Recurrent vaginitis: why it comes back and how it is treated

What recurrent vaginitis is

Itching, burning, discharge that is different from usual: vaginitis that was treated and then came back after a few weeks is a common and particularly frustrating experience. In this article we will look at the main causes, which recur for different reasons.

Vaginitis is an inflammation of the vagina that usually shows up as itching, discharge and irritation. It is called recurrent when there are at least three episodes in a year: this is the definition used both for bacterial vaginosis and for vulvovaginal candidiasis.

Recurrences are common. According to the data collected by the authors of the review, after a first episode bacterial vaginosis comes back in 50-80% of women, candida in about half, and trichomoniasis in 10-25%. This is why vaginitis is among the most frequent reasons for seeing a gynecologist, and those who suffer from it often report a worse quality of life.

Not all vaginitis is an infection, however. In a 2019 study cited by the authors, 35% of vaginal swabs from women with symptoms were negative for all the infections tested. Itching and discharge can therefore also have non-infectious causes, and this is one of the reasons why repeating the same treatments without a diagnosis often does not work.

The most common causes of recurrent vaginitis

Bacterial vaginosis: a balance that does not rebuild itself

In a healthy vagina, lactobacilli prevail: "good" bacteria that produce lactic acid and protect the mucosa. In bacterial vaginosis this balance breaks down and other bacteria take over. About one woman in three has it at least once in her life.

Vaginosis comes back for three reasons that often add up.

The first is the biofilm: the bacteria organize themselves into a layer that sticks to the vaginal wall, a kind of protective film, which antibiotics reduce but do not completely eliminate. As a result, once treatment is over, the bacteria start again from what is left.

The second is that the antibiotic eliminates the responsible bacteria but does not bring back the protective lactobacilli, and the vagina is often repopulated by species that are less effective at defending it.

The third is reinfection: more and more data show that the bacteria of vaginosis pass from the male partner to the woman during intercourse.

Candida: the problem is mainly the body's response

Candida is a fungus that normally lives in the gut and in the vagina, often without causing any trouble. The authors estimate that recurrent candidiasis affects more than 138 million women worldwide every year.

There are two forms. In the "secondary" form there is a factor that favors the fungus: antibiotics taken for other reasons, pregnancy, poorly controlled diabetes, some diabetes medicines, cortisone, estrogen-based medicines or a weakened immune system. In the "idiopathic" form, the most frequent, there is no obvious trigger: the fungus is almost always the common Candida albicans, which is sensitive to medicines, and the problem lies in the way the body reacts. For partly genetic reasons, the mucosa of these women responds to the presence of the fungus with excessive inflammation, and it is this that causes the symptoms.

This explains why recurrent candida is not "cured" like an ordinary infection. Treatments eliminate the fungus and control the symptoms as long as they are continued, but about half of women have episodes again after stopping, because the predisposition remains. In some cases recurrent candida does not cause acute episodes but a continuous discomfort, which shows up only as pain during intercourse.

Trichomoniasis: reinfection, incomplete treatment or resistance

Trichomoniasis is a sexually transmitted infection caused by a parasite, Trichomonas vaginalis. When it persists after treatment, the authors point to several possible mechanisms as an explanation: the therapy was not completed as prescribed, the partner was not treated and passed the infection back, there was a new infected partner, or the parasite is truly resistant to the medicines. This last possibility is the least common: small studies put it at around 4-10% of infections.

When to see a doctor

A visit, and not a new do-it-yourself treatment, is useful in these situations:

• symptoms that come back three or more times in a year, or that do not go away with treatment;
• a first episode of symptoms never had before, or discharge that is different from what you already know;
• a current pregnancy or wanting to become pregnant;
• a new partner or the possibility of a sexually transmitted infection;
• diabetes or treatments that can favor infections, such as cortisone.

The natural point of reference is the gynecologist; for resistant trichomoniasis or difficult candida, the authors also advise seeing a dedicated specialist. Knowing what to expect from the gynecological examination helps to face it with less anxiety.

