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Every year, just over 21 million women in the U.S. develop bacterial vaginosis (BV). In other words, if you're experiencing something a little “off” down there, you’re far from alone. BV is the number one cause of abnormal vaginal odor and discharge. Luckily, there are many effective treatment options.
What is bacterial vaginosis (BV)?
Bacterial vaginosis (BV) is an infection, caused when certain types of bacteria in your vagina are out of balance. Specifically, BV develops when Lactobacillus bacteria, which naturally occur in the vagina to maintain a slightly acidic environment, are overgrown and replaced by other vaginal bacteria that should only be present in small numbers.
BV is a very common infection that can happen to any woman, regardless if she's sexually active—with male or female partners. However, not everyone will show symptoms so it’s important to be regularly tested by your doctor. If you do experience symptoms, they usually include a fishy odor and gray or white discharge. BV and a vaginal yeast infection can be very similar as they’re both forms of vaginitis (inflammation of the vagina). Only your doctor can determine for sure which condition you have using simple tests.
The good news is, once you’re diagnosed with BV it is easily treatable, usually with a short course of oral or topical antibiotics. In some mild cases, it will go away on its own. It’s always important to correctly follow the treatment plan your healthcare provider recommends. When left untreated, bacterial vaginosis may increase your risk for sexually transmitted infections (STIs) like gonorrhea and chlamydia and can cause problems during pregnancy.
How is bacterial vaginosis diagnosed?
The imbalance of vaginal flora that leads to BV can be caused by products that alter vaginal pH levels, like douches and vaginal deodorants. While not an STI, having sex may increase the likelihood of developing the condition. Your partner’s natural chemistry can affect the acidity of your vagina and cause an overgrowth of bacteria such as Gardnerella vaginalis.
When you visit your doctor, be prepared to answer questions such as:
- When did these symptoms start?
- Are you sexually active?
- What is your medical history?
- Are you taking any medications?
- Have you had BV before?
There are tests that can diagnose BV. Women should schedule regular checkups with their primary care provider or gynecologist, regardless if they’re experiencing symptoms such as abnormal vaginal discharge, odor, or itching.
The tests involve a pelvic examination, much like a Pap smear. Your doctor will likely use a tool called a speculum to gently open the vagina and take swabs to check for clue cells, as well as look for any physical signs of infection. Your doctor uses the swabs to determine if there is any imbalance or harmful bacteria present.
Although the idea of this type of examination may make you nervous, remember your doctor is a professional you can trust, and many women experience little to no discomfort during these examinations. It’s generally advised that for at least 24 hours before your test, you should not douche, use tampons, or have sex. Your doctor may also suggest the test be performed on a day when you don't have your period.
BV treatment options
If you’ve been diagnosed with bacterial vaginosis, your doctor will likely prescribe a course of antibiotics. However, if you’re not experiencing any symptoms your physician may suggest you let it clear up on its own and check in after a few weeks.
Sometimes the infection will come back and become recurrent, even when you correctly use your antibiotics. If this is the case, your doctor may suggest you take the antibiotics for a longer period of time or prescribe a different medication.
Pregnant women in particular need to seek treatment from their preferred medical provider, as BV during pregnancy increases risk of premature birth and low birth weight.
BV medications
The first-line treatment for bacterial vaginosis is antibiotics, specifically metronidazole or clindamycin as a pill, vaginal gel, or vaginal cream. Tinidazole is an alternative antibiotic, according to the U.S. Centers for Disease Control and Prevention (CDC).
There are currently no officially recommended over-the-counter treatments for bacterial vaginosis. Home remedies, like prebiotics, may help prevent flare-ups down the road.
Metronidazole
Used since the early 1980s to treat BV, metronidazole is a nitroimidazole antimicrobial agent that works by killing the overgrown and unwanted bacteria that cause BV. The most common brand name of metronidazole is Flagyl.
The potential side effects of metronidazole—particularly the pill form—include headache, nausea, or stomach pain, as well as a metallic taste in your mouth. You should not drink alcohol while taking metronidazole.
Clindamycin
Clindamycin,commonly known by the brand name Cleocin, is another antimicrobial agent for the treatment of BV. This lincosamide antibiotic stops the unwanted bacteria from growing. Various treatment forms are available, including vaginal (ovule and cream) and oral.
Some potential side effects of clindamycin include diarrhea, a metallic taste in your mouth, nausea and vomiting.
Tinidazole
Like metronidazole, tinidazole is a nitroimidazole antibiotic and an antiprotozoal agent that kills bacteria and is sometimes used to treat BV. First used in Europe and Asia, it’s now licensed in the U.S. as a generic drug. The CDC lists it as an alternative treatment to first-line antibiotics.
It’s incredibly important to note that you should not consume alcohol during (and one day after) treatment with nitroimidazoles, as the combination can make you violently ill. Clindamycin has its own risk factors; topical applications can weaken latex condoms and diaphragms for five days after use. You should use alternative birth control methods during this time.
It’s generally advised that women should refrain from sexual activity or use condoms consistently and correctly during the treatment regimen.
What is the best medication for BV?
