best probiotics for bv - bacterial vaginosis

Bacterial vaginosis (BV) can be an incredibly frustrating condition to live with. Luckily, some of the best probiotics for BV can be found easily and may be very helpful in dealing with this issue. More often than not, bacterial vaginosis is something that women deal with for months or years, with little help from their doctors. In this article, I’ll go over exactly what bacterial vaginosis is, the typical BV treatment, how to address recurring BV, and how probiotics for bacterial vaginosis can help.

Updated June 2021.

In doing research for this post, I came across so many stories from women all over the Internet and it really broke my heart to read them. Women who experienced extreme pain during sex, said they were embarrassed to have any sexual contact, were constantly thinking about how “fishy” they smelled, or worried if they would ever find someone who could love them. There were many women who told their stories of living with BV for years, and could not find a solution.

So this article is dedicated to you – I hope using some of the best probiotics for BV allows you to find relief.

Disclosure: Some of the links in this post are affiliate links, which means that I receive compensation when you buy from these vendors. Please note that I vet each product and do not recommend products that I do not believe in. Thank you for supporting me!

What is BV (Bacterial Vaginosis)?

Bacterial vaginosis (BV) is an imbalance of good and bad bacteria (also referred to as dysbiosis) in the vagina. BV is thought to be a sexually-transmitted disease.

BV is the most common cause of vaginal symptoms and it is believed that ~29% of women of childbearing age have bacterial vaginosis. The rates of BV differ between ethnicities, with Black women being at the highest risk (51%), followed by Mexican women (32%), and white women (23%). (1)

Normally, the majority of the bacteria in the vagina are from the Lactobacillus genus. When Lactobacilli are in high numbers, these bacteria keep the vaginal environment acidic by producing lactic acid, which helps to prevent “bad” bacteria from taking over. This is also why taking probiotics for BV can be helpful in keeping the vaginal environment acidic enough to prevent dysbiosis.

When you develop bacterial vaginosis, there is a shift away from Lactobacillus bacteria toward a more diverse mix of bacteria. This imbalance of bacteria leads to an increase in the pH of the vagina, which can cause a number of symptoms.

Men cannot get bacterial vaginosis, though they may harbor some of the bacteria (Gardnerella vaginalis) that is thought to play a role in the development of BV in women. (2)

Bacterial Vaginosis (BV) Symptoms

Despite how common BV is, it does not always cause symptoms. In fact, 84% of women with BV do not exhibit any symptoms at all. (1)

That said, there are some tell-tale signs of BV. Symptoms of BV are often chronic and usually fairly mild. They include:

  • Thin, white or grey vaginal discharge
  • A strong fishy odor, especially after sex
  • Itching, burning, or pain in or around the vagina

Bacterial Vaginosis vs Yeast Infection

Despite the fact that yeast infections are talked about much more, they are the second most common cause of vaginal symptoms, beat out only by bacterial vaginosis.

So what’s the difference between the symptoms of bacterial vaginosis and a yeast infection?

Common symptoms of a yeast infection include itchiness or burning in or around the vagina, and a white discharge that often looks like cottage cheese. This discharge is typically odorless and might have a yeasty smell (like beer or bread). (3)

This differs from the thin consistency and strong fishy odor of the discharge associated with bacterial vaginosis.

Of course, the best thing to do if you have any of these symptoms is to visit your healthcare provider who can perform an exam and testing to determine which of these infections you might have.

Bacterial Vaginosis (BV) Causes

While researchers aren’t quite sure exactly what causes BV, there are certain lifestyle factors that may make you more likely to get BV.

Factors that may increase your risk of developing BV include (4):

  • Sexual activity. Having a new sexual partner or multiple sexual partners increases your risk of BV. Women who have not had sex rarely have BV.
  • Douching. Douching disrupts the balance of bacteria as well as the pH of the vagina, putting you at higher risk of BV.

Conventional BV Treatment

Some doctors do not recommend treatment of BV, especially if you have no symptoms. This is because the typical antibiotic treatment for BV can cause you to develop a yeast infection, essentially trading one infection for another. Many cases of BV also spontaneously resolve on their own.

However, treating BV makes you less likely to contract other STDs, including HIV. In addition, you are less likely to suffer from infections after gynecological surgery like an abortion or hysterectomy if you treat BV prior to surgery.

Lastly, if you are pregnant, having BV can increase the risk of having a preterm birth or a low birth-weight baby (<5.5 pounds at the time of birth). (4)

Most practitioners will choose to treat women who complain of symptoms of BV, women with BV who are about to undergo gynecological surgery, or pregnant women with BV, especially if you’ve had a preterm birth in the past.

Typical treatment for BV is a course of antibiotics. Antibiotics for BV include metronidazole (oral or vaginal), clindamycin (oral or vaginal), tinidazole (oral), or secnidazole (oral). Thankfully, doctors are now starting to recognize that using some of the best probiotics for BV can also be useful!

Recurring BV

Many women have recurring BV infections and find pharmaceutical antimicrobial treatment ineffective over the long-term. In addition to this, the side effects of antibiotics (such as yeast infections) can often make antibiotics seem not worth it.

If rings a bell, you might want to know how to stop recurring BV infections permanently or how to get rid of BV without antibiotics.

One thing to note here is that researchers believe that treating the sexual partners of those with BV may reduce recurrence rates. Early research in the field showed that this was not effective, but it was later discovered that this early research was not up to snuff. Researchers are now diving deeper into this topic and will hopefully have a definitive answer for us soon as to whether or not treatment of sexual partners can help reduce the recurrence of BV. (2)

In the meantime, there are numerous BV over-the-counter treatments as well as home remedies for BV that can make treatment a success and decrease the likelihood of a recurrent infection. One of my favorite options is probiotics – so let’s talk about some of the best probiotics for BV.

