Bacterial Vaginosis Medication: Know Your BV Treatment Options

One of the signs of good vaginal health is the presence of a thin, mild-smelling, clear or light  yellow discharge. This healthy discharge helps to lubricate the vagina, maintain normal pH, and support healthy bacteria. Bacterial vaginosis (BV) is a common condition where higher levels of unhealthy bacteria take over, causing a thicker, foul-smelling discharge with burning or itching. 

Fortunately, there are treatments that can bring you relief from bacterial vaginosis symptoms right away. Let’s take a closer look at BV treatments so you can discuss your options with a healthcare professional to resolve your symptoms quickly.

Bacterial vaginosis treatments

If your BV symptoms linger more than a few days, or if they’re severe, you’ll need to see a healthcare professional for treatment. Luckily, bacterial vaginosis is easily treated with antibiotics, which can come in a variety of forms. 

Oral antibiotics for BV

Taking metronidazole (Flagyl) 500 mg pills twice a day for 7 days is one of the most common BV treatments. Metronidazole is an effective antibiotic to treat BV, but some people have a recurrence.

Using metronidazole pills as bacterial vaginosis medication does come with an increased risk of side effects, though. So some may choose to use another treatment option.

Vaginal gel for BV 

Another option is to insert the antibiotics for BV vaginally. Metronidazole 0.75% vaginal gel once a day for 5 days is also a first-choice treatment option. This form of treatment tends to have fewer side effects than the pills.

EXPERT PICKS: WHAT TO READ NEXT

• Vaginal infections: Learn more about the symptoms, causes, and treatment of bacterial vaginosis (BV) and other types of vaginitis.

• Probiotics and BV: There may be a role for probiotics in treating and preventing BV.

• BV in Black women: Find out how health disparities are contributing to higher rates of BV complications in Black women.

Vaginal cream for BV

Clindamycin is another antibiotic that’s an effective BV treatment. Applying clindamycin 2% vaginal cream once a day for 5 days is also a first-choice treatment option. If someone has recurrent BV after using metronidazole repeatedly or has an allergy to it, this may be a good option to try.  

These treatments for bacterial vaginosis have been around for a while, and have been shown to work. More than 80% of people treated for BV using one of these methods are clear of the infection 1 month after treatment. But in some people, the infection can come back. This may require taking antibiotics for longer to get rid of the infection completely. 

Can you get rid of BV without antibiotics?

Antibiotics aren’t always necessary to treat BV. If your symptoms aren’t severe and you decide to “wait and see,” the American College of Obstetricians and Gynecologists (ACOG) recommends using good hygiene to speed up healing and reduce the risk of future episodes. This includes:

• Avoiding douching

• Using mild, unscented soap for showering and bathing

• Not scratching the vagina when it itches

• Avoiding feminine sprays, deodorants, bubble baths, bath oils, talc, and powder

• Avoiding scented menstrual products

• Wearing 100% cotton underwear and loose clothing, and avoiding nylon and rayon if possible

• Avoiding wearing pantyliners and thongs if possible

• Limiting using detergents, dryer sheets, and fabric softeners with fragrance

• Using condoms during sex

• Keeping reusable vaginal products clean (menstrual cups, cervical caps, spermicide applicators)

But if symptoms persist despite good hygiene measures, you should get medical attention. Untreated BV can increase your risk for pelvic inflammatory disease, sexually transmitted infections (STIs), and pregnancy complications.

Are there any at-home treatments for bacterial vaginosis?

There really aren’t any proven home remedies for BV. You may have heard of popular online recommendations, like yogurt, herbal douches, and garlic. Unfortunately, there’s no evidence to suggest that home remedies really work to treat BV. And, some — like douching or vaginal acidifying treatments — can actually make things worse. Most vaginal acidifying treatments don’t help heal the delicate bacterial balance in the vagina, but may disturb it further. 

Likewise, probiotics may be beneficial in preventing BV. But more evidence is still needed to determine just how effective probiotics are in actually treating bacterial vaginosis.

Keep in mind that about one-third of BV cases get better without antibiotic treatment. So some cases are likely to improve on their own, whether or not you use natural treatments for bacterial vaginosis. For the remaining two-thirds of cases that don’t resolve on their own, home remedies are likely not going to do the trick.

It’s still a good idea to follow a healthy vaginal hygiene routine. This can prevent further irritation of the vulva and vagina. 

Can bacterial vaginosis go away on its own?

Roughly 30% of bacterial vaginosis cases in nonpregnant women and 50% of cases in pregnant women clear up on their own. But if you have symptoms, treatment is recommended. And even if your symptoms start clearing when you first start your bacterial vaginosis treatment, experts advise completing your full treatment regimen. 

