Bacterial vaginosis (BV) is a vaginal infection. Antibiotics may help treat the condition and reduce symptoms. Some antibiotics can cause side effects, and there are some Food and Drug Administration (FDA) warnings on certain BV drugs.

The Centers for Disease Control and Prevention (CDC) state that BV is the most common vaginal condition in those aged 15–44 years.

This article discusses the different medications available for BV, the antibiotics that doctors may prescribe, and frequently asked questions that people may have for a doctor treating BV.

BV occurs when there is an imbalance of the vaginal flora, which are the types of bacteria that naturally live inside the vagina.

BV can occur in anyone with a vagina, but according to research from 2020, a person may be at an increased risk of developing BV if they:

  • have multiple sexual partners
  • are sexually active at a young age
  • are douching regularly

Research also mentions that people with BV may have a higher chance of contracting a sexually transmitted infection (STI).

BV can sometimes go away on its own. However, the CDC recommends that those with symptoms of BV contact a doctor to receive a diagnosis and a treatment plan.

Some symptoms of BV may include:

To diagnose BV, a doctor may perform a pelvic exam and take a sample of the vaginal discharge.

The forms of antibiotic medications that doctors can prescribe for people with BV are:

  • Tablets: People take this type of antibiotic orally. Some tablets are available as a one-time dose.
  • Creams or gels: A person applies this type of antibiotic directly to their vagina or with an applicator.

Please note that the writer of this article has not tried any of these products. All information presented here is purely research-based.

Metronidazole

Metronidazole is available as a tablet, capsule, or gel.

The FDA has issued a black box warning indicating that metronidazole has caused cancer in studies using rats and mice. As a result, the FDA advises that healthcare professionals should only prescribe this drug if other medications have not worked, especially if a person is pregnant.

People can take metronidazole tablets (Flagyl) twice per day for 7 days or take a single tablet as a one-time dose. MedlinePlus mentions that people may also divide the single pill into two doses in one day.

Some side effects associated with oral metronidazole include:

According to the FDA, people taking metronidazole should not consume alcohol while they take the medication or for at least 1 day after the course of treatment has ended. The FDA mentions that consuming alcohol while taking metronidazole can cause:

Metronidazole gel

A person may also use metronidazole as a gel, which is applied to the vagina through an applicator. The United Kingdom’s National Health Service (NHS) states to use this form of metronidazole every day for 5 nights.

Additionally, the NHS mentions that a person should not have sex while using the gel.

A doctor may not recommend this gel if the individual is menstruating.

The FDA states that metronidazole gel can cause:

Clindamycin

Clindamycin stops or slows the growth of bacteria.

Clindamycin comes as a cream, and doctors may prescribe it if a person’s symptoms keep coming back or they do not improve with metronidazole.

Clindamycin comes as a single, pre-filled applicator containing 5 grams (g) of the medication that a person inserts into their vagina every night for 5 days.

The CDC suggests that individuals avoid using latex and rubber condoms during treatment and for 5 days after use. This is because clindamycin cream contains mineral oil which may weaken latex condoms or diaphragms.

According to MedlinePlus, vaginal clindamycin does not treat irritation from a yeast infection or STIs.

Studies on the efficacy of clindamycin have shown that 88% of the study participants did not experience any BV symptoms 1–2 weeks after using the cream.

However, side effects of clindamycin cream may include:

Tinidazole

Tinidazole is available as a single-dose tablet.

A 2014 randomized controlled trial states that taking 2 g of tinidazole once daily for 2 days is as effective as taking metronidazole tablets twice daily for 7 days.

The study also states that tinidazole is cheaper than metronidazole and causes fewer side effects.

Some side effects associated with tinidazole include:

The following are common questions and answers about BV medications.

Can you get BV medication over the counter?

Antibiotics for BV are only available with a prescription.

However, individuals may wish to consider using natural products to treat BV, such as:

  • Garlic: A 2014 study found that garlic tablets may be an effective alternative treatment for BV.
  • Probiotics: Probiotics are bacteria found in food such as yogurt and probiotic supplements. A 2014 review found that they may be beneficial in preventing and treating BV without causing any adverse effects.

A person may also consider following these preventive measures to help reduce the chances of developing BV:

  • using unscented tampons or sanitary towels
  • wearing cotton underwear
  • avoiding douching
  • using barrier methods during sex, such as condoms

Can BV come back after medication?

According to research from 2018, a person may develop BV again after a few weeks. About half of those who have had BV experience symptoms again after 1 year of getting the first infection.

In these cases, a doctor may recommend a different treatment plan.

This research also states that because antibiotics affect all vaginal bacteria, using antibiotics to treat BV may lead to a vaginal yeast infection. This occurs in about 10% of those who take clindamycin or metronidazole.

Symptoms of a yeast infection include lumpy, white vaginal discharge or vaginal itching and redness.

Learn more about yeast infection symptoms here.

Does my partner need treatment for BV if I have had it?

The CDC explains that partners with a penis do not need to receive treatment for BV.

However, those with BV may spread the infection to sex partners who have vaginas.

A person can consider contacting a doctor if they are experiencing unusual vaginal discharge or a fever.

The doctor may perform a swab test and ask about medical and sexual history to determine if they have BV.

Individuals can also see a doctor if they experience worsening symptoms with BV medication or any worrying side effects.

BV occurs when there is an imbalance of bacteria in the vagina. BV does not always cause symptoms, but if they do occur, a person can seek medical advice from a doctor to receive a diagnosis and start a course of treatment.

A doctor may prescribe antibiotics to treat BV. If antibiotics are not effective, a doctor may recommend another treatment plan.

Those with BV cannot purchase medication without a prescription. However, a person can consider using home remedies to treat BV and potentially reduce the chance of BV from developing.