Bacterial Vaginosis Treatments and Medications

Bacterial vaginosis is one of the most common vaginal infections that affects almost a third of women in the U.S. It’s usually accompanied by symptoms like an unusual vaginal odor and discharge, and it’s caused when the normal balance of vaginal bacteria changes. However, it is often easy to treat with a short course of prescription antibiotics. In mild cases, it may even clear up on its own. Here is what you need to know about BV and the available treatment options.

How is bacterial vaginosis diagnosed?

Since BV can cause symptoms similar to other types of vaginitis, such as yeast infections, a healthcare provider will have to run specific tests to make a diagnosis. A gynecologist or primary care provider will generally do a pelvic exam, which involves taking a swab of vaginal fluid. This fluid can then be tested with a pH test or examined more closely under a microscope.

Overall, a BV evaluation may include:

• Questions about your symptoms, sexual history, and any past cases of BV

• A pelvic exam

• A swab of vaginal fluid to test its pH and check for clue cells

To get the most accurate test results, it’s important to avoid douching, tampons, and vaginal sex for at least 24 hours or more. It’s also a good idea to get evaluated on a day when you are not menstruating.

Bacterial vaginosis treatment options

Bacterial vaginosis is a treatable condition that can often be cured with prescription antibiotics. These antibiotics are generally given as a pill, vaginal gel, or vaginal cream. If you don’t have symptoms, a healthcare provider may recommend monitoring it, as mild cases may resolve without treatment. Treatment will depend on the severity of symptoms, whether the infection is recurring, and whether pregnancy is a factor, since BV during pregnancy can increase the risk of premature birth and low birth weight. Bacterial vaginosis that keeps coming back usually needs a longer course of antibiotics or a different medication altogether.

Types of BV medication

The first-line treatment for BV is an antibiotic, which is typically prescribed by a healthcare provider and chosen based on your symptoms and medical history. 

Metronidazole

Metronidazole, commonly known by its brand names Flagyl and Vandazole, is a nitroimidazole antibiotic that has been used for BV for decades. It works by killing the overgrown bacteria causing the infection. Metronidazole is taken as an oral tablet or a vaginal gel. Nuvessa is a brand-name single-dose gel administered directly into the vagina.

Clindamycin

Clindamycin, known by its brand name Cleocin, is a lincosamide antibiotic used to treat BV. It helps stop the bacteria from growing, and it’s administered as a vaginal cream, a vaginal suppository (ovule), or an oral capsule. Clindesse and Xaciato are single-dose options containing clindamycin. Clindamycin cream and ovules are made up of an oil-based formula that could weaken latex condoms for up to five days after use. 

Tinidazole

Tinidazole, or Tindamax, is another nitroimidazole antibiotic that can be used for BV. It’s generally used as an alternative if first-line antibiotics don’t work or aren’t appropriate. Tinidazole is taken as an oral tablet. 

Secnidazole

Secnidazole, known by the brand name Solosec, is a newer nitroimidazole antibiotic administered as a single dose and approved for BV. Although it may cost more than generic medications, it can be convenient to take as a single packet of granules eaten with applesauce, yogurt, or pudding. 

It’s important to avoid alcohol during treatment with metronidazole or tinidazole and for at least a day after the last dose. Mixing alcohol with these antibiotics could lead to increased nausea, vomiting, and flushing.

In any case, make sure to finish the full course of antibiotics even if symptoms go away quickly, and use condoms or avoid sex until treatment is finished.

Over-the-counter bacterial vaginosis medicine

No over-the-counter medicines can cure BV, so prescription antibiotics are the only reliable, proven treatment. However, certain OTC products, such as boric acid suppositories and pH-balancing gels, may help ease symptoms or reduce the risk of another BV infection. Over-the-counter douches and washes with added fragrances should be avoided, since they can disrupt the vaginal flora and increase the risk of BV.

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