What causes recurrent vaginitis?

Recurrent vaginitis can be overwhelming, but it is treatable and typically not an indicator of anything dangerous going on. It just takes longer to reset the balance for some women than for others. While there is no exact number of occurrences used as a criterion to define recurrent vaginitis, the typical threshold is considered to be at least four cases per year.

In the case of “cyclic vaginitis,” a term sometimes used for vaginitis that recurs in conjunction with menses, a change in pH caused by menstrual blood or fluctuating hormones is thought to be a triggering factor. Recurrent BV can also be associated with sex, particularly with a new partner. In this case, when starting a sexual relationship with someone new, exposure to new bacteria from your partner’s body can trigger BV. On the other hand, you can also experience recurrent BV with the same partner, though the reasons behind this condition are less clear. 

Recurrent yeast infections are most commonly caused by excess moisture. Fungus thrives in dark, moist environments (like wet clothing). In addition, it is technically possible to develop yeast infections as a result of moisture exposure from sexual fluids but this is less common. Recurrent yeast infections associated with menstruation are also possible. If wearing pads or period underwear, it's important to change them frequently to keep things dry and minimize the risk of excessive moisture exposure.

When it comes to treating recurrent BV or yeast, the general idea is the same: start by treating the infection at hand with one full course of antibiotics (BV) or antifungal medicine (yeast), and then continue with low doses of treatment for a number of months in an effort to totally eradicate the infection.

In the case of recurrent BV, the most common treatment approach is to start with one week of oral metronidazole, followed by twice weekly applications of vaginal metronidazole. The vaginal antibiotic treatment should continue twice a week for four to six months.

A similar framework would be used for recurrent yeast infections. Commonly, initial symptoms are treated with three doses of oral fluconazole, taken once every 72 hours, followed by once weekly doses for six months. It's important to monitor liver function during long-term fluconazole treatment, as this medicine can impact the liver.

Alternatively, if you don’t want to take antibiotics or antifungal medicine consistently for six months, you could augment this treatment with boric acid instead. For those who prefer to try boric acid, long-term treatment can be initiated with one course of antibiotics (for BV) or antifungal medicine (for yeast), then followed by twice weekly boric acid suppositories for six months.