Recurrent Bacterial Vaginosis: Causes, Symptoms & Treatment

Written by Medicover Team and Medically Reviewed by Dr Thajammul Samrin , Gynecologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Recurrent bacterial vaginosis is a condition in which bacterial vaginosis returns repeatedly after treatment. It occurs due to an imbalance in the normal vaginal bacteria and may require long-term management to reduce recurrences and maintain vaginal health.

Recurrent Bacterial Vaginosis happens when certain bacteria grow out of control in the vagina, leading to a disruption in the natural balance. This condition can be frustrating for many women due to its tendency to come back despite treatment. Understanding the factors that contribute to this imbalance is important in managing the condition effectively.

By identifying potential triggers and making lifestyle adjustments, it is possible to reduce the frequency of recurrent episodes. Taking proactive steps to support vaginal health can help in preventing the recurrence of Bacterial Vaginosis and promote overall well-being.

What Are the Types of Recurrent Bacterial Vaginosis?

Recurrent Bacterial Vaginosis can be classified into two main types: relapse and reinfection. Relapse occurs when symptoms return shortly after completing treatment due to the bacteria not being fully eradicated. Reinfection, on the other hand, happens when a new strain of bacteria enters the vagina after the initial infection has been successfully treated. Proper diagnosis and treatment are essential to effectively manage recurrent cases.

Atypical Bacterial Vaginosis: This type of recurrent bacterial vaginosis is characterized by a diverse microbial population in the vaginal flora, often including pathogens not typically associated with BV, leading to persistent or frequently recurring symptoms.
Post-Treatment Bacterial Vaginosis: Some individuals experience recurrent BV shortly after completing a course of antibiotics, as the treatment may not completely eradicate all pathogenic bacteria, allowing for a rapid resurgence of the infection.
Hormonal Imbalance-Related Bacterial Vaginosis: Fluctuations in hormone levels, such as during menstrual cycles, pregnancy, or menopause, can disrupt the delicate balance of vaginal flora, making individuals more susceptible to recurrent episodes of bacterial vaginosis.

What Are the Symptoms of Recurrent Bacterial Vaginosis?

Recurrent bacterial vaginosis can cause symptoms like unusual vaginal discharge, often with a strong fishy odor, itching, and irritation in the vaginal area. Some individuals may also experience discomfort during urination or sex. If you notice these symptoms returning frequently, consult your healthcare provider for proper diagnosis and treatment. Proper management can help prevent recurrent episodes.

Recurrent bacterial vaginosis may cause a strong fishy odor coming from the vaginal discharge.
Women with recurrent bacterial vaginosis may experience itching and irritation in the vaginal area.
Some individuals may notice a change in the color or consistency of their vaginal discharge with recurrent bacterial vaginosis.
Recurrent bacterial vaginosis can lead to discomfort or pain during sexual intercourse.
Women may also experience burning sensation while urinating as a symptom of recurrent bacterial vaginosis.

What Causes Recurrent Bacterial Vaginosis?

Poor hygiene practices, smoking, and underlying health conditions such as diabetes or immune system disorders can also contribute to recurrent episodes. Identifying and addressing these triggers is crucial in managing and preventing the recurrence of bacterial vaginosis.

Poor intimate hygiene practices may lead to recurrent bacterial vaginosis by disrupting the natural balance of bacteria in the vagina.
Sexual activity with multiple partners can increase the risk of recurrent bacterial vaginosis by introducing different strains of bacteria into the vaginal environment.
Use of certain antibiotics may contribute to recurrent bacterial vaginosis by killing off both harmful and beneficial bacteria, allowing for an overgrowth of harmful bacteria.
Hormonal changes, such as fluctuations in estrogen levels, can predispose some individuals to recurrent bacterial vaginosis by altering the vaginal pH and promoting bacterial overgrowth.
Underlying medical conditions, like diabetes or a weakened immune system, can make individuals more susceptible to recurrent bacterial vaginosis by compromising the body's ability to maintain a healthy vaginal flora and fight off infections.

