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.
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.
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.
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.
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.
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, 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.
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.
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.
| Drug name | Learn more | See SingleCare price |
|---|---|---|
| Flagyl | flagyl details | Get free coupon |
| Metronidazole | metronidazole details | Get free coupon |
| Cleocin | cleocin details | Get free coupon |
| Clindamycin | clindamycin-hcl details | Get free coupon |
| Tinidazole | tinidazole details | Get free coupon |
There are a number of side effects that may occur when taking medication for bacterial vaginosis. Although uncommon, these can include:
Metallic taste in your mouth
Nausea
Headache
Vomiting
Constipation
Diarrhea
Tiredness
Upset stomach
More serious, but again, rare, side effects are:
Rash
Hives
Swelling of the lips, throat, and face
Seizures
Fever
Itching
Numbness
Difficulty speaking
This is not a full list of side effects. You should always talk to a healthcare professional for a complete list of possible adverse events and drug interactions. If you think you are experiencing any adverse side effects from your medication, seek medical advice immediately.
While antibiotics are the most effective form of treatment for BV, you may prefer to try over-the-counter or at-home remedies first, especially if you’re trying to avoid potential side effects from prescription medication. These home remedies may help to prevent a recurrence of BV.
Taking probiotics can be an effective way to maintain a healthy balance of bacteria in your vagina. Danielle R. Plummer, Pharm.D., of HG Pharmacist, suggests taking vaginal probiotics rather than products designed for gut health. Specifically, “vaginal probiotics of at least 8 billion units of Lactobacillus rhamnosus, Lactobacillus acidophilus and Streptococcus thermophilus per capsule. Do this every other week (treat for 7 days, then do not treat for 7 days, then repeat),” Dr. Plummer says.
You can also try consuming probiotic-rich foods, such as yogurt.
Douching can disrupt the pH balance of the vagina, allowing bacteria such as Gardnerella vaginalis to overgrow. Although some women douche to make themselves cleaner, the truth is that bacteria are a natural, necessary part of regulating the vagina. The vagina is self-cleaning. Douching only disrupts the precious balance of the vagina’s natural environment.
It’s best to avoid any chemical washes, including soaps and bubble baths, as they can enter the vagina and disrupt the environment. In other words, use warm water only.
According to the Office of Women’s Health, women with more sex partners or a new sexual partner are at higher risk of developing a BV infection. One way to reduce the likelihood of experiencing BV is to always use condoms. “Condom use during sex is associated with less prevalence of BV,” explains Amesh A. Adalja, MD, FIDSA, FACP, FACEP, a board-certified infectious disease physician and Senior Scholar at Johns Hopkins Center for Health Security.
Bacterial vaginosis is caused by the overgrowth of certain naturally occurring bacteria in your vagina and the reduction of healthy bacteria, lactobacilli.
While men cannot get BV, it is unclear whether they can spread the infection. Sexually active women have a higher risk of developing the infection, regardless if they have a male or female sex partner. Women who are not sexually active can still experience BV.
Yes, in mild cases, BV can clear up on its own. However, if you are experiencing symptoms, it's advised to seek treatment from your doctor. If left untreated, BV can increase your risk of contracting sexually transmitted infections or pelvic inflammatory disease, which can lead to infertility.
You can try to prevent BV with some lifestyle changes, such as taking vaginal-specific probiotics, avoiding douches, and using condoms. However, the recommended course of treatment for symptomatic BV is antibiotics prescribed by your doctor.
In mild or asymptomatic cases, BV can sometimes clear up on its own. There are no proven at-home or over-the-counter remedies to treat BV, so you should always speak with your primary care provider or gynecologist about the best treatment plan for you.
Bacterial vaginosis is not a sexually transmitted disease. However, it’s considered a "sexually-associated" infection. This is “because it's rarely seen in women who have never been sexually active,” explains Kristy Goodman, MS, Assistant Professor at the Southern California University of Health Sciences PA Program.
Diflucan is a common antifungal treatment for other vaginal infections, like bacterial yeast infections, which often have similar symptoms to BV. According to the CDC, it is not a recommended treatment for bacterial vaginosis.
Marissa Walsh, Pharm.D., BCPS-AQ ID, graduated with her Doctor of Pharmacy degree from the University of Rhode Island in 2009, then went on to complete a PGY1 Pharmacy Practice Residency at Charleston Area Medical Center in Charleston, West Virginia, and a PGY2 Infectious Diseases Pharmacy Residency at Maine Medical Center in Portland, Maine. Dr. Walsh has worked as a clinical pharmacy specialist in Infectious Diseases in Portland, Maine, and Miami, Florida, prior to setting into her current role in Buffalo, New York, where she continues to work as an Infectious Diseases Pharmacist in a hematology/oncology population.
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