Management of Recurrent Vaginitis

This review summarizes current evidence regarding the pathogenesis, diagnosis, and management of recurrent BV, recurrent VVC, and persistent trichomoniasis while highlighting emerging therapies and research priorities.

Recurrent BV is driven by persistence of a polymicrobial biofilm on vaginal epithelial cells, failure to restore a Lactobacillus-dominant vaginal microbiome following antibiotic therapy, and reinfection from untreated sexual partners. Emerging therapeutic approaches including live biotherapeutic products, vaginal microbiota transplantation, and male partner treatment seek to address these mechanisms beyond conventional antibiotic suppression. In contrast, recurrent vulvovaginal candidiasis primarily reflects host susceptibility and immune dysregulation rather than persistent infection, making long-term suppressive antifungal therapy the cornerstone of management while newer antifungal agents expand treatment options for selected patients. Persistent trichomoniasis most commonly results from reinfection or incomplete therapy, although antimicrobial resistance remains an important consideration requiring specialized diagnostic testing and alternative treatment regimens.

Recurrent vaginitis is a common and frustrating clinical problem that substantially impairs women's quality of life and accounts for frequent healthcare utilization. Although bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV) share overlapping signs and symptoms, the mechanisms underlying recurrence differ considerably and require disease-specific management strategies.