Bacterial Vaginosis Medication: Know Your BV Treatment Options

A healthy vagina naturally maintains a balance of bacteria that supports normal discharge and protection against infection. Bacterial vaginosis (BV) happens when that balance is disrupted, leading to symptoms like unusual discharge, a strong odor, itching, or burning. 

BV treatment relieves symptoms and lowers the risk of complications. Understanding your options can help you choose the approach that works best for your body and your lifestyle. Let’s take a look at the three most commonly prescribed BV treatments, plus tips to help you recover.

1. Oral antibiotics for BV

Oral antibiotics are a common treatment option for bacterial vaginosis. Metronidazole (Flagyl) is the most commonly prescribed antibiotic for BV. People usually take it twice a day for 7 days.

Metronidazole isn’t right for everyone. Your healthcare team may suggest a different medication. Other medications that can treat BV include tinidazole and clindamycin.

2. Metronidazole vaginal gel for BV

BV can also be treated with topical medications, like vaginal gels and creams. Applying metronidazole 0.75% vaginal gel once a day for 5 days is also a first-choice treatment option for BV. Metronidazole gel tends to cause fewer side effects than the oral form.

3. Clindamycin vaginal cream for BV

Clindamycin is another topical 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. It’s a good option for people who are allergic to metronidazole. It may also be a good option if you keep getting BV after metronidazole treatment.

Can bacterial vaginosis go away on its own?

BV can go away on its own. Studies show that roughly 30% of bacterial vaginosis cases in nonpregnant women and 50% of cases in pregnant women clear up on their own. 

But experts recommend treatment if you have symptoms, especially if you’re pregnant. 

If you don’t have any symptoms, you can try a “wait and see” approach. There are extra steps you should take to help your body heal during this time. Be sure to:

• Avoid douching.

• Use mild, unscented soap for showering and bathing.

• Don’t scratch the vagina when it itches.

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

• Avoid scented menstrual products.

• Wear 100% cotton underwear and loose clothing, and avoid nylon and rayon, if possible.

• Limit use of detergents, dryer sheets, and fabric softeners with fragrance.

• Use condoms during sex.

• Keep reusable vaginal products clean. (These include menstrual cups, cervical caps, and spermicide applicators.)

Follow up with your healthcare team to make sure your BV goes away. You may need to start treatment if it doesn’t. 

You can also choose to start BV treatment, even if you don’t have any symptoms. Untreated BV can increase your risk for pelvic inflammatory disease, sexually transmitted infections (STIs), and pregnancy complications. Some people prefer to start treatment right away to limit these risks.

Are there any at-home treatments for bacterial vaginosis?

There aren’t any proven home remedies for BV. And there aren’t any OTC treatments that can cure 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. 

Probiotics help prevent BV. But there’s no strong evidence they can treat BV. 

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

Who needs treatment for bacterial vaginosis?

You’ll need treatment if you test positive for BV and: 

• You have symptoms.

• You’re pregnant. Treatment for BV is safe in pregnancy and lowers the risk of complications, like premature birth.

• You need gynecological surgery, such as a hysterectomy (removal of uterus) or a dilation and curettage. Treatment lowers the risk of complications after surgery.

What bacterial vaginosis treatment is best for me?

The best treatment for BV varies from person to person and depends on:

• Your preference for oral or topical treatment

• How you responded to treatment in the past

• Medication availability in your area

• Cost

Bacterial vaginosis treatment side effects

Most people don’t experience any side effects from BV treatment. In general, oral medications tend to cause more side effects than topical gels and creams. 

Common side effects of oral metronidazole include:

• Headache

• Nausea

• Stomach pain

• Metallic taste 

You shouldn’t drink alcohol while taking oral metronidazole. You should wait at least 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. Your healthcare team can help you decide when it’s safe to drink alcohol after you finish treatment. 

Clindamycin cream can weaken latex condoms to the point that they break. You may need to use additional birth control and STI prevention methods during treatment.

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 if your symptoms get better or go away completely. BV can come back. Not finishing your antibiotics as prescribed may allow the infection to come back more quickly.

My bacterial vaginosis symptoms came back. What now?

Bacterial vaginosis can come back. Studies show that up to 80% of people develop BV again within 3 months, even if they receive treatment. Experts aren’t really sure why this happens. 

You should seek medical care if your BV comes back. Your team may suggest a longer course of treatment (usually 7 days) with a medication you haven’t tried before. They may also suggest adding vaginal boric acid suppositories to your treatment plan.

People who keep getting BV may need long-term treatment to stop the infection from coming back. Your team may suggest 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?

Your partner may need BV treatment if you have BV.

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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:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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