What lifestyle or behavioral modifications can I recommend to patients to help prevent recurrence of bacterial vaginosis?

To help prevent the recurrence of bacterial vaginosis (BV), advise patients to reduce exposure to modifiable lifestyle and behavioral factors known to contribute to recurrence. Specifically, recommend avoiding smoking, vaginal douching, and the use of antiseptics, bubble baths, or shampoos in the bath, as these can disrupt the vaginal flora and increase the risk of BV recurrence. For women using an intrauterine contraceptive device (IUD) who experience recurrent BV, consider discussing removal and switching to an alternative contraceptive method. Routine screening and treatment of male partners is not indicated, but testing and treating female partners in same-sex relationships may be considered. Although probiotics have been studied, current evidence and guidelines do not support their routine use for prevention of BV recurrence. If symptoms recur frequently despite adequate management, suppressive treatment with metronidazole vaginal gel may be considered under specialist advice. Emphasize adherence to prescribed antibiotic regimens during acute episodes to reduce recurrence risk. Overall, lifestyle modifications focus on minimizing vaginal irritants and maintaining vaginal health to prevent BV recurrence NICE CKS Donders 2010Vodstrcil et al. 2021.