The best medication for bacterial vaginosis varies from person to person, and can only be determined by your healthcare provider. It will be based on your medical condition, medical history, and medications you may already be taking that could interact with bacterial vaginosis medication as well as your response to treatment. There may also be lifestyle and personal preferences regarding the use of a pill or topical gel/cream.
| Best medication for BV | ||||
|---|---|---|---|---|
| Drug name | Drug class | Administration route | Standard dosage | Common side effects |
| Flagyl (metronidazole) | Nitroimidazole antimicrobials | Oral or topical (intravaginally) | 500 mg orally twice daily for 7 days; gel 0.75% 1 applicatorful (5 g) intravaginally at bedtime for 5 days | Vomiting, nausea, diarrhea, metallic taste in your mouth |
| Cleocin (clindamycin) | Lincomycin antibiotics | Oral or topical (intravaginally) | 300 mg by mouth twice daily for 8 days; Cream 2%, 1 applicatorful (5 g) intravaginally at bedtime for 7 days; 100 mg ovules intravaginally at bedtime for 3 days | Burning sensation of the vagina, white patches in the mouth, nausea, diarrhea |
| Tinidazole | Nitroimidazole antimicrobials | Oral | 2 g orally once daily for 2 days or 1 g orally once daily for 5 days | Metallic taste in your mouth, nausea, headache |
Please note, proper dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are common side effects of BV medication?
There are a number of side effects that may occur when taking medication for bacterial vaginosis. Although uncommon, these can include:
- Metallic taste in your mouth
- Nausea
- Headache
- Vomiting
- Constipation
- Diarrhea
- Tiredness
- Upset stomach
More serious, but again, rare, side effects are:
- Rash
- Hives
- Swelling of the lips, throat, and face
- Seizures
- Fever
- Itching
- Numbness
- Difficulty speaking
This is not a full list of side effects. You should always talk to a healthcare professional for a complete list of possible adverse events and drug interactions. If you think you are experiencing any adverse side effects from your medication, seek medical advice immediately.
What are the best home remedies for bacterial vaginosis?
While antibiotics are the most effective form of treatment for BV, you may prefer to try over-the-counter or at-home remedies first, especially if you’re trying to avoid potential side effects from prescription medication. These home remedies may help to prevent a recurrence of BV.
Probiotics
Taking probiotics can be an effective way to maintain a healthy balance of bacteria in your vagina. Danielle R. Plummer, Pharm.D., of HG Pharmacist, suggests taking vaginal probiotics, rather than products designed for gut health. Specifically, “vaginal probiotics of at least 8 billion units of Lactobacillus rhamnosus, Lactobacillus acidophilus and Streptococcus thermophilus per capsule. Do this every other week (treat for 7 days, then do not treat for 7 days, then repeat),” Dr. Plummer says.
You can also try consuming probiotic-rich foods, such as yogurt.
Avoid douching
Douching can disrupt the pH balance of the vagina, allowing bacteria such as Gardnerella vaginalis to overgrow. Although some women douche to make themselves cleaner, the truth is that bacteria are a natural, necessary part of regulating the vagina. The vagina is self-cleaning. Douching only disrupts the precious balance of the vagina’s natural environment.
It’s best to avoid any chemical washes, including soaps and bubble baths, as they can enter the vagina and disrupt the environment. In other words, use warm water only.
Use condoms
According to the Office of Women’s Health, women with more sex partners, or a new sexual partner, are at higher risk of developing a BV infection. One way to reduce the likelihood of experiencing BV is to always use condoms. “Condom use during sex is associated with less prevalence of BV,” explains Amesh A. Adalja, MD, FIDSA, FACP, FACEP, a board-certified infectious disease physician and Senior Scholar at Johns Hopkins Center for Health Security.
Frequently asked questions about bacterial vaginosis
What causes bacterial vaginosis?
Bacterial vaginosis is caused by the overgrowth of certain naturally occurring bacteria in your vagina, and the reduction of healthy bacteria, lactobacilli.
Can I get BV from my boyfriend?
While men cannot get BV, it is unclear whether they can spread the infection. Sexually active women have a higher risk of developing the infection, regardless if they have a male or female sex partner. Women who are not sexually active can still experience BV.
Can BV clear up on its own?
Yes, in mild cases BV can clear up on its own. However, if you are experiencing symptoms, it's advised to seek treatment from your doctor. If left untreated, BV can increase your risk of contracting sexually transmitted infections or pelvic inflammatory disease which can lead to infertility.
How can I get rid of BV at home?
You can try to prevent BV with some lifestyle changes, such as taking vaginal specific probiotics, avoiding douches, and using condoms. However, the recommended course of treatment for symptomatic BV is antibiotics prescribed by your doctor.
Can BV be treated without antibiotics?
In mild or asymptomatic cases, BV can sometimes clear up on its own. There are no proven at-home or over-the-counter remedies to treat BV, so you should always speak with your primary care provider or gynecologist about the best treatment plan for you.
Is bacterial vaginosis a STD?
Bacterial vaginosis is not a sexually transmitted disease. However, it’s considered a "sexually-associated" infection. This is “because it's rarely seen in women who have never been sexually active,” explains Kristy Goodman, MS, Assistant Professor at the Southern California University of Health Sciences PA Program.
Can Diflucan be used to treat bacterial vaginosis?
Diflucan is a common antifungal treatment for other vaginal infections, like bacterial yeast infections, which often have similar symptoms to BV. It is not a recommended treatment for bacterial vaginosis, according to the CDC.