If you’re experiencing symptoms like a fishy odor, watery gray discharge, burning, pain, or vulvar irritation, and this isn’t the first time you’ve dealt with these issues recently, it’s likely you have a bacterial vaginosis (BV) infection that just won’t go away.
BV can frequently come back, especially if you haven’t addressed the underlying cause, which is an overgrowth of the bacteria Gardnerella vaginalis.
While this bacterium is naturally found in the vagina and usually doesn’t cause problems, sometimes it can become too aggressive.
Causes of Recurrent Bacterial Vaginosis
Recurrent bacterial vaginosis (BV), defined as having three or more BV infections in a year, can be frustrating and challenging to manage. Despite receiving treatment and taking preventive measures, BV may persistently recur.
While there are several reasons why BV infections can come back, it’s important to understand that recurrent BV is not always the fault of the affected individual.
Research indicates that around 58% of BV cases among study participants recurred even after receiving treatment, highlighting the stubborn nature of some cases. Despite efforts to follow treatment protocols and preventive measures, BV can still return.
Recurrent bacterial vaginosis (BV) often stems from a persistent imbalance between “good” and “bad” vaginal bacteria. Instead of viewing BV as a simple infection, it may be more accurate to consider it as a continuous state of imbalance.
Ideally, the vagina maintains a balance of “good bacteria,” primarily lactobacilli (common bacteria naturally found in the vagina and in probiotics), and “bad bacteria,” such as Gardnerella vaginalis.
Interestingly, an overgrowth of lactobacilli can also lead to a yeast-infection-like condition called cytolytic vaginosis, underscoring the delicate equilibrium within the vaginal microbiome.
Lactobacilli produce acid, which helps to keep harmful bacteria in check. However, when there’s insufficient acidity, the vaginal pH can become disrupted, paving the way for an overgrowth of harmful bacteria and resulting in a BV infection.
Various factors can contribute to this imbalance, potentially exacerbating recurrent BV.
What Causes or Worsens Bacterial Vaginosis
- Sex
Although bacterial vaginosis (BV) is not classified as a sexually transmitted infection (STI), the bacteria responsible for BV can be transmitted between sexual partners.
During sexual intercourse, the exchange of genital fluids can introduce bacteria into the vagina, disrupting its natural chemistry and pH balance. This alteration in the vaginal microbiome can contribute to the development of BV.
Repeated exposure to a partner whose genital pH differs from yours can increase the likelihood of acquiring BV, as the bacteria associated with BV may be transferred back and forth between partners. Thus, having a consistent sexual partner can elevate the risk of recurrent BV.
Additionally, BV can be triggered by engaging in sexual activity with new partners or multiple partners, particularly if unprotected intercourse is involved.
- Cleaning Inside the Vagina
Using certain products around or inside the vagina, such as douches or cleansers, particularly those containing fragrance, can disrupt your vaginal pH and contribute to bacterial vaginosis (BV).
These products have the potential to remove the beneficial lactobacilli that play a crucial role in maintaining a balanced and acidic pH in the vaginal microbiome, thereby creating an environment conducive to the proliferation of infection-causing bacteria.
It’s important to avoid using these products and to refrain from using soap to wash the vagina, as the vagina is self-cleaning and does not require any external cleansers.
Additionally, it’s essential to recognize that the vagina has a natural odor, and attempting to mask this odor with scented products can disrupt the natural balance of the vaginal microbiome. Instead of promoting cleanliness or healthiness, these products may actually increase the risk of developing BV.
Ultimately, using such products may lead to a more pronounced and unpleasant odor associated with BV, negating any perceived benefits of attempting to mask the natural vaginal scent.
- Other Habits
In addition to well-known factors, such as sexual activity, there are other unexpected habits that may contribute to recurrent bacterial vaginosis (BV). For example, smoking cigarettes has been linked to an increased likelihood of experiencing BV more frequently.
Research published in Nature suggests that smoking can disrupt the vaginal microbiome and reduce levels of beneficial lactobacilli bacteria. This alteration in the bacterial balance may make individuals more susceptible to infections, highlighting the importance of quitting smoking for those who smoke.
While we have identified certain factors associated with recurrent BV, the exact reasons why some individuals experience frequent recurrences remain unclear. Further research is needed to better understand which additional lifestyle factors are most likely to contribute to recurrent BV.
How to Handle Recurrent BV
- Be Honest and Open with Your Doctor
To ensure healthcare providers can make a thorough diagnosis, it’s important to provide them with all relevant information about your symptoms. Bacterial sexually transmitted infections (STIs) can have similar symptoms to bacterial vaginosis (BV).
Conditions like trichomoniasis typically involve funky-smelling discharge and itchiness, while Mgen can cause unusual or smelly discharge, burning during urination, and vulvar discomfort.
To prevent misdiagnosis, healthcare providers should test for all STIs, particularly those transmitted by bacteria and parasites, or those with symptoms of vaginal itching and discharge with an unusual odor (such as gonorrhea and chlamydia). They have the expertise to differentiate between normal and abnormal symptoms and provide appropriate assistance.
