Bacterial vaginosis, or BV, is a common vaginal condition caused by an imbalance in the bacteria that normally live in the vagina. It is treatable with prescription antibiotics, and most people get relief within days. But recurrence is the hard part: BV comes back in a large share of people within months, which is why treatment usually needs to address more than just the infection itself.
What Is BV And What Causes It?
BV happens when the normal mix of vaginal bacteria shifts. A healthy vagina is usually dominated by Lactobacillus species, which produce lactic acid and keep the environment slightly acidic. In BV, that population drops and other bacteria multiply, often including Gardnerella vaginalis and a range of anaerobic bacteria that thrive without oxygen.
Researchers do not fully understand why this shift happens in any one person. What is clear is that BV is not caused by poor hygiene, and it is not a sexually transmitted infection in the classic sense. It can occur in people who have never had sex. Still, sexual activity is strongly associated with BV, and having a new partner or multiple partners raises the risk.
Known factors linked to BV include:
- Douching, which disrupts the normal vaginal bacteria
- New or multiple sexual partners
- Having an intrauterine device (IUD)
- Smoking
- Use of some scented products in the genital area
Hormonal changes also play a role. BV is uncommon before puberty and after menopause, which points to estrogen’s effect on the vaginal environment.
What Are The Symptoms Of BV?
The most common symptom is a thin, gray or white discharge with a fishy odor, often more noticeable after sex or during menstruation. Some people also notice burning during urination. Roughly half of people with BV have no symptoms at all.
BV does not usually cause significant pain, itching, or redness. If those are your main symptoms, something else may be going on. The discharge of BV is typically thin and uniform, not thick and clumpy like the discharge of a yeast infection.
Because symptoms overlap with other conditions, a diagnosis based on symptoms alone is not reliable. A clinician can confirm BV by examining a sample of vaginal fluid under a microscope or using a simple swab test.
How Is BV Treated?
BV is treated with prescription antibiotics. The main options are metronidazole, clindamycin, and tinidazole, given either by mouth or as a vaginal gel or cream. These are the treatments supported by clinical guidelines and they work well in the short term: symptoms usually improve within two to three days.
It is important to finish the full course even if you feel better. Stopping early can allow the infection to return.
Two points are worth knowing. First, BV can clear on its own in some people, but this is unpredictable, and treatment is recommended when symptoms are present. Second, treating a male partner is not routinely recommended, because studies have generally not shown that it reduces recurrence in the partner. This is different from how sexually transmitted infections are usually handled, and it reflects the fact that BV is a disruption of a bacterial community rather than a single infection passed back and forth.
Over-the-counter products marketed for vaginal health, including probiotics and home remedies, have not been shown in large trials to cure BV. Some may help with symptoms or support the vaginal environment, but they are not a substitute for antibiotics when an active infection is present.
Why Does BV Keep Coming Back?
Recurrence is the central problem with BV. It returns in a substantial proportion of people within several months of treatment, even when the first course worked. This is not a sign that treatment failed or that you did something wrong.
The likely reason is that antibiotics reduce the harmful bacteria but do not always restore the protective Lactobacillus population. The vaginal environment can stay vulnerable, and the same bacteria can regrow. Biofilms — sticky layers of bacteria that resist treatment — may also play a role, though this is an active area of research rather than a settled explanation.
Factors that appear to raise the risk of recurrence include:
- Douching or using scented vaginal products
- New sexual partners
- Smoking
- Certain hormonal patterns, including some phases of the menstrual cycle
Some evidence suggests that using vaginal boric acid or a maintenance course of antibiotics may reduce recurrence in certain people, but results vary and these approaches should be discussed with a clinician rather than self-prescribed. Boric acid is toxic if swallowed and should never be taken by mouth.
How To Get Rid Of BV And Stop It Coming Back: Practical Steps
Getting rid of BV starts with a proper diagnosis and a full course of prescribed antibiotics. Stopping it from returning is less certain, but there are steps that align with what the evidence supports.
Get tested and treated properly. Do not assume a discharge or odor is BV. Other conditions can look similar, and using the wrong treatment delays relief.
Finish the full antibiotic course even if symptoms clear quickly.
Stop douching. Douching disrupts the vaginal bacteria that help prevent BV. This is one of the clearest steps you can take.
Avoid scented products in the genital area, including scented soaps, sprays, and wipes.
Talk to your clinician about prevention options if BV keeps returning. Some clinicians recommend a longer maintenance course of antibiotics or other approaches, though the evidence for any single strategy is not strong.
Consider stopping smoking if you smoke, since smoking is linked to BV.
Probiotics are often suggested, but the evidence for preventing BV with probiotics is mixed and no specific product has been confirmed to work in large human trials. If you want to try them, discuss it with your clinician rather than relying on them alone.
When To See A Doctor
See a clinician if you have discharge with an unusual odor, especially if it is new or recurring. You should also seek care if you have pelvic pain, fever, or bleeding between periods, since these are not typical of BV and may point to another condition.
BV is linked to a higher risk of certain complications, including an increased risk of acquiring some sexually transmitted infections and, in pregnancy, a higher risk of preterm birth. Because of this, BV during pregnancy should be evaluated and treated by a clinician.
If you have had BV more than once, ask about a plan for prevention rather than waiting for the next episode. Recurrence is common, and having a strategy in place makes it easier to manage.
Frequently Asked Questions
Can BV go away on its own?
It can in some people, but this is unpredictable and symptoms may persist or worsen. Treatment with antibiotics is recommended when symptoms are present.
Can my partner give me BV?
BV is not considered a sexually transmitted infection, but sexual activity is associated with it. Treating a male partner is not routinely recommended because studies have not consistently shown it prevents recurrence.
Are probiotics effective for BV?
The evidence is mixed, and no specific probiotic product has been confirmed in large human trials to cure or prevent BV. They are not a substitute for antibiotics when an active infection is present.
How long does BV treatment take to work?
Symptoms usually improve within two to three days of starting antibiotics. It is important to finish the full course even if you feel better, because stopping early can allow the infection to return.
