What is the treatment for bacterial vaginosis?
Not treating is an option for some women
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. Any disruption in the balance of vaginal germs (bacteria) may be corrected naturally, with time. So, if you have no symptoms or only mild symptoms, you may not need any treatment.
However, if you are pregnant and you are found to have BV but have no symptoms, you may still be advised to take antibiotic treatment. The benefit of treating pregnant women who have BV and no symptoms is a little uncertain. Your doctor may seek advice from a gynaecologist about whether or not you need treatment.
Note: all pregnant women who have symptoms due to BV should be offered treatment. If you are found to have BV and are undergoing a termination of pregnancy, treatment with antibiotics may also be advised even if you do not have any symptoms. This is because there is a risk of BV causing a more serious infection of the womb (uterus) or pelvis after the procedure if it is not treated. Some doctors also suggest antibiotics for women with BV (and no symptoms) who are about to undergo other gynaecological procedures such as an endometrial biopsy - a biopsy of the lining of the womb.
A course of metronidazole tablets is the common treatment. Metronidazole is an antibiotic. It clears BV in most cases. Read the leaflet that comes with the tablets for a full list of possible side-effects and cautions. However, 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 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.) If you are taking the seven-day course, it is important to finish the course 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, and for at least 48 hours after stopping treatment. The interaction with alcohol can cause vomiting and other problems such as flushing and an increased pulse rate.
- Breast-feeding: metronidazole can get into breast milk but will not harm your baby. However, oral metronidazole is not recommended and instead you should use vaginal metronidazole or clindamycin.
Alternative antibiotic treatments
Metronidazole vaginal gel or clindamycin vaginal cream placed inside the vagina can be used if you prefer this type of treatment, or have unpleasant side-effects with metronidazole tablets. The ability of these treatments to clear BV is about the same as metronidazole taken by mouth.
Note: as with metronidazole tablets, you should avoid alcohol while using metronidazole gel and for at least 48 hours after stopping treatment. Also, vaginal creams and gels can cause weakening of 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 STIs.
Overall, there is no strong evidence at the moment that live yoghurt or Lactobacillus acidophilus (found in certain commercial probiotic products) is helpful in treating or preventing BV. Antiseptics and disinfectants do not help treat BV.
Do I need a test of cure?
Women who are not pregnant
After treatment, you do not need any further tests to ensure that bacterial vaginosis (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.
What if it comes back?
If your symptoms come back and you did not have a test using a sample (a swab) of your vaginal discharge taken initially, your doctor or nurse may suggest that they take swab tests now. This is to confirm that it is bacterial vaginosis (BV) causing your symptoms.
BV may return if you did not complete your course of antibiotics. However, even if you have completed a full course of antibiotics, BV returns within three months in many women. If it does come back, a repeat course of antibiotics will usually be successful. A small number of women have repeated episodes of BV and need repeated courses of antibiotics.
If you have a copper coil for contraception - an IUCD - and have recurrent BV, your doctor or nurse may suggest that they remove your IUCD to see if this helps to improve your symptoms. You will need to consider alternative contraception measures.
Did you find this information useful?
- Management of bacterial vaginosis; British Association for Sexual Health and HIV (May 2012)
- Bacterial vaginosis; NICE CKS, July 2014 (UK access only)
- Brotman RM, Ghanem KG, Klebanoff MA, et al; The effect of vaginal douching cessation on bacterial vaginosis: a pilot study. Am J Obstet Gynecol. 2008 Jun 198(6):628.e1-7. Epub 2008 Mar 4.
- Oduyebo OO, Anorlu RI, Ogunsola FT; The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev. 2009 Jul 8 (3):CD006055. doi: 10.1002/14651858.CD006055.pub2.
- Brocklehurst P, Gordon A, Heatley E, et al; Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev. 2013 Jan 31 1:CD000262. doi: 10.1002/14651858.CD000262.pub4.
- Sexually Transmitted Infections in Primary Care; Royal College of General Practitioners and British Association for Sexual Health and HIV (Apr 2013)
- Senok AC, Verstraelen H, Temmerman M, et al; Probiotics for the treatment of bacterial vaginosis. Cochrane Database Syst Rev. 2009 Oct 7 (4):CD006289.
- Evans AL, Scally AJ, Wellard SJ, et al; Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting. Sex Transm Infect. 2007 Oct 83(6):470-5. Epub 2007 Jul 4.
- Vaginal discharge; NICE CKS, May 2013 (UK access only)
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