Treating bacterial vaginosis 

Bacterial vaginosis (BV) can be treated successfully with antibiotics.

There's currently no evidence that probiotics, such as those found in some yoghurts, are able to treat or prevent BV.

Antibiotics

Metronidazole is the most common and preferred antibiotic treatment for BV. It's available in three forms. These are:

  • tablets to be taken twice a day for five to seven days
  • a single larger-dose tablet you take only once
  • a gel you apply to your vagina once a day for five days

In most cases, metronidazole tablets taken over five to seven days are recommended, as they're considered to be the most effective treatment. These can be taken if you have symptoms of BV while you're pregnant.

If you're breastfeeding, metronidazole gel is usually recommended, as the tablets can affect your breast milk.

Occasionally, an alternative antibiotic may be recommended instead of metronidazole, such as clindamycin cream applied to the inside of the vagina once a day for seven days. This cream may be prescribed if you've had a reaction to metronidazole in the past, for example.

Whichever course of antibiotics you're prescribed, it's important to finish it, even if you start to feel better. This helps to reduce the risk of symptoms persisting or recurring.

Side effects 

Metronidazole can cause nausea, vomiting and a slight metallic taste in your mouth. It's best to take it after eating food. Contact your doctor if you start vomiting when you take the drug. They may recommend trying an alternative form of treatment.

Don't drink alcohol while taking metronidazole and for at least 48 hours after finishing the course of antibiotics. Drinking alcohol while taking this medicine can cause more severe side effects.

Further treatment

For some women, the first course of treatment doesn't treat BV effectively. 

If your initial treatment has been unsuccessful, your doctor will need to check you took the medicine correctly. If you did, you may be prescribed one of the different options described above.

If you have an intrauterine device (IUD) that may be contributing to your BV, your doctor may recommend having it removed and using an alternative form of contraception.

Vaginal pH correction treatments

Vaginal pH correction treatments are a relatively new way of treating BV. These usually involve applying a gel to the inside of your vagina that changes the acid balance, making it a less hospitable environment for harmful bacteria. Most vaginal pH correction treatments are available over the counter from pharmacists.

However, it's not clear how effective these treatments are for treating BV. Some studies have suggested they may help, whereas others suggest they're either ineffective or less effective than antibiotics.

Referral to a specialist

If you have repeated episodes of BV in a short space of time, your GP may refer you to a genitourinary medicine (GUM) specialist for further investigation and treatment.

If you're pregnant, you may be referred to your midwife or obstetrician (a specialist in pregnancies), who can discuss treatment options with you. 

Things to avoid during treatment

While you're being treated for BV, there are some things you should avoid to reduce the chances of treatment being unsuccessful.

For example, you should avoid cleaning the inside of your vagina (douching) or using antiseptics, scented soaps and bubble baths.

Page last reviewed: 12/10/2015

Next review due: 12/10/2017