When Should You See a Doctor for Recurrent Bacterial Vaginosis?

Recurring bacterial vaginosis should be evaluated by a healthcare provider because repeated infections may affect vaginal health and increase the risk of complications. Recurrent bacterial vaginosis is typically treated by gynecologists, obstetrician-gynecologists (OB-GYNs), or primary care physicians.

You should see a doctor if you have:

Repeated episodes of unusual vaginal discharge, odor, itching, or irritation.
Symptoms that return soon after completing treatment.
Pain during urination or sexual intercourse.

Get medical help immediately if:

Severe pelvic pain, fever, or foul-smelling discharge with worsening symptoms.
Heavy vaginal bleeding or severe abdominal pain.
Symptoms during pregnancy or signs of a spreading infection.

These could be signs of a serious complication of Recurrent Bacterial Vaginosis that requires prompt medical care.

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How is Recurrent Bacterial Vaginosis Diagnosed?

Diagnosing recurrent bacterial vaginosis involves evaluating symptoms, performing a pelvic examination, and conducting laboratory tests to confirm the presence of bacterial imbalance. Accurate diagnosis helps rule out other vaginal infections and guides appropriate treatment.

The healthcare provider may also inquire about symptoms, medical history, and previous treatments. Lab tests can confirm the presence of harmful bacteria. It's crucial to follow up with a healthcare provider for accurate diagnosis and tailored treatment.

Vaginal pH testing: A healthcare provider may perform a vaginal pH test to assess the acidity levels in the vagina, as recurrent bacterial vaginosis is often associated with an elevated pH.
Microscopic examination of vaginal discharge: Microscopic evaluation of vaginal discharge can help identify the presence of clue cells, which are indicative of bacterial vaginosis.
Cultures: Cultures of vaginal samples can be obtained to identify the specific bacteria causing the recurrent bacterial vaginosis and guide appropriate treatment.
PCR testing: Polymerase chain reaction (PCR) testing can detect the DNA of bacteria causing bacterial vaginosis with high sensitivity, aiding in accurate diagnosis.
Sensitivity testing: Sensitivity testing can determine the susceptibility of identified bacteria to various antibiotics, ensuring that the prescribed treatment will effectively target the pathogens responsible for recurrent bacterial vaginosis.

What is the Treatment for Recurrent Bacterial Vaginosis?

Treatment for recurrent bacterial vaginosis aims to restore the normal balance of vaginal bacteria, relieve symptoms, and reduce the risk of future recurrences. The treatment plan depends on symptom severity, recurrence pattern, and individual health factors.

Treatment options for recurrent bacterial vaginosis may include antibiotics, such as metronidazole or clindamycin, prescribed by your healthcare provider. Probiotics and home remedies like boric acid suppositories may also help restore vaginal balance. Lifestyle changes like wearing cotton underwear and avoiding douching can aid in preventing recurrence. Consulting with your healthcare provider is essential for personalized treatment.

Antibiotic therapy: Your healthcare provider may prescribe antibiotics, such as metronidazole or clindamycin, to treat recurrent bacterial vaginosis by targeting the overgrowth of harmful bacteria in the vaginal microbiome.
Probiotics: Incorporating probiotics into your daily routine, either through supplements or yogurt containing Lactobacillus strains, can help restore the balance of good bacteria in the vagina and reduce the recurrence of bacterial vaginosis.
Boric acid suppositories: Boric acid suppositories can be used as an alternative treatment for recurrent bacterial vaginosis, as they have antimicrobial properties that can help rebalance the vaginal flora and inhibit the growth of harmful bacteria.
Vaginal pH modifiers: Using products designed to maintain or restore the natural vaginal pH can help prevent the recurrence of bacterial vaginosis by creating an environment less conducive to harmful bacterial growth.

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What Are the Risk Factors for Recurrent Bacterial Vaginosis?

