Objective: To evaluate the clinical and microbiological effects of antimicrobial underwear as an adjunct to standard treatment in women with acute vaginitis. Methods: Sixty reproductive-age women with acute vaginitis received a 7-day intravaginal regimen of metronidazole and miconazole. Participants were assigned either to a group wearing antimicrobial underwear or to a control group wearing non-antimicrobial underwear. Vaginal symptoms and culture results were assessed before and after treatment. Results: The antimicrobial-underwear group showed significant improvement in vaginal symptoms, including discharge (96.7%→6.9% vs. 72.5%→27.5%; p < 0.001), pruritus (37.5% vs. 68.4%; p = 0.044), odor (19.6% vs. 53.8%; p = 0.016), and irritation (36.4% vs. 75%; p = 0.013). Dyspareunia was similar between groups. While no microbiological change was observed in controls (p = 0.950), negative cultures increased from 40% to 80% in the antimicrobial-underwear group (p = 0.018), with marked reductions in Candida spp., Gardnerella vaginalis, E. coli, and Klebsiella spp. Conclusions: Antimicrobial underwear, when used in conjunction with standard treatment, can enhance symptom relief and maintain genital hygiene. By improving the vulvovaginal microenvironment, antimicrobial textiles can reduce moisture and the persistence of pathogens.