You might not think about the bacteria living in your body, on the surfaces you touch, and in the air on a daily basis, but bacteria greatly outnumber people on the earth—in fact, scientists estimate there are 5 million trillion trillion (no, that’s not a typo!) on the planet. (1) Since some bacteria make people sick, the discovery of antibiotics—medicine that kills bacteria—has been of critical importance, particularly for those suffering from acute life threatening infections.

However, antibiotics are not the best initial treatment for every illness, including bacterial vaginosis, or BV. In fact, antibiotics are often referred to as “weapons of mass destruction” in the pharmaceutical world. That’s because antibiotics can’t differentiate between healthy bacteria and bad bacteria, so when you use them, you disrupt your body’s natural balance of bacteria. Antibiotics can also cause health issues—overuse of them for minor illnesses like the common cold can increase the risk of bacterial resistance to medicines, and their common side effects might also cause adverse reactions, like stomach upset.

While a health care professional should always be consulted if you’re experiencing any symptoms of infection, let’s see why antibiotics might not be the best first-line treatment regimen when it comes to treating a BV infection.

What is BV?

Bacterial vaginosis is an imbalance of good and bad vaginal bacteria. While some people find BV to be uncomfortable or embarrassing, many women with BV don’t even know they have it. If you develop BV, it’s important to seek medical attention to resolve your infection, since untreated BV can increase your risk of pelvic inflammatory disease, transmitting a sexually transmitted infection, or complications for pregnant women like preterm birth.

Common bacterial vaginosis symptoms include unusual thin and milky white to grayish discharge with a mild odor often described as a fishy smell. (2) It’s important to note that vaginal symptoms like painful urination or cottage cheese-like discharge are not bacterial vaginosis symptoms—these symptoms are more likely related to urinary tract infections or vaginal yeast infections, respectively, and should be communicated to your health care provider so you get the right treatment.

What Causes BV?

Under normal conditions, your vagina hosts many types of bacteria, including millions of good bacteria called lactobacilli. Good bacteria help keep your vagina clean and maintain your vaginal pH. BV occurs when your body’s natural balance of lactobacilli and bad bacteria become imbalanced.

Unfortunately, many factors can disrupt your body’s natural lactobacilli levels, including sexual activity and certain vaginal products. When your lactobacilli levels get low, your vagina becomes the perfect environment to facilitate the growth of bacteria that can cause infection. Specifically, women with BV often have high levels of a harmful bacteria called gardnerella in their vagina. (3)

How To Treat a BV Infection

According to the Centers for Disease Control and Prevention, about 84 percent of women with BV remain asymptomatic, meaning they do not experience any symptoms of their infection and require no treatment. (4) However, the remaining 16 percent of women with BV do require medical advice from a health care provider.

There are two key aspects of treating a BV infection:

  • Killing the bad bacteria, typically gardnerella
  • Replenishing your body’s stores of good bacteria, like lactobacilli

Antibiotics are commonly prescribed to treat BV, however, they’re a better choice for treating chronic BV infections rather than acute BV. This is because antibiotics are non-specific in nature and cannot differentiate between good and bad bacteria.

If you’re interested in treating your BV infection with over-the-counter or natural options, there are other effective treatment options available that will help you avoid the unwanted effects of antibiotic use.

Prescription Treatment Options for BV

A prescription bacterial vaginosis treatment regimen typically consists of one of three medicines: metronidazole, clindamycin, or tinidazole.

  • Metronidazole is an effective prescription treatment for BV and is the antibiotic drug of choice for many health care providers. (5) It works by killing anaerobic bacteria. Oral metronidazole can be taken by mouth in pill form, or metronidazole gel can be used as a vaginal suppository in the vagina at bedtime.
  • Clindamycin is an antibiotic used to treat a number of bacterial infections, including BV. Clindamycin is notorious for causing the overgrowth of bad bacteria in the intestines, causing diarrhea. (6) Like metronidazole, clindamycin gel can be inserted into the vagina at bedine, or, alternatively, it can be taken as oral tablets.
  • Tinidazole is considered an alternative antibiotic for the treatment of BV. Tinidazole can only be taken as an oral treatment.

The Drawbacks of Using Antibiotics To Treat BV

Antibiotics are designed to kill disease-causing bacteria. Unfortunately, while some antibiotics are smart enough to target only disease-causing bacteria, most antibiotics are non-specific in nature. When antibiotics reduce the body’s stores of good bacteria, harmful bacteria are able to grow back in number easily and can cause health issues.

When it comes to BV, research shows that antibiotic treatment can effectively minimize the numbers of bad bacteria in the vagina, but these bacteria can reappear within a few hours after treatment. (7) Reappearing bacteria can cause recurring BV infections. In order to prevent recurrent infections, try managing BV naturally.

How To Treat BV Naturally (Without Antibiotics)

If you need bacterial vaginosis treatment, antibiotics aren’t your only option. Try these alternative treatments the next time you notice that fishy odor.

