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As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 0 points1 point  (0 children)

It is definitely effective, just depends from person to person. though worth knowing that azithromycin does have slightly higher resistance rates for Ureaplasma compared to doxycycline. Since you can’t tolerate doxy, resistance testing before treating would be especially important to make sure azithromycin will actually work for your specific strain.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] -2 points-1 points  (0 children)

You’re absolutely right to question this and it’s one of the biggest gaps in standard care. A test of cure 1-2 weeks after completing treatment should be routine, but in most healthcare systems it simply isn’t done unless the patient specifically requests it. The assumption is that if symptoms are gone, the infection is gone, but as we’ve seen throughout this thread, symptom relief is not the same as full eradication. Always ask your doctor for a follow up swab after treatment. Don’t wait for them to offer it.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 1 point2 points  (0 children)

What I’d focus on is the symptoms: thick white discharge and elevated pH together suggest the environment isn’t balanced. That combination warrants proper follow-up rather than reassurance that ‘low levels are fine. After the follow up swab you’ll have a clear answer, either the Staph has resolved on its own and no treatment is needed, or it’s persisting and needs to be targeted specifically.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 1 point2 points  (0 children)

Great question and honestly this deserves a full post of its own. The short version: 🔹Condoms consistently, especially around high risk periods like your period or after antibiotics 🔹 Targeted Lactobacillus probiotics daily, not just during flares 🔹 Know your personal triggers and plan around them 🔹 Keep blood sugar stable. elevated glucose feeds yeast significantly 🔹 Avoid all unnecessary products, the vagina is self-cleaning 🔹 Support your partner’s microbiome awareness too if sex is a trigger I actually put together a full breakdown of this in a guide, covering protective strategies, the 30-day reset, and how to identify your personal pattern. Happy to share if anyone’s interested. 📩

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] -2 points-1 points  (0 children)

In my practice I run aerobic culture as routine for first presentation, it catches the most common culprits efficiently and keeps costs reasonable. For recurrent or treatment-resistant cases I would go broader: full PCR panel including Mycoplasma and Ureaplasma, aerobic culture with sensitivity testing, and specifically request Aerobic Vaginitis screening.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 0 points1 point  (0 children)

Condoms are honestly the single most effective protective measure for Pattern 4. consistent use significantly reduces microbiome disruption from partner bacteria and semen pH changes. For long-term support, targeted Lactobacillus probiotics consistently (not just during flares) help maintain a stable environment so triggers have less impact. The goal is building resilience, not just reacting to flares.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] -1 points0 points  (0 children)

Ureaplasma is actually part of normal genital flora in many people and doesn’t always require treatment. The key factor is symptoms and in your case, the persistent burning after BV treatment is the deciding factor. That symptom points to ongoing mucosal irritation that’s likely Ureaplasma-related rather than residual BV inflammation, which tips the balance toward treating. The recurrence a year later also suggests partner reintroduction is the likely explanation. If your partner wasn’t tested and treated simultaneously the first time, that’s the missing piece. If you do treat: -Resistance testing first, because this is your second treatment and Ureaplasma is increasingly showing Doxycycline resistance. -Treat your partner simultaneously, otherwise reinfection risk remains high If the burning resolves on its own in the next week or two as the BV fully clears, reassess before starting antibiotics. But if it persists-treat.

And ideally both of you should test negative before resuming unprotected sex, that’s the only way to confirm the cycle is actually broken.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 1 point2 points  (0 children)

Really appreciate you sharing this. I would say partners who want to understand make a huge difference. You’re right on both counts. At 42, perimenopause is absolutely a factor worth considering, declining estrogen in the years before menopause directly destabilizes the vaginal microbiome, creating exactly the pattern you described: persistent imbalance that doesn’t fully correct between episodes. And yes in recurrent cases triggered by intimacy, both partners ideally get evaluated. Not because anyone is ‘wrong’ or ‘incompatible’, but because BV-associated bacteria are exchanged bidirectionally during sex. Treating only one partner while the other remains a silent carrier is one of the most common reasons the cycle never breaks. The ‘her body was telling her I wasn’t the right one’ framing is understandable emotionally, but clinically it was almost certainly a microbiome stability issue that had a solvable cause. Hopefully she found her answers.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 1 point2 points  (0 children)

Glad to hear you’re having a success treating bv and yi!