Risk factors for recurrent bacterial vaginosis include multiple sexual partners, douching, smoking, and a lack of lactobacilli in the vaginal microbiome. Other factors such as antibiotic use, hormonal fluctuations, and a compromised immune system can also contribute to recurrent episodes. Addressing these risk factors through lifestyle changes and proper medical treatment can help reduce the likelihood of recurrent bacterial vaginosis.

Engaging in unprotected sex with multiple partners increases the risk of recurrent bacterial vaginosis due to the potential exposure to different bacteria.
Antibiotic use for other infections can disrupt the balance of bacteria in the vagina, leading to an increased likelihood of recurrent bacterial vaginosis.
Douching or using vaginal deodorants can disturb the natural pH balance of the vagina, making it more susceptible to recurrent bacterial vaginosis.
Having a history of previous episodes of bacterial vaginosis increases the chances of experiencing recurrent infections.
Certain lifestyle factors, such as smoking and a high-sugar diet, can weaken the immune system and contribute to the recurrence of bacterial vaginosis.

What Are the Complications of Recurrent Bacterial Vaginosis?

If left untreated or if it keeps recurring, bacterial vaginosis can increase the risk of complications, particularly during pregnancy or after gynecological procedures. Early diagnosis and treatment can help reduce these risks.

Increased risk of pelvic inflammatory disease (PID).
Higher susceptibility to sexually transmitted infections (STis).
Pregnancy-related complications such as preterm birth.
Persistent vaginal discomfort and reduced quality of life.
Recurrence despite treatment.

How Can Recurrent Bacterial Vaginosis Be Prevented?

Preventing recurrent bacterial vaginosis involves maintaining healthy vaginal flora and avoiding factors that disrupt the natural bacterial balance.

Avoid douching and scented vaginal products.
Practice safe sex and limit multiple sexual partners.
Complete prescribed antibiotic treatment as directed.
Wear breathable cotton underwear and avoid prolonged moisture.
Maintain good genital hygiene without overcleaning.

Frequently Asked Questions

1. How can recurrent bacterial vaginosis be identified through its signs?

Common signs include thin grayish-white vaginal discharge, a strong fishy vaginal odor, especially after intercourse, mild itching, burning during urination, or sometimes no symptoms at all.

2. What lifestyle changes should I make to manage recurrent bacterial vaginosis effectively?

Maintain good genital hygiene, avoid douching, wear breathable cotton underwear, practice safer sex, avoid scented vaginal products, and take medications exactly as prescribed by your healthcare provider.

3. What are the potential complications of recurrent bacterial vaginosis?

Complications may include pelvic inflammatory disease (PID), increased risk of sexually transmitted infections (STIs), pregnancy complications such as preterm birth, and recurrent vaginal discomfort.

4. What treatment options are available for recurrent bacterial vaginosis?

Treatment may include oral or vaginal antibiotics (such as metronidazole or clindamycin), suppressive antibiotic therapy for recurrent cases, probiotics in selected patients, and management of contributing risk factors.

5. What are the chances of recurrent bacterial vaginosis recurring?

Recurrence is common. Approximately 50% of women experience another episode within 6-12 months after treatment.

6. Is it possible to get rid of recurring BV?

Yes. Many people can successfully manage recurrent bacterial vaginosis with appropriate treatment, preventive measures, and, in some cases, long-term suppressive therapy prescribed by a healthcare provider.

7. How serious is recurrent BV?

Recurrent BV is usually not life-threatening, but untreated or repeated infections can increase the risk of pelvic inflammatory disease, sexually transmitted infections, and pregnancy-related complications.

8. What kills the bacteria that causes BV?

Antibiotics such as metronidazole and clindamycin are the standard treatments. They reduce the overgrowth of harmful bacteria and help restore the normal balance of vaginal bacteria.

9. What happens if you have BV for too long?

Untreated bacterial vaginosis can increase the risk of recurrent infections, pelvic inflammatory disease, sexually transmitted infections, complications during pregnancy, and discomfort that affects daily life.