Bacterial Vaginosis Treatments and Medications

Every year, just over 21 million women in the U.S. develop bacterial vaginosis (BV). In other words, if you're experiencing something a little “off” down there, you’re far from alone. BV is the number one cause of abnormal vaginal odor and discharge. Luckily, there are many effective treatment options.

What is bacterial vaginosis (BV)?

Bacterial vaginosis (BV) is an infection caused when certain types of bacteria in your vagina are out of balance. Specifically, BV develops when Lactobacillus bacteria, which naturally occur in the vagina to maintain a slightly acidic environment, are overgrown and replaced by other vaginal bacteria that should only be present in small numbers.

BV is a very common infection that can happen to any woman, regardless if she's sexually active—with male or female partners. However, not everyone will show symptoms so it’s important to be regularly tested by your doctor. If you do experience symptoms, they usually include a fishy odor and gray or white discharge. BV and a vaginal yeast infection can be very similar as they’re both forms of vaginitis (inflammation of the vagina). Only your doctor can determine for sure which condition you have using simple tests.

The good news is that once you’re diagnosed with BV, it is easily treatable, usually with a short course of oral or topical antibiotics. In some mild cases, it will go away on its own. It’s always important to correctly follow the treatment plan your healthcare provider recommends. When left untreated, bacterial vaginosis may increase your risk for sexually transmitted infections (STIs) like gonorrhea and chlamydia and can cause problems during pregnancy.

How is bacterial vaginosis diagnosed?

The imbalance of vaginal flora that leads to BV can be caused by products that alter vaginal pH levels, like douches and vaginal deodorants. While not an STI, having sex may increase the likelihood of developing the condition. Your partner’s natural chemistry can affect the acidity of your vagina and cause an overgrowth of bacteria such as Gardnerella vaginalis.

When you visit your doctor, be prepared to answer questions such as:

• When did these symptoms start?

• Are you sexually active?

• What is your medical history?

• Are you taking any medications?

• Have you had BV before?

There are tests that can diagnose BV. Women should schedule regular checkups with their primary care provider or gynecologist, regardless if they’re experiencing symptoms such as abnormal vaginal discharge, odor, or itching.

The tests involve a pelvic examination, much like a Pap smear. Your doctor will likely use a tool called a speculum to gently open the vagina and take swabs to check for clue cells, as well as look for any physical signs of infection. Your doctor uses the swabs to determine if there is any imbalance or harmful bacteria present.

Although the idea of this type of examination may make you nervous, remember your doctor is a professional you can trust, and many women experience little to no discomfort during these examinations. It’s generally advised that for at least 24 hours before your test, you should not douche, use tampons, or have sex. Your doctor may also suggest the test be performed on a day when you don't have your period.

BV treatment options

If you’ve been diagnosed with bacterial vaginosis, your doctor will likely prescribe a course of antibiotics. However, if you’re not experiencing any symptoms, your physician may suggest you let it clear up on its own and check in after a few weeks.

Sometimes, the infection will come back and become recurrent, even when you correctly use your antibiotics. If this is the case, your doctor may suggest you take the antibiotics for a longer period of time or prescribe a different medication.

Pregnant women, in particular, need to seek treatment from their preferred medical provider, as BV during pregnancy increases the risk of premature birth and low birth weight.

BV medications

The first-line treatment for bacterial vaginosis is antibiotics, specifically metronidazole or clindamycin, as a pill, vaginal gel, or vaginal cream. Tinidazole is an alternative antibiotic, according to the U.S. Centers for Disease Control and Prevention (CDC).

There are currently no officially recommended over-the-counter treatments for bacterial vaginosis. Home remedies, like prebiotics, may help prevent flare-ups down the road.

Metronidazole

Used since the early 1980s to treat BV, metronidazole is a nitroimidazole antimicrobial agent that works by killing the overgrown and unwanted bacteria that cause BV. The most common brand name of metronidazole is Flagyl.

The potential side effects of metronidazole—particularly the pill form—include headache, nausea, or stomach pain, as well as a metallic taste in your mouth. You should not drink alcohol while taking metronidazole.

Clindamycin

Clindamycin, commonly known by the brand name Cleocin, is another antimicrobial agent for the treatment of BV. This lincosamide antibiotic stops the unwanted bacteria from growing. Various treatment forms are available, including vaginal (ovule and cream) and oral.

Some potential side effects of clindamycin include diarrhea, a metallic taste in your mouth, nausea, and vomiting.

Tinidazole

Like metronidazole, tinidazole is a nitroimidazole antibiotic and an antiprotozoal agent that kills bacteria and is sometimes used to treat BV. First used in Europe and Asia, it’s now licensed in the U.S. as a generic drug. The CDC lists it as an alternative treatment to first-line antibiotics.

It’s incredibly important to note that you should not consume alcohol during (and one day after) treatment with nitroimidazoles, as the combination can make you violently ill. Clindamycin has its own risk factors; topical applications can weaken latex condoms and diaphragms for five days after use. You should use alternative birth control methods during this time.

It’s generally advised that women should refrain from sexual activity or use condoms consistently and correctly during the treatment regimen.

What is the best medication for BV?

The best medication for bacterial vaginosis varies from person to person and can only be determined by your healthcare provider. It will be based on your medical condition, medical history, and medications you may already be taking that could interact with bacterial vaginosis medication, as well as your response to treatment. There may also be lifestyle and personal preferences regarding the use of a pill or topical gel/cream.

Save big on your prescriptions

with the free SingleCare app.

4.8 average rating

Text a link to get the app

Send

Best medication for BV