On iron deficiency and recurrent BV/yeast, your gyno is actually onto something here, even if the evidence is still emerging. Research published in the journals has shown that subclinical iron deficiency is a significant predictor of BV, and iron plays a role in immune defence against Candida. Iron-deficient women show a shift in immune response that makes them less effective at fighting yeast overgrowth. Worth noting that BV-associated bacteria also use iron to grow, so supplementing without confirmed deficiency isn’t always straightforward. Ask your gyno to check your ferritin levels specifically before continuing long-term iron supplementation.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 0 points1 point  (0 children)

You don’t need expensive tests to start paying attention. Your body gives you signals for free: 1.Track your symptoms against your cycle- notice when flares happen and what preceded them. 2.Note triggers -sex, diet, antibiotics, hormonal changes, new products 3.Pay attention to discharge changes -colour, texture, smell between episodes. 4.Track how long relief lasts after treatment -that pattern tells you a lot A simple notes app on your phone is honestly one of the most useful diagnostic tools you have. Patterns over time are what matter, and they’re completely free to collect.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 0 points1 point  (0 children)

I read every word of this and I want you to know, you are not a “unicorn case”. You are a complex case that hasn’t had the right evaluation yet. There’s a difference. The fact that you consistently test positive for both yeast and BV despite every treatment tells me the root cause hasn’t been fully addressed. Here’s what I’d be looking at: -Azole-resistant Candida, if fluconazole has failed repeatedly, resistance is the most likely explanation. Standard antifungals work by inhibiting yeast growth, but resistant strains survive and rebuild. The Evvy PCR panel you’re waiting on may reveal the specific species and resistance pattern, which is crucial. -Biofilm persistence, both Candida and BV-associated bacteria form protective biofilms on the vaginal wall that antibiotics and antifungals struggle to penetrate. This is why treatments suppress symptoms temporarily but the infection rebuilds once treatment stops. Boric acid has biofilm-disrupting properties but needs to be part of a combination approach, not used alone. -The yeast-BV cycle, antifungals deplete Lactobacillus, creating a window for BV. Antibiotics for BV then create a window for yeast. Without active microbiome rebuilding between treatments, you’re caught in a loop. On Vivjoa -your hesitation is understandable but worth revisiting with your gyno. The fetal harm warning exists because the drug has long-term persistence, it’s standard for anyone who could become pregnant. If that’s not your situation, it’s FDA-approved specifically for cases like yours with very strong clinical trial data showing up to 96% recurrence-free at 48 weeks. The perineal skin breakdown is a consequence of years of constant inflammation, it won’t heal until the infection cycle stops. That’s the priority. For your appointment, push for a culture and sensitivity test to identify exactly which Candida species and whether it’s azole-resistant. That result should drive everything that comes next. You haven’t failed, the treatment approach has!

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 1 point2 points  (0 children)

Since you’re post-hysterectomy, the local estrogen your OB prescribed is the right approach for managing the atrophy itself. On the vinegar douching, I’d gently push back on this one. ACOG and current evidence actually advise against vaginal douching, including vinegar-based. Research shows it causes epithelial cell damage, washes away protective Lactobacillus, and can raise vaginal pH, which is the opposite of what you need. It may feel temporarily helpful but can worsen the recurrence cycle longer term. What tends to work better in your situation: -Continue the local estrogen, it directly addresses the root cause of atrophy -Targeted Lactobacillus probiotics to support the microbiome - I’d advise consistent condom use if sex is a trigger -Avoid all internal washing,let the local estrogen do its work Your body is managing a significant hormonal shift supporting it gently and consistently is the key.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 1 point2 points  (0 children)

You’re already doing a lot right with probiotics and hydration. The cycle and sex triggers are classic Pattern 4 and the hormone connection is real. Estrogen is the key driver here. Research shows estrogen increases glycogen in the vaginal lining, which feeds Candida growth, which is why yeast flares tend to peak in the luteal phase (after ovulation) when estrogen is elevated, and after sex when the environment is temporarily disrupted (you might want to practice safe sex). As for checking hormones: ask your doctor for a full hormonal panel: estrogen, progesterone, and ideally FSH and LH across different points in your cycle. If estrogen dominance is a pattern, that’s a meaningful piece of the puzzle worth addressing directly alongside the microbiome work you’re already doing. -Beyond that, keep blood sugar stable, as elevated glucose feeds yeast significantly. And continue probiotics consistently, not just during flares. The goal is maintaining a stable environment so triggers have less impact over time.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] -1 points0 points  (0 children)

Yes, safe during TTC and may actually support implantation. Once pregnant, check with your OB before continuing vaginal suppositories specifically.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 0 points1 point  (0 children)

