You treat it. Your symptoms settle. And then a few weeks or months later, that familiar change in discharge or odour is back.
If you’ve experienced recurrent bacterial vaginosis, you’ll know how frustrating that cycle can be.
And importantly, recurrent BV doesn’t necessarily mean you’ve done something wrong or that the original treatment simply “didn’t work”. BV has a notoriously high recurrence rate, and research suggests there may be several reasons why it returns.
So when BV keeps coming back, the question becomes:
What is happening in the vaginal environment that allows it to return?
First, what actually happens with BV?
A healthy vaginal microbiome is commonly dominated by Lactobacillus species.
These bacteria produce lactic acid, helping maintain the naturally acidic vaginal environment that makes it more difficult for potentially problematic bacteria to overgrow.
With bacterial vaginosis, this microbial balance shifts. Lactobacillus species become less dominant and there is an increase in a diverse group of anaerobic bacteria.
This can result in symptoms such as:
A change in vaginal discharge
A strong or “fishy” odour
Irritation or discomfort
But BV can also occur without obvious symptoms.
And while treatment can reduce BV-associated bacteria and resolve symptoms, restoring a stable Lactobacillus-dominant vaginal microbiome afterwards can be more complicated.
So why does BV keep coming back?
There probably isn’t one answer.
Researchers are investigating several overlapping reasons for recurrent BV, including persistence of BV-associated bacteria, biofilms, antimicrobial resistance, reinfection and difficulty re-establishing a stable vaginal microbiome after treatment.
1. Your vaginal microbiome may not have fully recovered
Removing problematic bacteria is one part of the picture.
What happens after treatment matters too.
Ideally, protective Lactobacillus species become dominant again. But research suggests this doesn’t always happen. Some vaginal microbiomes remain in a less stable state following treatment, which may leave the environment more susceptible to BV returning.
This is why at Floura, we’re interested in more than whether your symptoms temporarily disappeared.
We’re interested in the environment those symptoms are occurring in.
2. BV-associated bacteria can form biofilms
This is a particularly interesting area of BV research.
BV-associated bacteria can form structured microbial communities on the vaginal lining, often described as biofilms.
Think of a biofilm almost like a protective community of bacteria. This structure may make it more difficult for antimicrobial treatment to completely reach and eradicate the bacteria living within it.
Evidence suggests these bacterial communities can persist even following treatment, which may be one reason symptoms return. Researchers are actively investigating therapies that target BV-associated biofilms, but many potential approaches remain experimental.
3. Sexual activity may play a role
Our understanding of BV and sexual transmission is evolving.
Sexual activity and exposure to a partner’s genital microbiota may influence the vaginal microbiome, and reinfection is increasingly being investigated as one contributor to recurrent BV.
The important point is that BV recurrence is not simply a hygiene problem.
Repeatedly washing, douching or using increasingly harsh intimate products isn’t the answer and may further disturb the vaginal environment.
4. The vaginal environment isn’t static
Your vaginal microbiome can change.
Hormones, menstruation, sexual activity and other biological factors can all influence the vaginal environment.
That’s why some women notice their symptoms seem to follow a pattern, perhaps appearing around their period, after sex or repeatedly at particular points in their cycle.
Those patterns can provide useful information when we’re trying to understand recurrent symptoms.
Treating the symptom vs understanding the pattern
Antibiotics remain an important evidence-based treatment for BV.
But when someone has experienced BV repeatedly, simply moving through another cycle of:
Symptoms → treatment → symptoms disappear → symptoms return
can understandably become frustrating.
Recurrent symptoms deserve reassessment.
That may include confirming that BV is actually responsible for the symptoms, considering other causes of vulvovaginal symptoms, reviewing previous treatments and looking at the broader clinical pattern.
Recurrent BV is recognised as a challenging clinical problem, and researchers are still working to establish the best strategies for preventing recurrence.
What we look at, at Floura
When someone comes to us with recurrent vaginal symptoms, we’re interested in the whole story.
Not just:
“Do you have BV?”
But:
When did this start?
How often does it return?
Does it change around your period?
Does it occur after sex?
What treatments have you already used?
What other vaginal or pelvic symptoms are happening?
Depending on your individual presentation, appropriate testing and collaboration with your GP, gynaecologist or other healthcare providers may also form part of the picture.
Because when something keeps coming back, it’s worth asking why.
The takeaway
Recurrent BV is common, frustrating and more complex than simply having “bad bacteria”.
Treatment is important, but recurrence may involve the vaginal microbiome failing to return to a stable Lactobacillus-dominant state, persistence of BV-associated bacterial communities, sexual reinfection and other factors researchers are continuing to investigate.
If your BV keeps coming back, you don’t have to keep guessing.
At Floura, we look at your vaginal symptoms in context and help you understand what may be contributing to the pattern.
This article is for educational purposes only and does not replace individual medical advice, diagnosis or treatment. Persistent or recurrent vaginal symptoms should be appropriately assessed by a healthcare professional.