Bacterial vaginosis - Treatment 

Bacterial vaginosis (BV) can be treated with antibiotics. If used correctly, treatment is effective in around 9 out of 10 cases.

There is currently no evidence that probiotics, such as those found in live yoghurt, are of any benefit in treating or preventing BV.

Metronidazole

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.

As a precaution, the use of metronidazole (and most other types of medication) is not normally recommended during pregnancy. But an exception is made in the case of BV, as leaving it untreated poses a far bigger risk to the pregnancy then taking the medication.

More women find that their BV is more likely to return if they choose to take the single larger dose. 

Warning on alcohol

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.

If take as directed, it is very rare to experience side effects when taking metronidazole.

After treatment

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

Further treatment

The first course of treatment may not be effective in around 1 out of 10 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.

Referral to a specialist

If you have repeated episodes of BV in a short space of time, your GP may recommend you are
referred to a gynaecologist (a specialist in treating conditions of the female reproductive system) for further investigation.

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.