Best Probiotics for BV

probiotics for bv - probiotic supplements

Because bacterial vaginosis is an imbalance of the good and bad bacteria in the vagina, taking probiotics orally or inserting probiotic bacteria vaginally can be useful in treating BV.

Taken orally, probiotic bacteria can actually help rebalance the vaginal flora. (5)

If you are interested in inserting probiotics vaginally for BV, make sure to discuss this option with your healthcare provider.

Below are some of the best probiotics for BV.

Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 for BV

One of the most studied combinations of probiotic strains for bacterial vaginosis is Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. (Remember that knowing the strain of the probiotics you’re taking is incredibly important — you can’t just take any probiotic!)

Study 1

In a study of 32 women with BV, half the women were given metronidazole and a combination of these two probiotic strains, while the other half were given metronidazole and a placebo. They received the antibiotics for the first 7 days of the study. As for the probiotics, they took two capsules (each capsule containing at least one million bacilli per strain) for the first 30 days, and then 1 capsule per day for the remaining 30 days of the study.

For those in the probiotic group, 81% (13 women) had cured their BV by day 30. They remained BV-free until the end of the study at 60 days, as well.

This is in contrast to the placebo group (remember, they still got the conventional treatment — 7 days of metronidazole). In this group, only 31% (5 women) were free of BV by the end of the study and almost 70% of the women who only received metronidazole treatment still had BV. (6)

Study 2

In another study (double-blind, placebo-controlled, randomized) on these two strains, women who had received these probiotics in addition to conventional metronidazole treatment for BV were cured at a much higher rate than those who only received metronidazole treatment.

125 women were split into two groups, and of those on the combination of probiotics and metronidazole, 88% were cured at the 30-day follow up. Only 40% of women who received metronidazole treatment alone were cured. (7)

Study 3

Another very similar study in 2017 showed, again, that women who took these probiotic strains in addition to metronidazole antibiotic treatment were much more likely to cure their BV. 83% of those who took the combination of probiotics and antibiotics for BV had cured their BV by the end of the 30-day study, while only 37% of women who only received antibiotics had cleared their BV by the end of the study. (8)

You may have also heard milk-based drinks with Lactobacillus cultures like Yakult for BV, or Actimel for BV. They do not contain the same strains of Lactobacillus as mentioned above, and thus may not be as effective for BV. That said, I’m always open to seeing more research so if you want to share any, please do so in the comments section!

Best Probiotic for BV that Includes Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14

Clearly, these two probiotics strains have some promising results for those with BV. If you’re looking for a BV treatment over the counter to help improve the efficacy of your medical treatment, probiotics are a wonderful choice. It’s an easy remedy that you can administer at home!

Fem-Dophilus from Jarrow Formulas is a great option if you’re looking for a probiotic supplement that contains these two strains.

You can also find these same strains in RepHresh Pro B probiotic capsules.

Ideally, I would love these companies to share the exact CFU counts for each individual strain, but none of them do (opting to list it as a “proprietary blend” instead). Both of these options contain 5 billion total CFUs, but they don’t specify how much of those 5 billion is coming from each of the strains. If you know of a brand that tells you how much of each strain their supplement contains, I’d love to hear about it in the comments!

Other BV Treatments Over the Counter & Home Remedies for BV

In addition to probiotics for BV, there are some other over the counter treatments for BV that you might want to consider.

Garlic for BV

In a study of 120 women with BV, 60 women were given 500 mg capsules of garlic and 60 women were given the standard treatment of metronidazole. 63% of women who received the garlic were successful in their treatment, while 48% were successful in the metronidazole group. (9)

This shows that garlic may be a better treatment for BV than antibiotics. Perhaps combined with the probiotics listed above, we’d see even higher rates of clearance!

If you’re looking for a quality garlic supplement, Allimax is a good choice.

Boric Acid Suppositories for BV

Boric acid suppositories have long been used for vaginal infections, including BV and yeast infections. It is regarded as a simple, safe home remedy for vaginal infections. It is thought that boric acid may affect the biofilms of BV-causing bacterial. (2)

One study showed that treatment with nitroimidazole followed by 21 days of intravaginal boric acid suppositories (600 mg) and then, if in remission, metronidazole gel twice weekly for 16 weeks. BV cure rates at 12, 16, 28, and 36 weeks were 87%, 78%, 65%, and 50%, respectively. (10)

Though the BV cure was not permanent for 50% of women in the trial, this study indicates that boric acid (along with other maintenance therapies), may be useful in delaying recurrence of BV. More studies are needed to determine if ongoing use of boric acid may be helpful for BV prevention, especially for those with recurring BV.

Please note: Oral use of boric acid is toxic — vaginal use only. Pregnant women should not use boric acid.

You can purchase boric acid suppositories online quite easily. As always, it is best to discuss any of these remedies with your doctor before use.

Other home remedies for BV that are less studied include: herbal suppositories (such as this one from Dr. Aviva Romm), tea tree oil for BV, and hydrogen peroxide for BV.

If you are considering any BV treatment over the counter or home remedies for BV, talk to your doctor.

The Bottom Line:

Bacterial vaginosis is the most common vaginal infection and affects almost 1 in 3 women. It causes symptoms such as thin, white or grey discharge with a strong fishy odor, and can cause itchiness or pain in or around the vagina.

Probiotics can be a great way to improve your chances of clearing BV. The best probiotics for BV are products that include both Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 strains. These can be found in both the Fem-Dophilus from Jarrow Formulas and RepHresh Pro B probiotic supplements. Taken orally, these probiotics can help rebalance the bacteria and lower the pH of the vagina and may help prevent and treat BV.