Bacterial vaginosis, or BV, can be treated with:

  • antibiotic tablets, such as metronidazole (brand name Flagyl)
  • or antibiotic intravaginal gel or cream, such as metronidazole (Zidoval or Metrogel) or clindamycin (Dalacin)

Currently, the first line treatment for BV in the UK according to NICE guidelines is oral metronidazole tablets (400mg taken twice a day for 5 to 7 days). The guidelines also suggest that if there is a particular issue with taking it for this period of time, then 2g as a single dose can be prescribed.

Topical creams or gels may be prescribed if oral tablets are contraindicated, or if the patient prefers topical treatment.

On this page, we’ll cover:

Does BV always need treatment?

No. If a woman has BV but doesn’t have any symptoms, and is not pregnant, then treatment is usually not necessary.

The patient will usually be advised not to aggravate the condition by douching, or using antiseptics or shampoos when in the bath.

However, if someone who has BV is presenting symptoms, or is pregnant, they will usually be advised to have treatment.

Why is it important to treat BV in some cases?

In most cases, BV isn’t a serious condition if it is properly managed. However, it can cause problems in rare cases.

There is evidence to suggest that if you contract BV during pregnancy it can cause pregnancy complications. These include a higher risk of:

  • premature birth
  • miscarriage
  • the breaking of the amniotic sac, which holds the fluid where an unborn baby develops
  • postpartum endometritis, which is an infection of the womb lining after giving birth.

If you have symptoms of BV, you should see your GP, or get tested at a GUM clinic. You can also buy test kits for BV online; but if you’re pregnant, it’s strongly recommended you see a doctor in person.

Whilst the chances of developing one of these complications is low, it is worth treating BV to minimise the risk.

BV can also increase the risk of contracting an STI, such as chlamydia. This due to the altering acid levels which affect bacteria levels in the vagina, making it more prone to infection.

Although the connection is not clear, pelvic inflammatory disease is also linked with BV. PID causes inflammation of the genital tract, and is a serious condition that can lead to infertility if not treated correctly.

What antibiotics are used to treat BV?

Oral metronidazole is the current first line antibiotic treatment for BV. This is prescribed as a 400mg dose, taken twice daily for 5-7 days; but it can also be given as a higher one off dose of 2g.

Alternatives are available. If the patient does not respond well to oral metronidazole or prefers topical treatment, then intravaginal cream versions of either metronidazole or clindamycin might be recommended. Metronidazole gel is applied once a day to the vagina for 5 days, whereas clindamycin cream is applied once a day for 7 days.

If these are contraindicated, then oral tinidazole and clindamycin are other less-preferred options that might be considered.

How do antibiotics work in treating BV?

Bacterial vaginosis is caused by an in balance of ‘good’ and ‘harmful’ bacteria in the vagina. For instance, lactobacilli is a type of bacteria which is beneficial, and helps to keeps other harmful bacteria at manageable levels. When the presence of this bacteria is reduce, anaerobes can grow in number, causing a BV infection.

Metronidazole is a type of antibiotic which specifically targets anaerobic bacteria. It breaches the cell walls of bacteria causing the infection, and stops them from producing DNA which they need to survive.

Clindamycin works slightly differently, and attacks the bacteria responsible by preventing it from generating self-sustaining proteins. Once it has done this, the bacteria is no longer able to reproduce, and dies.

Where can you get treatment for BV from?

In some cases, your pharmacist may be able to provide an over-the-counter treatment to help reduce the symptoms associated with BV. But if these have not worked or are unsuitable, then antibiotic treatment may be advised.

Antibiotics are only available on prescription, so you will need to either:

  • visit your GP
  • go to a GUM clinic
  • or consult with a doctor online

before you can be issued with this treatment.

A doctor or nurse may ask about your symptoms, or take a test to check that you have BV before prescribing an antibiotic. Testing can be carried out using a urine sample or a swab.

Read more about how to buy BV treatment online.

Page last reviewed:  19/10/2018