Bacterial vaginosis (BV), the world’s most common vaginal infection, costs you time, comfort, and money. BV is associated with increased incidence of sexually transmitted diseases (including HIV), spontaneous abortion, and pre-term labor.
Current treatment for women with symptomatic BV includes both oral and intravaginal antibiotics, which have success rates of 70 – 80% at 1 month after treatment.
What treatment is best for BV?
- Three are equal. Oral metronidazole (Flagyl) 500 mg twice a day for 7 days, metronidazole (Metrogel-Vaginal) gel 0.75% and vaginal suppository once a day for 5 days, and clindamycin (Cleocin, Clindesse) cream 2% and vaginal suppository once a day for 7 days have equivalent effectiveness for ridding you of BV symptoms.
- Because they are equivalent, think about side effects. Some folks don’t like using vaginal suppositories while others don’t like taking a pill. Remember that metronidazole has been used like Antabuse (disulfiram), so you cannot drink any alcohol while taking it and for a few days after stopping. Seriously though, you can’t drink ANY alcohol or you will be violently ill.
Women should refrain from sexual intercourse during treatment, but routine treatment of male and female partners is not warranted.
BV commonly recurs, and there are a few choices for treatment if does come back:
- Re-treatment with the same topical regimen is an acceptable approach for treating recurrent BV.
- Metronidazole for 7 days followed by intravaginal boric acid for 21 days may be another option. Intravaginal boric acid (600 mg capsule) has been used for more than 100 years for the treatment of vaginal infections and it is cheap, easily accessible, and easy to use.
- For women with multiple recurrences, metronidazole gel twice weekly for up to 4 to 6 months has been shown to reduce recurrences.
- Probiotics may be of some help too, so start using active culture yogurts or a probiotic capsule if you are having recurrent BV.