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 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:

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

Recurrent BV is when a person has the symptoms of this condition within 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 initial treatment.

A 2016 study notes that people with recurrent BV are often frustrated with the lack of treatment options, with participants stating that they experienced adverse side effects such as thrush and stomach cramps when taking repeated courses of antibiotics.

Research shows that people who take antibiotics for recurrent BV also frequently develop vaginal candidiasis, which means they may also have to use antifungal medications.

It is also important to note that frequent use of antibiotics can cause antibiotic resistance.

Some participants in the 2016 study were dissatisfied with how healthcare professionals approach this condition. Some of the participants in this study note that doctors had insensitive or dismissive attitudes, inconsistent or inappropriate advice, and healthcare professionals may offer incorrect diagnoses.

The researchers also found that the participants tried home remedies and lifestyle changes that had little to no effect on symptoms, such as probiotics, salt baths, and frequent showers. However, a 2014 review found probiotics may help prevent and treat BV.

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:

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.

It is not uncommon for BV to return after around 3 months, in which case, the 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.

It is important to consult a doctor if any symptoms worsen during BV treatment or if the medication causes side effects.

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 then recommend an approach to treatment based on the test results.

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.

Medical News Today follows a strict product selection and vetting process. Learn more here.

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.

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 is available as a cream, which doctors may prescribe it 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 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 500 mg metronidazole tablets twice daily for 7 days.

The study also states that tinidazole causes fewer side effects.

Some side effects associated with tinidazole include:

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?

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 2014 study found that garlic tablets may be an effective alternative treatment for BV.
  • Probiotics: Probiotics are bacteria in food such as yogurt and some fermented products. A person can also take probiotic supplements. A 2014 review found that they may help prevent and treat BV without causing any adverse effects.

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.

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.