just three days.
If you prefer a faster option, a single-dose oral treatment called secnidazole is also FDA-approved. You mix the granules into applesauce, yogurt, or pudding and take it all at once. In clinical trials, it produced a clinical cure rate of about 68%. A single-dose vaginal clindamycin gel showed similar results at 64%. These one-and-done options are convenient, though your provider may still recommend a longer course depending on your history.
Why BV Keeps Coming Back
Recurrence is the most frustrating part of BV. The antibiotics kill the overgrown bacteria, but they don’t rebuild the population of beneficial lactobacilli that normally keep the vaginal environment acidic and inhospitable to harmful microbes. Once treatment ends, the same imbalance can re-establish itself quickly.
Sexual activity plays a bigger role than previously thought. In October 2025, the American College of Obstetricians and Gynecologists recommended for the first time that male sexual partners be treated alongside women with recurrent BV. The updated guidance suggests a combination of oral and topical antimicrobials for male partners, based on growing evidence that BV-associated bacteria can be carried and transmitted during sex. This was a notable shift. For years, the data hadn’t shown a clear benefit to partner treatment, and it wasn’t recommended.
Probiotics for Vaginal Health
Probiotics containing Lactobacillus crispatus, the dominant beneficial species in a healthy vagina, show real promise as a complement to antibiotics. In a randomized, double-blind, placebo-controlled trial, both oral and vaginal capsules containing L. crispatus strains reduced BV symptoms, including improvements in discharge amount, odor, and itching. The vaginal capsules specifically increased lactobacilli counts while decreasing BV-related bacteria.
Not all probiotic products are equally useful. Generic “women’s health” probiotics often contain strains like L. rhamnosus or L. acidophilus, which are better studied for gut health than vaginal health. If you’re choosing a probiotic specifically to support vaginal balance, look for one that lists L. crispatus strains. These are available in both oral and vaginal capsule forms.
Boric Acid Suppositories
Boric acid vaginal suppositories are widely used as an adjunct therapy, particularly for recurrent BV. The typical protocol is a 600 mg suppository inserted vaginally at bedtime for 14 consecutive days. Boric acid works by lowering vaginal pH, creating conditions that favor healthy lactobacilli and discourage the alkaline-loving bacteria behind BV.
Boric acid is not a replacement for antibiotics during an active infection. It’s most commonly used after completing a course of antibiotics to help maintain results, or between episodes to extend the time before recurrence. These suppositories are available over the counter, but they are toxic if swallowed and should never be taken orally or used during pregnancy.
Vitamin D and BV Risk
Vitamin D deficiency appears linked to higher BV rates. A meta-analysis of observational studies found that vitamin D deficiency increased the risk of BV during pregnancy by 54%. At least one clinical trial in non-pregnant women found that correcting a vitamin D deficiency helped eliminate asymptomatic BV. The connection likely involves vitamin D’s role in supporting immune function and maintaining the mucosal lining of the vaginal wall.
This doesn’t mean vitamin D supplements will cure an active infection. But if you’re dealing with recurrent BV, checking your vitamin D levels is a reasonable conversation to have with your provider, especially if you have limited sun exposure or darker skin.
Habits That Protect Vaginal Balance
The vagina maintains a naturally acidic pH (below 4.5) through its resident lactobacilli, which produce lactic acid. Anything that disrupts this ecosystem raises your BV risk. Douching is the biggest offender. It directly alters vaginal pH, strips away protective lactobacilli, and some antiseptic douching products contain agents that actively kill these beneficial bacteria. The result is an environment where BV-causing organisms can take hold more easily.
Beyond avoiding douching, a few straightforward habits help maintain balance:
- Skip scented products near the vulva and vagina. Fragranced soaps, washes, sprays, and wipes can shift pH and irritate tissue. Warm water alone is sufficient for external cleaning.
- Wear breathable underwear. Cotton or moisture-wicking fabrics reduce the warm, moist conditions that favor bacterial overgrowth.
- Use condoms consistently. Semen is alkaline (pH around 7.2 to 8.0) and temporarily raises vaginal pH after unprotected sex. Condoms also reduce transmission of BV-associated bacteria between partners.
How BV Is Diagnosed
If you suspect BV, a healthcare provider can usually confirm it in a single office visit using a set of bedside tests called the Amsel criteria. A BV diagnosis requires at least three of four findings: a thin, grayish-white discharge; vaginal pH above 4.5; a fishy odor when a chemical solution is added to a sample of discharge; and the presence of “clue cells” (vaginal cells coated in bacteria) under a microscope.
Some clinics use a lab-based method called the Nugent score instead, which examines a stained vaginal smear under magnification and scores the ratio of healthy lactobacilli to BV-associated bacteria on a scale of 0 to 10. A score of 7 or higher confirms BV. This method is considered more objective but takes longer to process. Either approach is reliable, and your provider will choose based on what’s available.