If you have a vagina and you’ve had some form of sex, there’s a good chance you’ve had bacterial vaginosis at one point in your life. 

The infection is incredibly common, and it’s not something anyone should be embarrassed about. But you may have some questions. Namely: Why do I keep getting bacterial vaginosis? Does it have something to do with my sex partner(s)?

Truth is, we’re still learning all there is to know about bacterial vaginosis. However, the growing body of evidence does point to sexual transmission of the infection. Here’s why you may be getting recurrent bacterial vaginosis, what you can do about it, and how you can reduce the risk moving forward.

Let’s back up: What is bacterial vaginosis (BV) again?

Bacterial vaginosis (BV) is a vaginal infection marked by changes in the vagina’s bacterial environment. When people have BV, there are lower numbers of the bacteria lactobacilli and higher numbers of other bacteria. This imbalance disrupts the vagina’s “normal” bacterial environment.

BV is the most common vaginal infection among people with vaginas in their reproductive years. More than one-third will have BV at some point. Black people with vaginas have higher rates of BV than other races/ethnicities.

Most people who get BV don’t have symptoms. For those who do have symptoms, they can include:

While BV can sometimes clear up on its own, antibiotic treatment can increase the risk of certain health problems associated with getting the infection. People with BV have higher rates of:

  • Getting or transmitting human immunodeficiency virus (HIV)

  • Having preterm births

  • Having sexually transmitted infections (STIs) like chlamydia and gonorrhea

Anyone with possible BV symptoms should talk to a healthcare provider and get tested.

What is recurrent BV?

Recurrent BV is when someone has at least three infections that are confirmed as bacterial vaginosis in 12 months.

Many people have a recurrence of BV after their initial treatment. One-third may get BV again within three months — and over one-half may get it again within a year. In some cases, recurring BV is caused by a new infection. Sometimes, the same infection returns. 

Why do some people get recurrent BV?

There are several possible reasons BV can come back after being treated:

  • The treatment was stopped too early.

  • The medication wasn’t used as the directions recommended.

  • The initial infection wasn’t fully treated.

  • The bacterial environment of the vagina stayed unbalanced.

OB/GYN Dr. Dorothy Bestoyong, DO adds that BV often recurs because of continued exposure to the same things that may have contributed to the infection to begin with. “People usually find the things that can trigger them to get BV and find ways to eliminate or prevent them,” Dr. Bestoyong says. (More on this in a bit.)

How is recurrent BV treated?

First, it’s important to get tested for BV and make sure that the infection is causing those symptoms. Once BV is confirmed, the infection is treated with an oral or topical (used in the vagina) antibiotic. These include metronidazole (oral), metronidazole (vaginal gel), or clindamycin cream (vaginal cream). You don’t have to use the same form of the antibiotic as you did before, but you can.

Some people with recurrent BV may be offered follow-up “maintenance therapy” after treatment. Maintenance therapy can include:

  • Metronidazole gel twice weekly for 4-6 months

  • Intravaginal boric acid during treatment and continuing for 3-4 weeks

  • Intravaginal boric acid several times a week as needed

Can you prevent recurrent BV? 

Taking the following steps may reduce the risk of recurrent BV:

  • Complete the full BV treatment even if symptoms go away before it’s over.

  • Use condoms.

  • Consider using birth control pills if you’re trying to prevent pregnancy. There’s some evidence that combination pills (containing the hormones estrogen and progestin) can decrease the chances of recurrent BV. This may also be true for other hormonal birth control options, but the research isn’t there yet.

  • Don’t douche. Douching can disrupt the vagina’s bacterial balance. It may also introduce harmful bacteria into the uterus and fallopian tubes.

Dr. Bestoyong recommends doing an “evaluation of your daily products, garments that you use. Avoid any scented/fragranced soaps. Wear cotton underwear. Avoid tight-fitting clothing in the evening/during sleep.” Dr. Bestoyong also suggests asking if your healthcare provider can prescribe you antibiotics in advance of recurring BV, so you have them on hand.

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Based on the best evidence we have, probiotics are not proven to be effective in preventing recurrent BV.

Can your sexual partner(s) pass BV to you?

BV is not considered an STI. That said, the infection can be spread through sexual contact (e.g., sharing sex toys, oral sex, fingering). BV is more common among people with multiple sex partners, people whose sex partners have the infection, and people who don’t use condoms.

Research has also found that having an ongoing sexual partnership with a person who has a penis may increase the likelihood of recurrent BV. This finding supports the belief that people with penises may be able to transmit BV, but experts are still exploring this.

We know from research that partners with vaginas can pass BV to partners with penises through penis-in-vagina sex. Partners with vaginas can also pass BV to other partners with vaginas.

Exactly how BV can spread through sex is TBD.

If you have BV, should your partner(s) get treated?

There’s no existing evidence that proves there’s a benefit in treating sex partners for BV. Still, some researchers hypothesize that reinfection from an untreated partner is possible. Clinical trials investigating BV treatment for partners with penises have been inconclusive. More research here is necessary. 

People with vaginas whose partners have BV can get the infection and may need treatment. 

If you or your partner is being treated for BV, talk to your healthcare provider for personalized guidance on whether partner treatment may be helpful.

“Recurrent BV can be very cumbersome,” says Dr. Bestoyong. “Stay positive [and] seek a provider that is willing to listen and help work with you to come up with a plan to prevent recurrent BV.”

Sarah duRivage-Jacobs is a sexual and reproductive health writer, educator, and communicator. In addition to Rescripted, her words can be found on the blogs of reproductive health and mental health companies like Modern Fertility, Hey Jane, Millie, Carrot, Origin, O.school, and Charlie Health. You can visit her website here.