Bacterial Vaginosis Treatment

Authored by Dr Mary Lowth, 14 Dec 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Louise Newson, 14 Dec 2017

Bacterial vaginosis (BV) often causes no symptoms, or the symptoms are mild. Also, there is a good chance that BV will gradually clear without treatment.

There are various different treatments for bacterial vaginosis (BV). There are also some things which you should avoid doing, which may help the problem to resolve itself.

These include avoiding the use of douches, vaginal deodorants, bath additives and harsh soaps. Refraining from intercourse for a couple of weeks, or using a condom and a water-based lubricant, can be helpful.

The body is often very good at getting back its own balance. The disruption in the balance of vaginal germs (bacteria) that causes BV may correct naturally, with time. So, if you have no symptoms or only mild symptoms, you may not need any treatment, particularly if you take some of the general healthy steps above?

You normally need treatment for BV if it is causing symptoms, or if the characteristic smell is noticeable to you. If you are pregnant, trying to become pregnant, or about to have a gynaecological procedure then you may be advised to get treatment for BV.

Pregnancy
If you are pregnant and you are found to have BV then you will usually be offered antibiotic treatment with oral metronidazole (see below).

If you are trying to conceive and you think you may have BV, it is a good idea to try to eradicate the BV through natural methods or treatment prior to conceiving. If you have symptoms then you should discuss having antibiotic treatment with your doctor.

Termination of pregnancy
If you are found to have BV and are undergoing a termination of pregnancy, treatment with antibiotics may be advised even if you do not have any symptoms. This is because there is otherwise a risk of BV causing infection of the womb (uterus) or pelvis after the procedure. This could lead to later fertility problems.

Gynaecological procedures
Antibiotics are not usually recommended for women with BV (and no symptoms) who are about to undergo 'minor' gynaecological procedures such as an endometrial biopsy - a biopsy of the lining of the womb. In fact women having these procedures are in any case not usually tested for BV, so they would not know they had it.

Women having vaginal hysterectomy are given antibiotics prior to the procedure, even if they don't have BV, in order to lower the risk of postoperative infection. These antibiotics will also wipe out any BV-causing bacteria.

There are a variety of possible treatments for BV.

Antibiotics for bacterial vaginosis

Oral antibiotics are the first-choice treatment in pregnant women with BV.

Metronidazole tablets
A full course of metronidazole tablets is the common treatment. Metronidazole is an antibiotic. This clears BV in most cases. It is important to read the leaflet that comes with these tablets for the full list of possible side-effects and cautions. The main points to note about metronidazole include:

  • The usual dose is 400-500 mg twice a day for 5-7 days. A single dose of 2 grams of metronidazole is an alternative, although this may be less effective and may cause more side-effects. (Note: this single dose is not recommended if you are pregnant.) It is important to finish the course you have been prescribed, and not to miss any tablets.
  • Some people feel sick or may be sick (vomit) when they take metronidazole. This is less likely to occur if you take the tablets straight after food. A metallic taste is also a common side-effect.
  • Do not drink any alcohol while taking metronidazole, nor for 48 hours after stopping treatment. The interaction of metronidazole with alcohol can cause severe sickness and vomiting, and may also cause flushing and an increased pulse rate.
  • Metronidazole can get into breast milk in small amounts but will not harm your baby, although it may make the milk taste different. The manufacturer recommends that if you are breastfeeding you should take the 5- to 7-day lower dose course of metronidazole rather than the single large dose.

Alternative antibiotic treatments
Tinidazole tablets may be offered if you know you are intolerant of metronidazole. Tinidazole is a similar antibiotic and you need to take 2 g once a day for two days, or 1 g once a day for five days. It has the same interaction with alcohol that is seen with metronidazole, meaning that alcohol should not be consumed whilst you are taking it, nor for 48 hours afterwards. Tinidazole is not recommended in pregnancy.

Metronidazole vaginal gel or clindamycin vaginal cream placed inside the vagina can be used if you prefer this type of treatment, or if you experience unpleasant side-effects with metronidazole tablets. These treatments are believed to be almost as effective as antibiotics by mouth.

Note: as with metronidazole tablets, you should avoid alcohol while using metronidazole gel and for at least 48 hours after stopping treatment, although the tendency of the gels to make you feel sick are not as noticeable as for the tablets.

Vaginal creams and gels can weaken latex condoms and diaphragms. Therefore, during treatment and for five days after treatment with clindamycin vaginal cream, do not rely on condoms or diaphragms to protect against pregnancy and sexually transmitted infections (STIs).

Other antibiotic tablets taken by mouth are also sometimes used to treat BV. These are clindamycin tablets or tinidazole tablets.

Some women with BV say that things settle more quickly and symptoms are eased by applying a thin coat of plain, live yogurt to the outside of the vagina daily, and by applying a small amount of plain live yoghurt on a tampon for internal use before bed.

The evidence that live yoghurt is helpful in treating or preventing BV is mixed, with some trials saying that it is helpful and some saying that it is not helpful. Overall specialists feel that there is not enough evidence in its favour to suggest it over other treatments.

Treatment with acetic acid gels aims to keep the vaginal pH at less than 4.5, to encourage lactobacilli to grow, and to discourage anaerobic bacteria from growing. Some studies have suggested that long-term use of vaginal acidifiers of this type reduces recurrences of BV. However, other studies suggest that this treatment, whilst harmless, is not effective.

Lactobacillus suppositories and oral tablets are sold in some health food shops, for use in BV.

Orally consumed probiotics are believed to reach the vagina via the bowel. There is some evidence that this can be helpful in treatment and in prevention of BV. These studies suggest treatment needs to continue for at least two months. Other studies don't show a clear benefit. Overall, specialists feel that there is not enough evidence in its favour to suggest it over other treatments.

Intravaginal lactobacillus treatment seems as though it ought to be an obvious solution - why not put the right bacteria where they are meant to go? However, results of studies on vaginal treatments with lactobacilli are also mixed, with some studies suggesting this treatment is effective and others not.

There is no evidence that treating a male sexual partner prevents his female sexual partner from developing BV. One small trial looked at whether using a sterilising alcohol gel on the penis protected their partners against BV - but the gel appeared to make BV more, rather than less, common in the women.

If you have a female partner then it does appear that treating her for BV at the same time as you - even if she doesn't have symptoms - will prevent recurrence (in either of you).

Women who are not pregnant

After treatment, you do not need any further tests to ensure that BV has cleared (a test of cure) provided that your symptoms have gone.

Women who are pregnant

If you are pregnant, it is suggested that you do have a test one month after treatment to ensure that BV is no longer present. A sample (a swab) of the discharge in your vagina is taken. This is tested to check you no longer have BV.

If you have persistent BV (ie it does not settle down with the first treatment you try) then your doctor may want to take further vaginal swabs to check whether there is another cause of the discharge. They will usually suggest that you use the seven-day course of metronidazole if you have not had this before.

Another treatment which may be tried is using metronidazole gel twice a week for up to six months.

If you have a persistent BV infection which does not respond to treatment, and you have an intrauterine contraceptive device (IUCD) then your doctor may advise removing the device until things settle down, as there is some evidence that IUCDs can contribute to persistent BV.

If you have persistent BV and a same-sex partner then treating both of you at the same time is likely to be helpful in preventing persistence and recurrence - even if your partner does not have symptoms.

Further reading and references

I was pretty excited to come on this site to share what has cured me because i know how frustrating bv is and i am sure some of you have tried many things. I had bv for 3 months. I am just now...

kris29
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