Modifying the vaginal microbiome with antibiotics or probiotics may only have a limited effect and research indicates such an intervention may not be reliable. However, studies into probiotics have found potential benefits such as reducing the risk of BV returning with a course of intra-vaginally administered L crispatus after a course of metronidazole.^12,32

Lactobacillus-based probiotics are being studied to see what impact they can have on restoring the vaginal microbiota, given orally or intravaginally, and alongside antifungals for treating VVC. In vitro studies show L acidophilus can slow Candida metabolism and interfere with Candida biofilm formation by suppressing adhesion-related genes. Given prophylactically, lactobacilli may also stimulate the immune response to pathogens.²³

Vaginal microbiota transplantation is also being explored, but is still experimental. Healthy microbiota inoculation can be done by transplanting vaginal fluid from a healthy donor into a woman with BV or by transplanting cultured derivatives.³³

Medical grade honey, with its known broad-spectrum antimicrobial and wound-healing properties, has also been suggested for a potential role in BV. Possible contributory mechanisms include its low pH, production of hydrogen peroxide, anti-biofilm activity and anti-inflammatory modulation, but research so far has been limited.³⁴