Bacterial vaginosis (BV) can be treated with antibiotics. Several different antibiotics, which come in different forms, can be used. If used correctly, treatment is effective in 85-90% of cases.
There is currently no evidence that probiotics, such as those found in live yoghurt, are of any benefit for treating or preventing BV.
Metronidazole is the most common, and preferred, antibiotic treatment for BV. It is available in three forms:
- as tablets to be swallowed twice a day, for seven days
- as tablets to be taken as a single larger dose that you only take once
- as a gel that you apply to your vagina once a day, for five days
The most effective way to take metronidazole is in tablet form over seven days. This is also the preferred treatment if you are pregnant or breastfeeding. More people find that their BV is more likely to return if they choose to take the single larger dose.
It is recommended that you do not drink alcohol while taking metronidazole and for 48 hours afterwards. This is because metronidazole can react with alcohol, causing you to feel very unwell.
Clindamycin is an alternative antibiotic that may be prescribed for treating BV. It is available in two forms:
- as a cream that you apply to your vagina once a day for seven days
- as capsules that you swallow twice a day, for seven days
The capsules are rarely used nowadays as they have been linked to a serious side effect called pseudomembranous colitis. This is severe inflammation (swelling) of the inner lining of the colon (large intestine).
Clindamycin cream can weaken barrier methods of contraception, such as latex condoms, diaphragms and caps. This means that they will not be effective at preventing pregnancy and will not protect you against sexually transmitted infections (STIs).
You will need to use additional contraception and protection against STIs while you are using clindamycin cream and for five days afterwards. Some types of condom, such as those made from polyurethane, may still work. Ask your GP for advice.
Tindiazole is an alternative medication that may be prescribed, although its effect on bacterial vaginosis has been less well studied. Tinidazole is taken orally (by mouth) as a single dose. As with metronidazole, you should not drink alcohol while you are taking this medication.
If your BV symptoms disappear after treatment, you will not need to be tested for BV again to confirm that the treatment has worked. However, you will need to be tested if:
- your signs and symptoms do not go away
- your signs and symptoms return, or
- you are treated for BV while you are pregnant
The first course of treatment may not be effective in around 10-15% of people. If your treatment has been unsuccessful, your GP will need to check that you took the medicine correctly. If you did and it did not work, you may be prescribed one of the different options described above.
Alternatively, you may be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system). If you are pregnant, you may be referred to an obstetrician (a specialist in pregnancies). They will be able to discuss further treatment options with you.
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease, and some are good for you.
The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs).
Sexually transmitted infections (STIs)
STIs are diseases passed on through intimate sexual contact, such as vaginal, oral or anal sex.
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.