How to Deal with the Most Troublesome "Recurrence" When Diagnosed with Bacterial Vaginosis (BV)

Introduction: BV is Not Due to "Uncleanliness"

Bacterial Vaginosis (BV) is not a condition that occurs due to genital uncleanliness. The vagina naturally contains a variety of bacteria, with lactobacilli usually being dominant, keeping the vaginal environment acidic. However, if lactobacilli decrease and bacteria associated with BV increase due to certain triggers, the vaginal pH rises, leading to symptoms like distinctive discharge and odor, or a diagnosis of BV during tests. CDC+1

BV is very common. It is essentially a "disruption of the vaginal environment balance" that can happen to anyone. The important thing is not to let embarrassment or a sense of personal responsibility prevent you from understanding how to manage it, including recurrences. CDC+1

1) First Check: What Are the Symptoms of BV?

Common Symptoms

• A strong fishy odor (especially noticeable after intercourse)

• Increased grayish to whitish, thin discharge
  nhs.uk

"Often No Pain or Itching"

BV does not necessarily come with "itching or severe pain." Symptoms can be mild, and about half of the cases are said to be asymptomatic. nhs.uk

Important: Don't Self-Diagnose as "Candida"

Severe itching and white cottage cheese-like discharge may suggest Candida, while frothy, yellow-green, and strongly inflamed discharge may indicate Trichomonas or other causes. Many symptoms resemble BV, so it is safer to avoid "waiting to see with over-the-counter medication → prolonged symptoms." nhs.uk+1

2) How is the Diagnosis Made? (Examination Process)

In medical facilities, diagnosis is made through symptom interviews, physical examinations, secretion sampling, and pH testing. In BV, vaginal pH tends to be 4.5 or higher, and findings like "clue cells (vaginal epithelial cells with bacteria attached)" are observed. Mayo Clinic+1

Preparation Before Consultation

To improve test accuracy, you may be advised to avoid menstruation, tampons, douching, and intercourse from the day before to the day of the test if possible. Mayo Clinic

3) What to Do First If Diagnosed with BV (Action Checklist)

Here is the main topic. We summarize practical steps for "What to do if diagnosed?" in order of priority.

✅ ① Use Prescribed Medication "Until the End"

BV is treated with antibiotics. Even if symptoms disappear midway, stopping treatment on your own increases the risk of recurrence. Mayo Clinic+1

✅ ② Avoid Intercourse During Treatment / Use Condoms Consistently

The CDC recommends avoiding intercourse during treatment or consistently and correctly using condoms. CDC

✅ ③ Do Not Douche

Douching may increase the risk of recurrence (relapse) and is not recommended for treatment or symptom relief. CDC+1

✅ ④ Avoid Scented Soaps / Deodorant Products

Scented products and vaginal care items can lead to irritation and bacterial imbalance. The NHS also lists lifestyle precautions such as "avoiding scented products." nhs.uk

✅ ⑤ Inform if Pregnant or Possibly Pregnant

Symptomatic BV during pregnancy is associated with adverse outcomes such as preterm birth and premature rupture of membranes, so treatment is recommended. CDC+1

4) What Medications Are Prescribed? (Typical Options)

The first choice for BV is mainly metronidazole or clindamycin. Medications include "oral medications" and "vaginal medications." CDC+1

Recommended Regimens by CDC (Examples)

• Metronidazole 500mg: Twice daily for 7 days (oral)

• Metronidazole Vaginal Gel 0.75%: Once daily for 5 days (vaginal)

• Clindamycin Vaginal Cream 2%: At bedtime for 7 days (vaginal) CDC

"Oral Medication vs Vaginal Medication" Which is Better?

The CDC states that "there is insufficient data directly comparing oral and topical treatments," but offers multiple options. Your doctor will suggest based on lifestyle, side effects, pregnancy status, etc. CDC+1

5) Common Concern ①: No Alcohol During Metronidazole Treatment?

In the past, it was strongly advised that "metronidazole + alcohol is dangerous (disulfiram-like reaction)," but the CDC states that "there is no convincing evidence," and it is not necessary to strictly prohibit alcohol consumption. CDC

However, in practice, you may be advised to "avoid it just in case." Some people experience side effects like nausea, so the correct approach is to "follow your prescription instructions." Mayo Clinic

6) Common Concern ②: Can It Be Transmitted to a Partner? Should They Be Treated Too?

This is an area where information is being updated.

Current General Perspective (Guideline-Oriented)

The CDC states that "traditional trials have shown that partner treatment does not improve treatment response or recurrence in women," therefore, **routine partner treatment is not recommended**. CDC

However, Recently: Research on "Partner Treatment" to Reduce Recurrence is Gaining Attention

On the other hand, a 2025 multicenter randomized trial (StepUp) reported that adding"oral metronidazole + topical clindamycin on the penile skin" for 7 days to the standard treatment for womenreduced recurrence within 12 weeks, with differences in recurrence rates and time to recurrence. National Institute for Health Education+2The Guardian+2

How to Act?

• First-Time or Occasional BV: Focus on ensuring your own treatment first.

• Frequent Recurrence of BV:
  It is worth consulting your doctor about "Should the partner also be treated?" considering research results.
  However, note that policies may differ by country, region, or medical institution, and it is not an immediately applicable "definitive rule" for everyone. CDC+1

7) Realistic Measures Against the Most Troublesome "Recurrence"

BV often "comes back even after it seems cured." Mayo Clinic also states that "recurrence can occur within 3 to 12 months even after proper treatment." Mayo Clinic

What to Do First If Recurrence Occurs

• Do Not Use Leftover Medication Based on Self-Judgment(There may be other causes, resistance, or different diseases)

• Reevaluate Even If Symptoms Are the Same##