How recurrent vaginitis is diagnosed

The central point of the review is that vaginosis, candida and trichomoniasis look alike in their symptoms but come back for different reasons, and each requires its own strategy. This is why a precise diagnosis matters more than any treatment repeated "by eye".

The doctor takes the history of the episodes, examines the patient and takes a sample of the vaginal secretions. Molecular tests, which look for the genetic material of germs, are today more accurate than simple observation under the microscope: a randomized study cited by the authors clearly showed this. The microscope is still useful, however, to recognize non-infectious causes, such as some forms of inflammatory vaginitis.

In more complex cases second-level tests may be needed. If drug-resistant candida is suspected, a sensitivity test is done on the cultured fungus, although it is not available everywhere. If the swab shows a candida species other than albicans, the doctor must first understand whether it is really responsible for the symptoms, because these species are often harmless. For persistent trichomoniasis, once other causes have been ruled out, the parasite is cultured and its sensitivity to medicines is measured. The follow-up test after treatment of trichomoniasis should be done no earlier than three weeks after the end of therapy, because before then it can give unreliable results.

What to expect from treatment

All the treatments described below are chosen and dosed by the doctor based on the diagnosis, the patient's history and any pregnancy. None should be started on your own.

Recurrent bacterial vaginosis

After a recurrence the doctor may change the type of medicine and continue with maintenance therapy for a few months, which reduces relapses as long as it is taken. If vaginosis comes back again, there are more intensive combined regimens, always decided by the doctor.

A new development of recent years concerns the partner. In 2025 an Australian study showed that also treating the regular male partner reduces new episodes of vaginosis in the woman: treating the couple was enough to prevent a recurrence. American and international gynecological scientific societies now recommend considering it, but the authors point out that the study did not specifically concern women with recurrent forms. It is therefore a choice to be shared with the doctor, intended above all for stable and motivated couples.

Vaginal products based on live lactobacilli, which aim to rebuild the protective flora, are also being studied: in one study the strains given settled in 66.1% of participants in the first five weeks, and in about half they were still present at twelve weeks. Even more experimental is vaginal microbiota transplantation from a donor: in the first study 4 women out of 5 had complete remission. These are promising paths but not yet treatments available in practice.

Recurrent candidiasis

The basic strategy is long-term antifungal maintenance therapy, decided and followed by the doctor. It works well and allows many women to live without symptoms, but it does not cure the predisposition: this is why, when it is stopped, some women start having episodes again. In pregnancy some oral medicines must be avoided and the gynecologist chooses suitable local treatments.

In secondary forms, treatment also includes correcting the favoring factor: better control of diabetes, reviewing medicines such as cortisone or estrogens with the doctor, treating any associated vaginosis. The authors are clear on this point: without controlling vaginosis, recurrent candida cannot be controlled. For resistant forms or those caused by species other than albicans there are alternatives, to be managed with the specialist, and new antifungal medicines are on the way.

For recurrent candida, according to the authors, commercially available probiotics and treating the partner are not recommended.

Persistent trichomoniasis

First of all, the doctor checks that the therapy was completed and that the partner was treated. Only when these causes are ruled out is resistance suspected, sensitivity tests are done and more intensive or combined regimens are used, which require a specialist and sometimes compounded preparations.

Vaginal ozone therapy: what the studies say

Among the complementary options there is also vaginal ozone therapy (page in Italian), which uses the antimicrobial action of ozone, a particular form of oxygen. It is applied in the vagina as ozonated oil, as a mixture of ozone and oxygen or as a wash with ozonated water. Clinical evidence is still limited but promising.

For candida, a randomized Iranian study of 100 women with vulvovaginal candidiasis compared ozonated olive oil with clotrimazole cream, a commonly used antifungal, for 7 days. The two treatments reduced itching and discharge similarly and made the culture test negative with no significant differences; clotrimazole reduced burning more. However, the women were checked only at the end of treatment: the study does not say whether the candida came back later, which is precisely the problem of recurrent forms.