It’s also advisable to request a specific test for BV during your appointment. Healthcare providers often begin with a verbal screening to understand your symptoms before taking a vaginal swab sample for laboratory analysis. With accurate information about your condition, they can develop a tailored treatment plan to address your needs.
- Stick With the Treatment
When a doctor prescribes treatment for bacterial vaginosis (BV), it’s crucial to follow their instructions diligently and complete the entire course of medication, even if your symptoms improve before finishing the treatment.
Treatment for BV typically involves oral or vaginal antibiotics, such as clindamycin or metronidazole. In cases of recurrent BV, doctors may recommend a longer course of antibiotics, lasting seven to 10 days, along with a weekly dose of vaginal antibiotic gel for four to six months afterward to prevent recurrence.
Alternatively, newer treatments like clindamycin vaginal gel, which can be applied like a tampon, may be prescribed for a strong single dose of medication.
It’s essential to adhere to the prescribed treatment regimen without deviation. Skipping doses or stopping treatment prematurely, even if symptoms alleviate, can lead to a recurrence of BV.
Inadequate treatment disrupts the normal vaginal flora, which must be restored to prevent recurrence. Therefore, completing the full course of medication as instructed is vital to minimize the risk of BV recurrence.
- Ensure Proper Lubrication
To maintain a healthy vaginal pH and reduce the risk of infection, it’s important to ensure adequate lubrication on a regular basis. Vaginal dryness, often caused by factors like lower estrogen levels during menopause or breastfeeding, can disrupt the acidic pH balance.
Using a vaginal moisturizing gel is recommended to alleviate dryness and help maintain optimal vaginal moisture levels.
- Avoid Self-Diagnosing
It’s important not to self-diagnose when experiencing symptoms that could indicate bacterial vaginosis (BV), as mistaking it for a yeast infection or urinary tract infection (UTI) is common due to their similar symptoms, such as itchiness and irritation.
Attempting to self-diagnose may lead individuals to use over-the-counter yeast infection treatments, which can exacerbate BV or prolong discomfort.
While it’s possible to have both BV and another infection simultaneously, seeking confirmation from an obstetrician-gynecologist (ob-gyn) or a sexual health clinic is recommended to ensure an accurate diagnosis.
BV is the most common cause of abnormal vaginal discharge, but co-infections with yeast or other bacteria can occur, complicating diagnosis.
Getting evaluated by a healthcare provider is crucial for an accurate diagnosis and appropriate treatment. If current treatment or answers are not satisfactory, seeking a second opinion is advisable.
- Be Mindful of the Products You Use
Before using any over-the-counter products that could potentially disrupt your vaginal pH and exacerbate BV, it’s advisable to consult with your gynecologist.
Avoid using vaginal washes or other products in or near your vagina, as they can disrupt the normal balance of bacteria and lead to further complications.
Remember that the vagina is self-cleaning, and vaginal discharge helps to remove bacteria while regulating pH and natural odor. Trusting the body’s natural processes is often the best approach to maintain vaginal health.
- Refrain from Self-Medicating
Before considering the use of over-the-counter (OTC) suppositories, such as those containing boric acid, it’s crucial to seek advice from a healthcare provider to confirm a diagnosis of BV. It’s essential to understand that boric acid supplements are not FDA-approved, and their effectiveness in treating BV is still under debate.
Typically, healthcare providers refrain from prescribing boric acid alone to treat acute BV, as it is considered a homeopathic remedy and lacks sufficient evidence to demonstrate superiority over prescription antibiotics. However, in some cases, they may recommend it as a maintenance treatment to help acidify the vagina and prevent recurrent BV.
It’s important to note that boric acid may cause vaginal irritation in some individuals and may not be suitable for everyone. Additionally, pregnant individuals or those trying to conceive should avoid boric acid supplements due to insufficient research on their safety for fetal development.
If a healthcare provider approves the use of boric acid, the typical treatment cycle is 30 days, and it should not be used for longer periods to avoid exacerbating irritation.
Furthermore, to prevent skin irritation in partners or damage to condoms or diaphragms, it’s advisable to abstain from penetrative or receptive oral sex while using boric acid.
- Postpone Intercourse
It’s important to abstain from penetrative sex or receiving oral sex, even with barrier protection, during your antibiotic treatment for BV. Engaging in sexual activity during this time can disrupt the process of restoring your vaginal pH to its normal balance.
Once you have completed the entire course of medication and your vagina has returned to a calm state, you can safely resume sexual activity.
If your partner’s pH may be a contributing factor, using condoms or dental dams can help reduce the spread of bacteria until the overall imbalance is under control. This precaution applies regardless of whether your partner has a penis or a vagina.
Bottom Line
Take a moment to breathe and be kind to yourself about dealing with BV. It’s frustrating, especially when it interferes with important life events like weddings, beach vacations, or intimate moments.
Recurrent cases can be particularly challenging to address, but remember that you’re not alone – BV is extremely common, and there are effective treatments available. It may require some trial and error, as well as patience, to find what works best for you.
With the right support and maybe a reassessment of the products you use near your vagina, you’ll navigate through this.