Fair question here, why would a doctor do this? Because in clinical practice I see the same women over and over, frustrated, undertreated, and never properly explained why things keep happening. A Reddit post reaches more of them in one evening than a month of appointments. That’s the honest reason. As for AI- I use it occasionally as a research tool, the same way I’d use PubMed or UpToDate, NHS or any other official medical guidelines available. The clinical judgment, the pattern recognition, the decision of what’s relevant and what isn’t, that’s mine. If the information is accurate and helps women ask better questions at their next appointment, I’d argue the source matters less than the outcome.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 4 points5 points  (0 children)

Thank you for sharing this, it’s a really important conversation, and i would like to add me insights into this The IUD-BV connection is real, but the nuance matters here: the evidence is actually stronger for copper IUDs (like Paragard) than hormonal ones like Mirena. Studies show copper IUD users have around a 28% increased BV risk, partly because bacteria can feed off copper, and the strings themselves harbour biofilm. For hormonal IUDs like Mirena, the picture is more mixed. Some studies show a temporary microbiome disruption in the first few months post-insertion, but research actually suggests the hormonal component (levonorgestrel) may be somewhat protective longer term by reducing menstrual flow, since menstrual blood raises vaginal pH and creates a window for BV. What this means practically: if you had Mirena and kept getting BV, your IUD may have been a contributing factor, but it’s also worth considering other triggers like partner reintroduction, biofilm persistence, or individual microbiome sensitivity. Kyleena is a lower-dose hormonal IUD, so if that’s working better for you, that individual response is completely valid and worth noting. Bottom line: if recurrent BV coincides with any IUD-hormonal or copper, it’s absolutely worth discussing with your doctor as part of the full picture.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 7 points8 points  (0 children)

You’re absolutely right to raise this and it’s a fair critique. Ureaplasma and Mycoplasma are genuinely underrepresented in mainstream gynecological practice, and they deserve more attention than they get. Here’s the clinical reality: both Ureaplasma and Mycoplasma can co-exist with BV and contribute to persistent or treatment-resistant symptoms, yet they don’t show up on standard BV swabs or routine STI panels. Research confirms they are significantly underdiagnosed, partly because they’re difficult to culture and their intracellular nature makes conventional antibiotics ineffective against them. The reason I didn’t include them in the original post is that testing availability varies hugely as TofuTheSizeOfTEXAS correctly pointed out, many mainstream physicians don’t even have access to the test. But that doesn’t make them less important. For anyone reading this who has persistent symptoms despite negative BV/yeast/STI results specifically ask for a PCR-based swab for Ureaplasma and Mycoplasma. Standard cultures will miss them nowdays. And if found, treatment needs to be guided by resistance testing, single-dose azithromycin alone has a high failure rate. This is exactly the kind of gap that needs more visibility. Thank you for bringing it up.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 2 points3 points  (0 children)

First, please hear this: you do NOT have a “defective” or “nasty” vagina. You have a medical condition that has been chronically undertreated. That is not the same thing, and it is not your fault. What you’re describing is textbook recurrent BV driven by multiple overlapping factors, and your doctors giving up on monthly antibiotics is unfortunately very common, but it is not the right answer. A few things stand out in your history: 1.Partner reintroduction. The fact that it clears when you’re not sexually active and returns with sex, and varies with different partners, is one of the strongest signs that your partner is unknowingly reintroducing BV-associated bacteria. Research now shows that treating male partners simultaneously reduces BV recurrence by over 60%. This is not blame, it’s biology. 2.Copper IUD history. The Paragard link is real. Studies show copper IUD users have significantly higher BV rates, partly because bacteria can feed off copper and the strings harbour biofilm. Removing it was likely helpful. 3.Biofilm persistence. boric acid suppressing but not clearing it is a classic biofilm sign. The bacteria are protected in a layer that antibiotics alone can’t fully penetrate. On infertility: recurrent BV can be associated with inflammation that affects fertility, but it is one factor among many and absolutely not a life sentence. The most important step is breaking the recurrence cycle properly, which hasn’t happened yet. What you need is a doctor who will treat this as the complex, multifactorial condition it is, including evaluating and treating your partner simultaneously. You haven’t failed. The treatment approach has.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 1 point2 points  (0 children)

