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

The Centers for Disease Control and Prevention (CDC) report that BV is the most common vaginal condition in people ages 15–44.

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.

Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.

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Antibiotic medications that doctors can prescribe for people with BV include:

  • 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.

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 daily for 7 days or take a single tablet as a one-time dose.

Some side effects associated with oral metronidazole include:

People taking metronidazole should not consume alcohol while taking the medication or for at least 1 day after the treatment course has ended. 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.

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

While this type of gel is typically safe to use, it can cause:

Clindamycin

Clindamycin stops or slows the growth of bacteria.

Clindamycin is available as a cream, which doctors may prescribe if a person’s symptoms keep returning 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 up to 7 days.

The CDC suggests that people 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.

Studies on the efficacy of clindamycin have shown that most people do 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.

An older 2016 comparative study of tinidazole and metronidazole involving 120 women found that tinidazole is more effective than metronidazole at a lower dose in treating BV in the long term. Tinidazole also has fewer side effects than metronidazole.

Some possible side effects of tinidazole include:

  • gastrointestinal irritation
  • metallic taste in the mouth
  • headache
  • nausea and vomiting

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

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

Research also mentions that people with BV may have a higher chance of contracting an STI.

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

Some symptoms of BV may include:

Recurrent BV is when a person continues to have symptoms 12 months after their initial treatment.

Up to 80% of people will experience recurrent BV. Usually, a healthcare professional will prescribe a second course of antibiotics if a person still has symptoms after the initial treatment.

A 2020 review notes that metronidazole and clindamycin are two effective antibiotics for BV. However, they may only work for short-term use. Additionally, frequent use of antibiotics can cause antibiotic resistance and thrush.

Older research suggests that home remedies, such as probiotics, salt baths, and frequent showers, have little to no effect on BV symptoms. However, a 2022 meta-analysis found that probiotics may be an effective short and long-term treatment for BV. However, more research is necessary.

A person might consider contacting a doctor if they have unusual vaginal discharge, a fever, or both.

Only 30% of BV cases resolve without medical treatment. It may be a good idea to speak with a healthcare professional as soon as possible. A person should do so if their symptoms do not improve within a few weeks.

If BV symptoms return, a healthcare professional may recommend a longer course of treatment.

Without treatment, BV may increase the risk of contracting an STI, cause pregnancy complications, or both.

A person should consult a doctor if their symptoms worsen during BV treatment or if they experience medication side effects.

How to prepare for a doctor’s appointment

People may wish to prepare a list of their symptoms, any medications, over-the-counter (OTC) treatments, or supplements they are taking, and consider a note-taking device for their appointment.

It may also be helpful if a person takes a list of questions they wish to ask the healthcare professional. Example questions include:

  • What treatment options are there for BV?
  • How effective are the treatment options?
  • Are there any specific instructions for taking medication for BV?
  • What should I do if I have recurrent BV?
  • Is there a way to prevent BV?
  • Are there any OTC treatments or lifestyle changes that may help reduce symptoms?

To diagnose BV, a doctor or another healthcare professional may:

  • Ask for a medical history, specifically relating to vaginal health.
  • Perform a pelvic exam.
  • Take a sample of vaginal discharge and send this to a lab for analysis.

They will recommend a treatment approach based on the history, exam, and test results.

People can lower their risk of getting BV by:

  • avoiding douching, as this can disrupt the balance between vaginal healthy and harmful bacteria
  • limiting the number of sexual partners
  • using condoms when engaging in sexual activity
  • avoiding using soaps and shower gels that contain perfumes
  • avoiding using vaginal deodorants
  • avoiding scented tampons or menstrual products
  • keeping the genital area dry

Below are answers to common questions about BV medications.

What is the best medication for BV?

The best medications for BV are topical or oral antibiotics. Each requires a prescription from a healthcare professional.

Can you get BV medication over the counter?

Antibiotics for BV are only available with a prescription.

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 I treat BV without antibiotics?

A person might consider using natural products to treat BV, such as:

  • Garlic: A 2018 study found garlic cloves can help treat vaginal infections when using them as vaginal suppositories.
  • Probiotics: Probiotics are bacteria in food, such as yogurt and some fermented products. A person can also take probiotic supplements. A 2022 study found that they may help prevent and treat BV without causing adverse effects.

Can BV come back after medication?

Yes. A person may develop BV again after a few weeks.

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

Additionally, 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.

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 help treat BV and potentially reduce the chances of BV developing.