Boric Acid

Boric acid is commonly used as an over-the-counter BV medication. It’s easily available at the pharmacy, and it’s inexpensive too. A clinical study was conducted to evaluate the effectiveness of boric acid as a treatment for BV, and the results concluded that 88–92 percent of the women treating BV with boric acid were cured within 7 to 12 weeks of treatment. (8)

If you want to use boric acid to treat your BV infection, follow the CDC’s guidelines: Apply intravaginal boric acid for 21 days at a dose of 600 milligrams per day to avoid a BV recurrence. (9)

Prebiotics + Probiotics

BV is caused primarily by a bacterial imbalance in the vaginal microbiome. In order to balance your microflora after getting BV, you need to add probiotics and prebiotics to your diet to restore your body’s bacterial levels. Together, prebiotics and probiotics enhance, build, and maintain the good microbial community in your body. (10)

Probiotics are live microorganisms which restore your body’s natural bacterial balance. You can take supplemental probiotics for vaginal health, or you can obtain them naturally from foods like yogurt with live cultures, kimchi, or sauerkraut.

Prebiotics are indigestible fibers which ferment in the large intestine. After fermentation, prebiotics serve as a food source for good bacteria, like lactobacilli, and for probiotics. Prebiotics can be found naturally in bananas, onions, garlic, artichokes, and the skins of apples.

Prebiotics + Probiotics

Preventing BV Infections in the First Place

Although effective BV treatments are available, the best way to avoid being inconvenienced by a BV infection—and to reduce your risk of the associated complications—is to prevent it completely. While no prevention method can entirely remove your risk of developing BV, a few simple swaps can help reduce it.

Dietary Changes

One way to prevent BV is to change your diet. Avoiding salt, sugar, and saturated fats can help keep your microbiome balanced, as can reducing your consumption of alcoholic beverages. (11,12) Supplementing your diet with folate, vitamin A, and calcium can also reduce the severity of BV if it does occur or act as a preventative treatment to counteract BV development.

Avoid Douches, Vaginal Soaps, and Cleansers

Your vagina is a pretty amazing organ, so much so that it’s actually capable of cleaning itself—you don’t need to go the extra-mile to keep it clean, and cleaning it by douching or using strong detergents can actually negatively impact your vagina’s health.

Many feminine products marketed for vaginal cleansing and washing, like perfumed bubble baths, scented soaps, and bath oils, are loaded with harsh chemicals. These chemicals can disturb your vaginal pH and wipe out your body’s stores of good bacteria.

Douching is bad for your vagina too—just ask any health care professional. (13) Douching increases your risk of infertility, cervical cancer, and HIV. While it might seem like douching makes your vagina cleaner, and, therefore, healthier, douching actually increases your risk of infection.

Avoid Unprotected Sex

BV isn’t a sexually transmitted infection, but your sexual habits play a large role in whether you will develop it or not. For example, though the link isn’t completely understood, women with same-sex partners are more likely to get BV than women who don’t have sex with female partners. (14)

On the other hand, women with male sex partners are not immune from getting BV. In fact, having unprotected sex with a man is also a risk factor for developing BV. That’s because semen has a pH that is more basic in nature than the vagina’s ideal pH. If you have unprotected sex, your vagina’s pH will be increased by the presence of semen in your vagina. To prevent intercourse from increasing your risk of developing BV, try these best practices:

  • Rinse your vaginal area with water after having an intercourse
  • Urinate right after having sex to rinse unhealthy bacteria from your vagina
  • Use latex-free condoms. Latex condoms can irritate the vaginal mucosa
  • If you use lubricant, choose a paraben-free variety. Some lubricants contain harsh chemicals that can irritate your vagina and vulva and cause vaginal infections

Wear Breathable Cotton Underwear

Bad bacteria grows best in a moist environment. The vagina is naturally moist, and wearing certain undergarments can make it even worse. Satin or silk panties, for example, are not breathable; when you wear them, you’re creating an ideal environment for bacteria to grow. Similarly, wearing wet underwear or swimsuits for long periods after exercising or swimming can increase our risk of getting BV or other vaginal infections.

Wear Breathable Cotton Underwear

To keep your genital area clean and dry, stick to cotton underwear. (15)

To Move Past BV and Prevent Its Recurrence, Try HappyV

Antibiotics are often recommended for an acute BV infection, however, antibiotics aren’t always the best choice for treating BV, since they might kill good bacteria as well as bad, and their use can result in recurrent BV infections.

To treat BV naturally, try HappyV’s pre- and probiotic supplement for vaginal health, or try over-the-counter boric acid to manage your infection. HappyV’s BV odor remedy can also help you manage the unpleasant symptoms of BV. Whether you’re dealing with BV, menopause, or any other vaginal issue, check out HappyV for natural, effective vaginal support.