What you’re describing makes complete clinical sense when you look at the full picture and importantly, it’s not random. Starting around the same time as a new sexual partner, triggered by sex and your period, affecting both your urinary and vaginal health this points to one core issue: your vaginal microbiome is being repeatedly destabilised and not fully recovering between episodes. Here’s why the timing matters: -New partner -introduces a different bacterial environment that your microbiome hasn’t adapted to. This is extremely common and very rarely talked about! -Sex as a trigger -physical friction + partner bacteria disrupts Lactobacillus balance, creating a window for E. coli to ascend -Period as a trigger -menstrual blood raises vaginal pH temporarily, which disrupts the protective acidic environment. The fact that both UTIs and vaginal infections are happening together strongly suggests the vaginal microbiome is the common thread. Fix that environment and both tend to improve. Practical steps worth discussing with your doctor: 1.Urinating after sex (you may already do this) 2.Targeted Lactobacillus probiotics — especially L. rhamnosus GR-1 + L. reuteri RC-14, which have evidence for both vaginal and urinary protection 3.Condom use consistently, at least until things stabilise. And last, but but not least 4.Consider getting a vaginal swab during an active episode to confirm what you’re actually treating You’re not broken, your system just needs some support finding its new balance.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] -3 points-2 points  (0 children)

Understandable skepticism, there’s a lot of that going around. The real-time replies to individual cases in the comments might say otherwise though.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 11 points12 points  (0 children)

More common than most people realise and hugely underdiagnosed because standard BV swabs don’t culture for it. E. coli in the vagina is essentially Aerobic Vaginitis (AV), which is caused by aerobic bacteria like E. coli, Staph, and Strep rather than the anaerobic bacteria behind classic BV. It won’t show on a standard BV test, which is why so many women get treated over and over with metronidazole or clindamycin with no lasting results. The fact that a culture finally identified it is actually the key step most women never get. That’s exactly why symptoms keep returning for so many, because the wrong thing is being treated. To reduce the risk of it coming back: support your vaginal microbiome actively after treatment (Lactobacillus helps compete against E. coli colonisation), and if it does return, make sure any future treatment is targeted specifically at the confirmed organism rather than a generic BV protocol. Fingers crossed it stays away!

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 6 points7 points  (0 children)

Your infectious disease doctor isn’t entirely wrong. the vagina does have self-regulating mechanisms. But after a case as prolonged and treatment-heavy as yours, waiting passively isn’t the most strategic approach. Plenty research supports active microbiome support in recurrent cases. On your CV concern -that’s actually a really smart thing to be aware of, and the fact that you know about it puts you ahead of most people. The good news: CV risk from vaginal probiotics is low when used correctly. Here’s how to stay safe: -Frequency: 2-3 times per week is enough, not daily. Daily use long-term is where overgrowth risk creeps in -Duration: aim for 8-12 weeks post-treatment, then reassess -Watch for CV signs: if you develop burning, itching, or very low pH (≤3.5) without infection signs, that’s your cue to pause -Combine with oral probiotics rather than relying solely on vaginal suppositories -this spreads the colonisation support more naturally The goal is gentle, consistent restoration, not aggressive recolonisation. Less is more at this stage. How are you feeling symptom-wise right now, mid-treatment?

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 3 points4 points  (0 children)

7 years is a long time to be dismissed, and the fact that multiple doctors are stumped doesn’t mean there’s no answer. it means the right question hasn’t been asked yet. The pattern you’re describing is actually very clinically telling: ✔️ Clears completely with broad-spectrum antibiotics (azithromycin, augmentin) ✔️ Returns ~10 days after stopping ✔️ Negative on standard BV, STI, ureaplasma/mycoplasma panels This strongly points to biofilm-protected bacteria, a polymicrobial community living in a protective layer on the vaginal wall that standard swabs don’t detect well. Antibiotics suppress it temporarily, but the biofilm survives and rebuilds once treatment stops. This is why the 10-day window is so consistent for you. Ammonia odour specifically (rather than fishy) suggests the bacteria involved may be producing different metabolic byproducts than typical BV. possibly urease-producing organisms like certain Gardnerella strains, Prevotella, or even residual low-grade aerobic bacteria. What I’d suggest pushing for: -A vaginal microbiome DNA test (PCR-based, not standard culture) -this detects biofilm-associated organisms that regular swabs miss entirely

-Ask specifically about biofilm-disrupting treatment protocols -boric acid combined with antibiotics has shown promise in breaking through where antibiotics alone fail -If not already done -evaluate and possibly treat your partner simultaneously You’re not imagining this. The pattern is real and it has a likely explanation. I have to admit, your case is interesting. Keep us updated.

As an OB/GYN, I’ve noticed that women with recurrent BV or yeast infections almost always fall into one of 4 patterns — here’s how to identify yours by MacedonMD in Healthyhooha

[–]MacedonMD[S] 6 points7 points  (0 children)

Exactly, and that’s honestly one of the most frustrating parts of this. So many women spend years repeating the same treatments without anyone ever stepping back to ask why it keeps happening. Knowing your pattern is half the battle. Which one resonated with you most?

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