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Bacterial vaginosis (BV) is a vaginal infection. Antibiotic medication may help treat BV and reduce symptoms. Some antibiotics can cause side effects, and some BV drugs have warnings from the Food and Drug Administration (FDA).
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.
Medical News Today follows a strict product selection and vetting process. Learn more here.
Antibiotic medications that doctors can prescribe for people with BV include:
- Tablets: People take this type of antibiotic orally. Some 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 (Flagyl) tablets
- Common side effects: Upset stomach, nausea and vomiting, headaches, dry mouth, loss of appetite, and an unpleasant metallic taste in the mouth.
- Advantages: Available in various forms, including tablets, capsules, extended-release tablets, or gel.
- Disadvantages: The FDA issued a black box warning that the medication may cause cancer.
People can take metronidazole tablets twice daily for 7 days or a single tablet as a one-time dose.
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:
- stomach cramps
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.
Where to get metronidazole
A person can purchase metronidazole through the online pharmacy Plushcare. The company does not state the exact cost of the product and says this varies between pharmacies and based on dosage.
However, membership to Plushcare costs $14.99 per month, plus copay for every visit with insurance. Without insurance, a person pays $129 for the first visit and $99 for visits afterward.
Doctors send Plushcare prescriptions to a person’s local pharmacy.
Metronidazole vaginal gel
- Common side effects: Candidiasis, headaches, vulvovaginal pruritus, nausea, diarrhea, and period pain.
- Advantages: It may suit people who find swallowing tablets difficult.
- Disadvantages: People may be unable to use it if they are menstruating.
A person may also use metronidazole as a gel, which that apply to the vagina via an applicator.
People who find swallowing tablets difficult may prefer to use this gel. However, a doctor may not recommend this gel if the person is menstruating. The drug’s prescribing information also states that it may not be suitable for people with health conditions affecting the central nervous system. There have not been any studies looking at the cancer risk of metronidazole vaginal gel.
Where to get metronidazole gel
People may receive a prescription and purchase metronidazole gel from Nurx, an online pharmacy. The cost varies depending on the local pharmacy from which a person will pick up the prescription.
A person must pay a $65 medication consultation fee, which includes one week of unlimited medical care.
- Common side effects: Headaches, back pain, constipation, yeast infection, abdominal pain, nausea and vomiting, constipation, diarrhea, and flatulence.
- Advantages: Studies have shown this cream
is effectivefor most people.
- Disadvantages: This cream contains mineral oil, which may weaken latex condoms or diaphragms.
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, prefilled 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
Studies on the efficacy of clindamycin have shown that
Where to get clindamycin cream
Clindamycin cream is available to purchase from Wisp, an online pharmacy. Once a doctor provides a prescription, a person can receive free delivery of their medication in 3–5 days or collect their order on the same day from a local pharmacy. The cost of clindamycin may vary between pharmacies.
People can choose whether to purchase this once or as part of a subscription. It costs $120 for a one-off treatment or $33 a month with a subscription for those who experience regular infections.
- Common side effects: Gastrointestinal irritation, metallic taste in the mouth, headaches, nausea and vomiting, weakness and fatigue, weight loss, dizziness, and constipation.
- Advantages: Tinidazole reportedly has fewer side effects than metronidazole.
- Disadvantages: People cannot take tinidazole with certain other medications, including cholestyramine (Questran) for high cholesterol.
Tinidazole is available as a single-dose tablet.
A 2019 study of tinidazole and metronidazole involving 90 females found that tinidazole is more effective than metronidazole in treating BV. Tinidazole also has fewer side effects than metronidazole.
Where to get tinidazole
Tinidazole is available via Blink Health, an online pharmacy that offers discounted prices on a wide range of medications. People must search for a medication and pay online. They can choose to collect their prescription from any of Blink Health’s participating pharmacies or opt for home delivery.
Blink Health will send a person a Blink Health card to show at the pharmacy so they do not pay twice. At the time of publication, tinidazole costs around $45 through Blink Health, although this may vary between pharmacies and locations.
BV occurs when there is an imbalance of the vaginal flora, which are types of bacteria that naturally live inside the vagina.
BV can occur in anyone with a vagina, but a person may be at an
- have multiple sexual partners
- are sexually active at a young age
- are douching regularly
- use fragranced vaginal washes and cream
- have an intrauterine device (IUD)
- have had a sexually transmitted infection (STI)
Research also mentions that people with BV may have a higher chance of contracting an STI.
Recurrent BV is when a person continues to have symptoms 12 months after their 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
That said, more research is necessary.
Find out more about home remedies for BV.
A person might consider contacting a doctor if they have unusual vaginal discharge, a fever, or both.
If BV symptoms return, a healthcare professional may recommend a longer course of treatment.
A person should also consult a doctor if their symptoms worsen during BV treatment or if they experience medication side effects.
How doctors diagnose BV
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.
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?
People can lower their risk of BV by:
- avoiding douching, as this
can disruptthe 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 rid of BV without going to the doctor?
Recent research does not suggest that home remedies are particularly effective for BV.
Is bacterial vaginosis an STI?
BV is not an STI. However, the CDC states that BV is
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 a doctor’s advice 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.