Bacterial Vaginosis Treatment

Bacterial vaginosis is a type of vaginal infection caused by the overgrowth of bacteria naturally found in the vagina. Although many women with bacterial vaginosis have no signs or symptoms, it can cause abnormal vaginal discharge, itching and a foul-smelling odour.

Although bacterial vaginosis is usually not serious, you will need antibiotic treatment if you do have it. The most prescribed antibiotic is metronidazole, although other antibiotics such as clindamycin, tinidazole and secnidazole are also sometimes given. Women with recurrent BV usually take extended-use metronidazole therapy.

What Causes Bacterial Vaginosis?

BV is not a sexually transmitted infection (STI), although it mostly affects women in their reproductive years. The cause is not completely understood, but certain activities, such as unprotected sex or frequent douching may increase your risk.

What Are The Symptoms Of Bacterial Vaginosis?

Although half of women with bacterial vaginosis do not have any symptoms, signs and symptoms may include:

  • Thin, grey, white, or green vaginal discharge
  • Foul-smelling “fishy” vaginal odour, particularly after sex
  • Occasionally, BV can cause vaginal itching
  • Burning during urination

Antibiotic Treatment

To treat bacterial vaginosis, your doctor may prescribe one of the following antibiotic medications:

  • Metronidazole – available in tablet and gel form
  • Clindamycin – available as a cream that you insert into your vagina
  • Tinidazole – available in tablet form
  • Secnidazole – available in granule form

A full course of metronidazole tablets is the most common treatment for BV and is the first-choice treatment in pregnant women. If you are intolerant of metronidazole, you might be advised to try Metronidazole vaginal gel or clindamycin.

Some women develop thrush (a vaginal yeast infection) after a course of antibiotics. If you develop symptoms of thrush, speak with your doctor or pharmacist for advice.


Metronidazole is available as a pill (to be taken orally) and as a topical gel that you insert into your vagina. It is the most prescribed treatment and clears bacterial vaginosis in most cases.

A full 5 – 7-day course of metronidazole tablets is the most common treatment for BV. A single dose treatment is also available. When using the gel form of Metronidazole, the usual course of treatment is one applicatorful at bedtime for five consecutive nights.

If you are pregnant or breastfeeding, you should take the 5- to 7-day lower dose course of metronidazole rather than the single large dose.


Clindamycin is available as a cream that you insert into your vagina. An applicatorful of cream is inserted into the vagina at bedtime for 3-7 consecutive days.


This medication is taken orally. It can be taken as a 2-day or 5-day course, with the 2-day course containing double the dose of the 5-day course. You should refrain from taking tinidazole whilst pregnant.


Secnidazole is an antibiotic treatment with both antibacterial and antiprotozoal properties. It is widely used to treat many different types of infections, including trichomoniasis and bacterial vaginosis. The medication comes as a packet of granules that you sprinkle onto a soft food, such custard or yogurt.

Treating Recurrent Bacterial Vaginosis

It is common for bacterial vaginosis to recur within three to 12 months of treatment. Individuals with three or more BV episodes in one year are defined as having recurrent BV. The most common reasons why bacterial vaginosis recurs is:

  • Inadequate treatment because of medication misuse or early discontinuation
  • Reinfection through unprotected sex
  • Infection relapse – relapse after adequate antibiotic treatment may result from failure to kill off the offending bacteria or failure to reestablish the normal protective vaginal microbiota (balanced beneficial bacteria mix) dominated by lactobacillus.
  • Impact of biofilm – infections involving biofilms can be more difficult to eradicate. A biofilm consists of a matrix of dense polymeric substances that host bacteria associated with BV.

Biotic Treatments For Bacterial Vaginosis

A more holistic approach to overcoming BV is lactobacillus colonisation therapy. This therapy attempts to boost the number of good bacteria in your vagina and re-establish a balanced vaginal environment. This can be achieved by eating foods that contain lactobacilli, such as yogurt.

A new kind of non-antibiotic treatment called Astodrimer sodium gel can help prevents BV. It works by creating a physical barrier which prevents pathogenic bacteria from adhering to the vaginal wall.

Frequently Asked Questions

No, bacterial vaginosis is not a sexually transmitted infection. Rather, it is a type of vaginal inflammation caused by the overgrowth of bacteria naturally found in the vagina, which upsets the natural balance.

You can still have sex while being treated for bacterial vaginosis as it is not a sexually transmitted infection. However, abstaining from sex is advised as antibiotics and creams can affect condoms and other forms of contraception.

Non-antibiotic treatments are probably most suitable in preventing BV from recurring after an initial antibiotic course. Lactobacillus colonisation therapy and astodrimer sodium gel are two great options.

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