How long does BV last?

With proper treatment, bacterial vaginosis can go away in a few days to a couple of weeks. But if left untreated, BV can sometimes take up to a few months to resolve. According to one study, it can take around 10 weeks or more for BV to clear itself from the body. Not undergoing treatment for bacterial vaginosis can potentially raise your risk of:

• Getting other STIs, including HIV (if your sex partner has HIV)

• Passing HIV to your sex partner if you have HIV

• Giving birth too early if you are pregnant and have BV

Who needs treatment for bacterial vaginosis?

Not everyone with BV needs antibiotics. In some mild- or low-risk cases, the vagina will restore the balance of good bacteria and the condition will resolve on its own. 

But other cases should be treated with antibiotics. You’ll need treatment if you test positive for BV and:

• You have significant symptoms.

• You are pregnant, even if you don’t have symptoms. Treatment for BV is safe in pregnancy. It’s also necessary to prevent complications in pregnancy that are caused by BV (for example, premature delivery or babies with low birth weight).

• You are about to have gynecological surgery, such as a hysterectomy (removal of uterus), or an abortion — whether you have symptoms or not. Getting treated lowers the risk of having complications after surgery.

What bacterial vaginosis treatment is best for me?

The best treatment for BV varies by individual and depends on a few different things, such as: 

• Personal preference, whether you prefer pills or vaginally inserted medication 

• Which type of medication is available

• Cost

• Side effects

• What has worked in the past for you

Bacterial vaginosis treatment side effects

Pills usually have more side effects than creams. And for metronidazole pills, these typically include:

• Headache

• Nausea

• Stomach pain

In addition, both metronidazole pills and creams can give you a metallic taste in your mouth.

There’s also a risk of Clostridioides difficile (C. diff) diarrhea with both metronidazole and clindamycin, but the risk is greater with clindamycin pills.

Bacterial vaginosis treatment precautions

If you’re taking metronidazole (Flagyl), drinking alcohol can make you violently ill. According to the FDA, it’s best to wait a minimum of 3 days after the end of your bacterial vaginosis treatment before drinking alcohol again. But keep in mind, if you’re taking any other medication, you might need to wait longer. 

It’s best to ask a healthcare professional to recommend a timeframe based on your individual health and medical history. 

If your bacterial vaginosis treatment involves using clindamycin vaginally, you’ll need to be careful using latex condoms for protection. This is because clindamycin cream can weaken condoms to the point that they break.

How do you know when BV is cleared?

You’ll know BV is getting better when the symptoms are gone. If you’ve been prescribed antibiotics, you’ll need to complete the entire prescription even after your symptoms resolve. BV can come back repeatedly over time in some people. Not finishing your antibiotics as prescribed may allow the infection to bounce back more quickly.

My bacterial vaginosis symptoms came back. What now?

While pills and vaginal creams are effective bacterial vaginosis treatments, it’s pretty common for symptoms to come back. In fact, close to 70% of BV comes back within 12 months of treatment.

Experts aren’t really sure why this happens. But it’s likely that bacterial vaginosis treatment isn't curing the cause of BV. Another possibility is that pills and creams might prevent healthy bacteria in the vagina from growing back — allowing unhealthy bacteria to flourish.

If you have a recurrence of BV and you have symptoms, you’ll be treated with a longer course of antibiotics (usually 7 days). The treatment options for recurring bacterial vaginosis are the same as the first time around: metronidazole 0.75% vaginal gel, metronidazole (Flagyl) 500 mg pills, or clindamycin 2% vaginal cream. Usually, it’s best to opt for a BV treatment that you haven’t tried yet. 

Sometimes, vaginal boric acid suppositories are recommended along with antibiotics. They don’t work on their own though, and they should never be taken by mouth. 

In people who have had several relapses of bacterial vaginosis, longer preventive treatment is needed. This usually involves applying metronidazole vaginal gel twice a week for 4 to 6 months. Other options can include a combination of antibiotics pills and vaginal creams. 

Does my partner need treatment if I had bacterial vaginosis?

If your sex partner has a penis, they typically don’t need treatment. But there’s some evidence that male partners may reinfect female partners with BV organisms. One study is looking at whether male partners of women with recurrent BV should be treated with antibiotics, too.

It’s also worth noting that there’s a lower chance you’ll get BV from a male partner if:

• Your partner is circumcised.

• Your partner regularly uses a condom during sex.

• You abstain from sex altogether.

If your sex partner has a vagina, then you should tell your partner you have BV. There’s a 25% to 50% likelihood that they will also have BV, so they need to know what symptoms to look out for. If your partner starts experiencing symptoms, they’ll need a test and treatment for bacterial vaginosis to feel better — just like you did.

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Written by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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