For bacterial vaginosis there is only one study, from Russia, of 102 women: ozone added to standard therapy, in particular used both in the vagina and systemically, gave better results than standard therapy alone, but the available abstract does not report the figures. A small Chinese study of 30 healthy women observed that three vaginal washes with ozonated water did not alter lactobacilli in the following three weeks: a reassuring finding about the protective flora, which however does not measure effectiveness against infections. Finally, for resistant trichomoniasis, the review on which this article is based reports a new ozonated oil active against the parasite in the laboratory, not yet tested in patients.

In my clinical outpatient experience I commonly use vaginal ozone therapy, and patients appreciate it very much for reducing the symptoms of vaginitis because it is not a drug or antibiotic treatment and it is just as effective as more traditional treatments. However, I do not yet have enough data to establish whether it can also reduce recurrences.

What can be done in practice

Recurrent vaginitis is managed better when the patient becomes an active part of the process. Some behaviors really help:

• Do not repeat treatments on your own. Each recurrent vaginitis has its own cause: treating them all the same way delays the right diagnosis.
• Keep a diary of the episodes. Dates, symptoms, treatments taken and results help the doctor understand which form it is and whether there are triggers, such as a course of antibiotics.
• Complete the prescribed treatments and follow maintenance therapies for the whole time indicated, even when the symptoms disappear.
• Involve the partner when the doctor says so, especially for trichomoniasis and, in selected cases, for vaginosis.
• Use a condom with a male partner: the authors list it among the factors that reduce susceptibility to vaginosis. The type of contraception can also have an influence, and it is a topic to discuss with the gynecologist.
• Treat favoring conditions, such as diabetes, and do not stop on your own medicines suspected of favoring candida: discuss it with the doctor who prescribed them.

Many women with recurrent vaginitis look for alternative remedies, such as oral probiotics or vaginal preparations bought on their own. For recurrent candida, the evidence in favor of commercially available probiotics is scarce for the moment.

Where this information comes from

The article is based on a narrative update review published in 2026 in the journal Current Obstetrics and Gynecology Reports by three US specialists in gynecology and infectious diseases. It is not a new study with patients, but a summary of current knowledge and guidelines, in particular the American ones: some medicines and tests cited by the authors are not available in Italy, and it is the gynecologist who indicates what is used in Italian practice. The part on vaginal ozone therapy is based instead on the clinical studies listed in the references (items 2-4).

The authors conclude that the new paths, from rebuilding the vaginal flora to treating the partner, have given encouraging initial results, but larger studies are needed to confirm their long-term effectiveness and safety.

Recurrent vaginitis: the message in brief

Vaginitis that keeps coming back is not a sentence and almost never depends on poor hygiene. Bacterial vaginosis, candida and trichomoniasis come back for different reasons: a bacterial biofilm and a flora that does not rebuild, the body's predisposition to candida, a reinfection or incomplete treatment for trichomoniasis. The most useful step is a precise diagnosis, followed by targeted therapy and a prevention plan built together with your doctor.

References

1. Powell AM, Sobel JD, Muzny CA. Management of Recurrent Vaginitis. Current Obstetrics and Gynecology Reports. 2026;15(1):41. doi:10.1007/s13669-026-00494-w. PubMed
2. Tara F, Zand-Kargar Z, Rajabi O, Berenji F, Akhlaghi F, Shakeri MT, Azizi H. The Effects of Ozonated Olive Oil and Clotrimazole Cream for Treatment of Vulvovaginal Candidiasis. Altern Ther Health Med. 2016;22(4):44-9. PubMed
3. Yarustovskaya OV, Kulikov AG, Shtro LP. [Ozonotherapy as an efficient component of the combined treatment of the patients presenting with bacterial vaginosis]. Vopr Kurortol Fizioter Lech Fiz Kult. 2015;92(5):45-49. doi:10.17116/kurort2015545-49. PubMed
4. Zhang QQ, Zhang L, Liu Y, Wang Y, Chen R, Huang ZY, Lyu T, Liao QP. Effect of ozonated water on normal vaginal microecology and Lactobacillus. Chin Med J (Engl). 2019;132(9):1125-1127. doi:10.1097/CM9.0000000000000216. PubMed