Ask the Herbalist

Hello Lior, I have taken several rounds of antibiotics to treat bacterial vaginosis, but it keeps coming back. What else can I do? Hello, Bacterial vaginosis is a form of dysbiosis where there is an imbalance between the strains of bacteria. It is associated with dysbiosis in other parts of the body. Therefore, you need to address gut ecology along with the vaginal environment. The most common symptom is a distinctive fishy odor, which can occur even without other typical symptoms like discharge or irritation. The smell is especially noticeable after intercourse when the alkaline pH of semen intensifies the odor. Healthy vaginal flora, dominated by lactobacilli, maintains an acidic pH (around 3.8-4.5) that inhibits pathogenic bacteria. When this balance shifts, we see an overgrowth of bacteria like Gardnerella vaginalis, Prevotella, and Mobiluncus species. Some factors that contribute to Bacterial vaginosis are: Antibiotic medicine High sugar consumption Alcohol Stress Vaginal douches or washes Some IUDs Some oral contraceptives The first line of treatment for bacterial vaginosis is antibiotics, specifically metronidazole or clindamycin. They're effective initially, with cure rates around 80-90%. However, the recurrence rate is high — often 50-70% within 6-12 months. This happens because antibiotics don't just kill the problematic bacteria, they also wipe out beneficial lactobacilli. An effective approach might be to avoid all the factors that disrupt gut and vaginal healthy biome ecology, then focus on supporting natural recolonization through diet, stress management and creating optimal conditions for beneficial bacteria. You might consider supplementing with probiotics such as Lactobacillus rhamnosus or Lactobacillus reuteri. The probiotics can work if taken orally or if inserted vaginally. Another strategy is to add selective prebiotics to your diet. Selective prebiotics create conditions that naturally favor beneficial bacteria over problematic ones. The most effective selective prebiotics are polyphenols and flavonoids found in plants — often the colored pigments that give fruits and vegetables their vibrant colors. These compounds selectively feed beneficial bacteria while inhibiting pathogenic ones. For optimal microbiome support, aim for around 1500mg of polyphenols daily. Some of the richest sources include: Black currants (758mg/100g) Bilberry (705mg/100g) Black olives (569mg/100g) Blueberries (560mg/100g) Plums (377mg/100g) Sweet cherries (274mg/100g) Blackberries (260mg/100g) Polyphenols create metabolic byproducts when broken down by beneficial bacteria that are strongly anti-inflammatory and immune-regulating. Essentially, you're feeding the bacteria you want to thrive while creating an environment less hospitable to problematic organisms. A high-fiber diet also results in a more diverse and dense microbiome overall. The fiber acts as food for beneficial bacteria, allowing them to produce short-chain fatty acids that help maintain the proper pH and create a protective barrier. This approach works systemically, supporting both gut and vaginal microbiome health. This article is for educational and informational purposes only and solely as a self-help tool for your own use. I am not providing medical, psychological, or nutrition therapy advice. You should not use this information to diagnose or treat any health problems or illnesses without consulting your own medical practitioner. Always seek the advice of your own medical practitioner and/or mental health provider about your specific health situation.