Key Points:

• Bacterial vaginosis (BV) is a very common condition. It’s usually treated with antibiotics.
• Common antibiotic treatments for bacterial vaginosis include Metronidazole and Clindamycin. There are options that can be taken by mouth as well as creams or gels that are put in the vagina.
• It’s important to treat bacterial vaginosis, even if you have minor/minimal symptoms. Without treatment, BV can cause more serious problems like an increased risk of sexually transmitted infection (STI) or increased risk for infertility, miscarriage and preterm birth.

Bacterial vaginosis (BV) is a very common problem, and more than 30% of people with vaginas will experience BV in their lifetime. The most common symptoms are a strong, fishy odor and thin, milky white discharge.

Bacterial vaginosis is usually treated with antibiotics. It’s important to get help for bacterial vaginosis, even if you don’t have symptoms, since BV can cause more serious problems if left untreated.

Will bacterial vaginosis go away on its own?

Bacterial vaginosis may get better without treatment, but it can cause potentially serious problems, even if your symptoms are mild. That’s why it’s a good idea to talk to your medical provider if you suspect that you have BV.

Untreated BV can increase the risk of getting a sexually transmitted infection (STI), including HIV, chlamydia and gonorrhea. It can also increase the risk of pelvic inflammatory disease (PID) and infertility.

It’s especially important to get treated if you’re pregnant since BV is linked to an increased risk of miscarriage, premature delivery and other birth complications.

How to treat bacterial vaginosis

Bacterial vaginosis is treated with antibiotics. There are no over-the-counter medications that will cure BV.

Male sexual partners don’t typically need treatment if their female partner is diagnosed with BV. Female partners may need to be checked for bacterial vaginosis if they also have discharge or other symptoms.

It’s also a good idea to avoid having sex (with both male and female partners) until you’ve finished the full treatment and your infection has gone away. Semen is alkaline, and it can disrupt the pH of your vagina while it’s recovering. Additionally, some BV treatments involve creams or gels that can make it more likely for condoms to break.

Antibiotics do carry a risk of side effects, and studies show that bacterial vaginosis comes back in more than 50% of women, even with treatment. Researchers are now looking at new therapies, including probiotics and other non-antibiotic treatments, that could help treat BV and make it less likely to return.

Medications for bacterial vaginosis

Medications for bacterial vaginosis can be used as a cream or gel that you put in the vagina. There are also options that come as a tablet that you take by mouth or as granules that you sprinkle over soft food (like applesauce) and eat.

The most common medications used to treat BV are Clindamycin, Metronidazole, Tinidazole and Secnidazole.

• Clindamycin: (also available under the brand name Cleocin and Clindesse) This medicine comes as a cream that is put into the vagina. It’s important to know that this medicine can make latex condoms less effective while it’s being used and for up to three days after you stop taking this medication.
• Metronidazole: (also available as Flagyl and Metrogel-Vaginal) Metronidazole is available both as a gel that you put into the vagina or as a pill that you swallow. This medicine interacts with an ingredient in alcohol, leading to stomach upset, abdominal pain or nausea, so it’s a good idea to avoid alcohol while using this medication and for three days after finishing the medicine.
• Tinidazole: (also available by the brand name Tindamax) Tinidazole is an oral medication that you swallow. Like Metronidazole, you should avoid alcohol while using this medication and for three days after finishing treatment to avoid side effects like stomach upset, nausea and stomach pain.
• Secnidazole: (also available as Solosec) Secnidazole comes as granules that are sprinkled over a soft food like applesauce, yogurt or pudding. Typically, you only need one dose. You should avoid alcohol while taking this medicine and for two days after finishing it. Also, you shouldn’t breastfeed for up to four days after finishing this medicine.

How to prevent bacterial vaginosis

There are several things you can do to help prevent bacterial vaginosis.

• Avoid douching: The vagina doesn’t require special products or cleaning beyond normal bathing. Douching can disrupt the normal balance of bacteria in the vagina and make bacterial vaginosis more likely.
• Use unscented hygiene products: Some products can irritate the vagina, including vaginal deodorants or sprays and scented tampons or pads.
• Practice safe sex: Multiple partners or unprotected sex can increase the risk of developing BV or sexually transmitted infections. Use latex condoms and limit the number of sex partners to reduce your risk.
• Don’t smoke: People who smoke are more likely to develop bacterial vaginosis due to the way that chemicals in cigarettes affect the immune system.

While antibiotics are effective for BV, some people experience BV that keeps coming back. You can support a healthy balance of bacteria in the vagina by eating products known to contain “good” bacteria like Lactobacillus.

A good diet for bacterial vaginosis might include yogurt or probiotic supplements, although research in this area is still emerging. Be sure to speak with your medical provider before starting any supplements, including probiotics.

Online treatment for bacterial vaginosis

Bacterial vaginosis can be frustrating, but there are options to help prevent and recover from BV more quickly. Antibiotics like Clindamycin and Metrodinazole are the most common treatment options for BV. Explore online BV treatments at Dr. B.

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