Recurring Vaginitis for Months Fixing the Approach

The average period people with chronic vaginitis endure alone at home before visiting the clinic is about 3 months. During that time, they try pharmacy medications, change cleansers, take probiotics, and search the internet and chatbots, repeatedly thinking, "Why am I not getting better?" However, often the problem isn't the body itself, but the approach. Using antifungal medication for bacterial vaginosis, or not using antibiotics when they are needed, can easily lead to chronic conditions. Even with similar discharge and itching, treatment should vary depending on the cause.

Vaginitis is not a disease caused by a lack of hygiene. Many people worry if it's a sexually transmitted infection when told "you have vaginitis" in the clinic, but the types of vaginitis discussed today are not STIs. Gardnerella, the cause of bacterial vaginosis, and Candida, the cause of yeast vaginitis, are not bacteria transmitted from outside; they are commensal bacteria that live in everyone's vagina. A healthy vagina has beneficial bacteria called Lactobacillus, which create a mildly acidic environment to prevent the growth of harmful bacteria. When this balance is disrupted, dormant bacteria can suddenly proliferate, leading to vaginitis.

Various factors can disrupt this balance. Stress is the most common, and lack of sleep, weakened immunity, or frequent antibiotic use also play a role. It can also occur after sexual intercourse, as alkaline male semen temporarily alters the acidic environment of the vagina. There is no need to blame your partner.

The most common type of vaginitis is bacterial vaginosis caused by Gardnerella. The quickest sign to notice is an odor, often described as a fishy smell. Those with a sensitive sense of smell report noticing the odor even when still. Discharge is often watery and grayish-white, and the odor tends to worsen after sexual intercourse because alkaline semen alters the vaginal environment.

In the clinic, the key characteristics of bacterial vaginosis are clear: the odor is strong, and itching is minimal or absent. Diagnosis is made through microscopic examination and vaginitis tests, and metronidazole is commonly used. Oral medication is typically taken twice a day for about a week; alcohol consumption should be avoided during treatment as it can affect liver function. A vaginal gel with the same active ingredient is also available.

When medication is prescribed, symptoms usually subside and the odor disappears within 2-3 days. Some people then stop taking the medication, thinking they are fully recovered, only to return with symptoms 2-3 weeks later. At the core of this recurrence is biofilm.

Gardnerella does not float freely on the vaginal mucosa; it forms a sticky film on the membrane and establishes itself. Simply put, the bacteria set up "tents" on the vaginal wall. When antibiotics are introduced, bacteria outside the tents quickly die, and the odor disappears, but bacteria inside the tents survive. If you stop the medication midway, these bacteria emerge again, proliferate, and the odor returns. This is the mechanism behind chronic vaginitis that "improves with medication but recurs when stopped." To eliminate the biofilm completely, you must take the prescribed medication until the very end.

The disappearance of symptoms is different from a complete cure. If you experience recurrent vaginitis, a check-up before stopping medication may be beneficial. Consult about Recurrent Vaginitis

Next is yeast vaginitis, or Candida vaginitis. It is one of the most common types of vaginitis for which people seek acute care, and its cause and treatment differ from bacterial vaginitis. The most prominent sign is itching, often severe enough to disrupt sleep at night. Discharge is commonly described as cheese-like, but it can vary from person to person.

For bacterial vaginitis, odor is key; for Candida, itching is key. However, despite seeming simple, distinguishing them on your own is not easy. Yeast vaginitis is usually treated with a single dose of fluconazole 150mg, and vaginal suppositories are also available.

Patients who come to the clinic saying, "It's really difficult," often experience a cycle of vaginitis. They treat bacterial vaginitis, then yeast vaginitis appears, and this alternating pattern repeats. It's commonly believed that "beneficial bacteria die due to antibiotics," which is true.

However, according to a study published in 2024, bacterial vaginosis itself is reported to disrupt the vaginal microbial balance and lower immunity, creating an inflammatory environment conducive to Candida growth. In other words, not only antibiotics but bacterial vaginosis itself can also be a precursor to yeast vaginitis. Therefore, to break this vicious cycle, proper diagnosis and treatment from the outset are crucial. Repeated self-treatment can lead to both types of vaginitis appearing alternately and easily becoming chronic.

In the past, when asked, "Should my boyfriend also take medication?" the answer was, "Since it's a commensal bacterium, you can take it alone." However, medicine continues to advance, and new evidence emerges. A study published in 2025 reported that when male partners of women with bacterial vaginosis were prescribed oral medication along with a topical cream, recurrence rates were reduced compared to treating the woman alone. This research was published in a reputable academic journal. Of course, if it's an occasional occurrence or vaginitis unrelated to sexual activity, partner treatment may not be necessary. However, if bacterial vaginosis recurs several times a year, the treatment paradigm for recurrent vaginitis is now shifting towards treating both partners.

Prevention is not about doing more, but doing less.

• Do not douche inside the vagina. Gently wash only the outside, and allow the inside to self-cleanse.
• Take prescribed medication until the end, even if symptoms disappear.
• Consistently take Lactobacillus probiotics. While not a cure, they can help boost immunity and reduce recurrence.
• Reduce sugar intake. Yeast vaginitis thrives on sugar, so reducing sweet foods alone can help lower recurrence. In fact, some individuals with severe yeast vaginitis and vulvar itching were found to have diabetes after blood tests.
• Choose cotton underwear and ensure good ventilation. Summer humidity and tight-fitting synthetic clothing can contribute to yeast vaginitis.

For reference, even if a Gardnerella positive result is found, it is not a sexually transmitted infection, so you can rest assured. It is detected when bacteria naturally present in the vagina proliferate.

Breaking the cycle of recurrence ultimately begins with an accurate diagnosis. This is because the treatment approach varies depending on whether the primary symptom is odor or itching, or if the conditions alternate. If you have been enduring it alone for over 3 months, simply re-evaluating the approach might reveal a path forward. Explore the causes of recurrent vaginitis together.

See also related articles: How to Manage Chronic Vaginitis, The Story of Bacterial Vaginosis and Gardnerella, Reasons Why Vaginitis Frequently Recurrs.

Written by: Lee Dong-hee Chief Director · Obstetrician and Gynecologist · View Medical Staff Profile

This article is based on the content of a YouTube video · First published April 20, 2026 · Last reviewed May 30, 2026

This article provides general health information and is not a substitute for individual diagnosis or treatment. If you have symptoms, please consult a medical professional for advice.