Interventions for Vaginal Health with CST 4


  • Women dominated by CST 4 are more susceptible to symptomatic and asymptomatic infections, which might be a risk factor for pregnancy complications. 
  • Antibiotics are the most commonly prescribed intervention if you are experiencing symptoms of BV. But you can combine an antibiotic treatment with probiotics, diet, and lifestyle changes to achieve the best possible results.
  • Probiotics are as effective against BV as antibiotics. The vaginal microbiome in healthy women is Lactobacillus dominated. Since most probiotics strains are selected from the genus Lactobacillus, using probiotics to treat or prevent vaginal infections is the logical choice.
  • Lifestyle changes, healthy diet, essential oils and home-made remedies can help you fight BV.
  • Do not use boric acid vaginal suppositories during pregnancy since this can have severe consequences. 
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Women dominated by the Type 4 vaginal community (CST 4) are more susceptible to infection due to the low levels of protective lactobacilli and high levels of disruptive bacteria [1]. Lactobacilli bacteria help to create an acidic environment in your vagina that wards off infection and keeps disruptive species in check. 

Bacteria associated with CST 4 play an important role in the development of bacterial vaginosis (BV) or aerobic vaginitis (AV). But in many cases, you may be asymptomatic. This means that you will not experience any typical BV symptoms such as vaginal itching and an unpleasant smell. However, these disruptive bacteria may still impact your health status and your pregnancy [2], [3], [4]. 

Symptomatic and asymptomatic bacterial vaginosis (BV) can have severe consequences during pregnancy. Which is why we recommend curbing the growth of disruptive bacteria. 

There are a few things you can do to support your vaginal microbiome during infection. This includes:

  • Smart antibiotic use
  • Probiotics
  • Essential oil suppositories
  • Two remedies you might already have in your kitchen

How to make antibiotics work for bacterial vaginosis (BV)

Antibiotics are the most commonly prescribed intervention if you are experiencing symptoms of BV [5] [6]. However, antibiotics are not the “golden standard” for BV since up to 80% of women report recurrence within three months [5] [6]. 

We recommend combining an antibiotic treatment with probiotics, diet, and lifestyle interventions to achieve the best possible results: 

  • Select a probiotic with Lactobacillus: Clinical studies have shown that combining antibiotic treatment with probiotics, have better outcomes and lower recurrence rates [7].
  • Make changes in diet that support vaginal health: Food choices, micronutrients, and even common kitchen spices can help manage vaginal infection, including BV and yeast infection.
  • Practice vaginal hygiene that supports your microbiome: From unscented toilet paper and cotton undies to microbiome-safe sex, here are 10 tips to help you care for your vaginal microbiome.

Fortunately, antibiotics for BV are usually applied directly to your vagina. This limits their negative influence on other microbiome communities, such as your gut microbiome.

Probiotics can be as effective as antibiotics  

Don’t underestimate the power of probiotics. Because the vaginal microbiome is Lactobacillus dominated, using probiotics to address or protect against infection makes a lot of sense.

Probiotics produce lactic acid, which helps to maintain low vaginal pH of around 4.5. This low pH hampers the growth of disruptive bacteria and yeast. They also make bioactive molecules (such as bacteriocins and biosurfactants) that have the ability to directly curb an infection [8].

Finally, because probiotics have the ability to stick to vaginal epithelial cells, they stop disruptive bacteria and yeast from binding to these cells [8]. 

Essential oil suppositories can relieve signs of vaginal infection

Essential oils have been laboratory tested and shown to have antimicrobial properties against disruptive bacteria that might cause BV or yeast infection, as known as vulvaginal candidoses. These essential oils include: 

  • Thyme
  • Lavender
  • Tea tree

Because essential oils have not been tested in a clinical setting and proven effective, use them with caution and always consult with your healthcare provider. 

If you’re wondering which products or methods might be best for you, Dr. Aviva Romm also shares her go-to homemade suppository essential oil blend for addressing BV and vaginal yeast infection. 

Try yogurt and honey for vaginal yeast infection

Never underestimate the power of your kitchen. In a randomized control study, yeast infection treated topically with a mixture of honey and yogurt was not only similar in effectiveness to antifungal (clotrimazole) vaginal cream, but was also more effective in relieving some symptoms of vaginal candidiasis [9].

Likewise, for pregnant women, a study found that a mixture of bee-honey and yogurt had a high clinical cure rate and a reasonable fungal cure rate compared to the antifungal treatment. The study suggested that a yogurt and bee-honey mixture could serve as a potential complement or alternative to antifungal agents, especially in patients with candidiasis during pregnancy [9]. 

If possible, consider using medical-grade honey with the yogurt to ensure safety and the best results. Always discuss with your healthcare provider first. 

Warning: Avoid boric acid suppositories for any BV and yeast symptoms during pregnancy      

Boric acid is a natural chemical and can be toxic if it’s swallowed. It’s often considered an alternative treatment for BV and yeast infection because it breaks down bacterial biofilms, directly killing disruptive bacteria or changing the vaginal pH. 

But boric acid should not be used during pregnancy.

This is because boric acid may be toxic and lead to premature delivery and miscarriage. 

It’s worth noting that in Germany, boric acid treatment for vaginal yeast infection is not even allowed [10]. Do not use boric acid if you have a Type 4 vaginal community during pregnancy. And always consult your healthcare provider before taking boric acid to confirm that it can help you address your symptoms, even if you are not pregnant.

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[1] Muzny, C.A. et al. (2018) Identification of Key Bacteria Involved in the Induction of Incident Bacterial Vaginosis: A Prospective Study. J Infect Dis 218, 966–978.

[2] Brown, R.G. et al. (2019) Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabor rupture of the fetal membranes. Translational Research 207, 30–43.

[3] Fettweis, J.M. et al. (2019) The vaginal microbiome and preterm birth. Nat Med 25, 1012–1021.

[4] DiGiulio, D.B. et al. (2015) Temporal and spatial variation of the human microbiota during pregnancy. Proc Natl Acad Sci USA 112, 11060–11065.

[5] Coudray, M.S. and Madhivanan, P. (2020) Bacterial vaginosis—A brief synopsis of the literature. European Journal of Obstetrics & Gynecology and Reproductive Biology 245, 143–148.

[6] Tomás, M. et al. (2020) Bacterial vaginosis: Standard treatments and alternative strategies. International Journal of Pharmaceutics 587, 119659.

[7] Wang, Z. et al. (2019) Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis. IJERPH 16, 3859.

[8] Younes, J.A. et al. (2018) Women and Their Microbes: The Unexpected Friendship. Trends in Microbiology 26, 16–32.

[9] Darvishi, M. et al. (2015) The Comparison of vaginal cream of mixing yogurt, honey and clotrimazole on symptoms of vaginal candidiasis. GJHS 7, p108.

[10] Mendling, W. (2015). Guideline: vulvovaginal candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis). Mycoses, 58, 1-15.