What is the treatment for bacterial vaginosis?

Bacterial vaginosis (BV) is treated with antibiotics. These can be taken by mouth (orally), or used in the vagina (as a cream or gel).

If you're prone to getting BV, it's also important to change things that increase your risk of developing it. Things that are helpful include:

• Avoiding vaginal douching, vaginal cleaning products, and vaginal deodorants.

• Avoiding bubble baths and using harsh soaps on the vulva and vagina.

• Using condoms during sex with a male partner.

If you think you have bacterial vaginosis, find out what to do here.

In this series of articles centred around bacterial vaginosis (BV), you can read about BV symptoms, BV causes, and BV treatments - all written by one of our expert GPs.

The rest of this feature will take an in-depth look at the treatment of bacterial vaginosis, as at Patient, we know our readers sometimes want to have a deep dive into certain topics.

What is the treatment for bacterial vaginosis?

Antibiotics

Antibiotics are the main treatment for BV. The antibiotics used for BV target anaerobic bacteria - the ones that cause BV - aiming to help restore a healthy balance of bacteria in your vagina.

The most commonly-used antibiotics are metronidazole and clindamycin.

• Metronidazole tablets or capsules taken by mouth are a good treatment. They are usually taken twice a day for 5 to 7 days. They can also be taken as a one-off dose, although this is less effective than the longer course.

  • Metronidazole can cause a bad reaction if you drink alcohol whilst taking it. Avoid drinking alcohol whilst taking metronidazole, and for 48 hours after stopping it.

• Metronidazole or clindamycin can also be used as an vaginal cream or gel, again for 5 to seven days.

Metronidazole and clindamycin creams can damage latex condoms. Use another method of contraception if you're using these.

Other treatments

There are a few other treatments that have been suggested for BV, although the evidence is more limited than for antibiotics.

• Astrodimer sodium gel is a relatively new treatment for BV. It stops bacteria from attaching to the vaginal wall. It can be bought without prescription as Betafem BV gel. One trial from 2019 found it was as effective as antibiotics for treating BV, although more evidence is needed to tell how well it works.

• Yoghurt contains good bacteria (Lactobacillus). Applying yoghurt directly to the vagina has been used as a treatment for BV for a long time. Some studies have also found that eating yoghurt regularly might reduce the risk of BV. However, there isn't enough good scientific evidence to show that eating or applying yoghurt to the vagina works for BV.

• Probiotics have been suggested as a treatment that could help to restore the natural balance of bacteria in the vagina. Again, though, there's limited evidence to show that they have a clear benefit.

• Lactic acid-containing products are available for treating BV. These are thought to restore the normal acidity of the vagina, to help treat bacterial vaginosis. They are available over the counter, such as Canesbalance and Balance Activ. Overall, though, there is not much good scientific evidence that they are effective treatments for BV.

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Can bacterial vaginosis go away without treatment?

BV can go away on its own without treatment, so you don't necessarily need to take antibiotics if you don't want to. If the symptoms are mild and not bothering you, it's reasonable to wait to see if things improve on their own.

However, if you're pregnant, or about to have a gynaecological procedure or operation, you are generally recommended to have BV treatment. This is because, in those situations, BV is more likely to cause problems if not treated.

How long does bacterial vaginosis last?

If treated with antibiotics, BV usually improves within a few days of starting the treatment.

Without treatment, BV may last longer. It can last for weeks to months.

It's common for BV to come back after treatment. Around half of women treated successfully for BV get another episode in the 12 months after treatment.

How to reduce the risk of getting BV

Things that can reduce the risk of getting BV include:

• Stop smoking.

• Use condoms regularly.

• Avoid vaginal douching. These aren't needed for vaginal health, and can make it worse, including causing BV.

• Avoid sharing sex toys, and wash them after every use.

• Avoid the use of bath oils, antiseptics, bubble baths, and scented soaps in the bath.

• Use water, or water with a mild, non-perfumed soap, to wash your vulva. Limit this to once a day - washing the vulva and vagina too much can irritate them.

• If you have a copper coil (IUCD) and recurrent BV is a problem, you may want to have the coil removed and use another form of contraception.

Some women with frequent episodes of BV might be offered regular metronidazole gel to try to prevent it coming back.

The link between sex and BV is complicated. BV is more common in sexually active women. There is some evidence that BV-causing bacteria can be spread sexually from one partner to another, although BV is not considered to be a sexually-transmitted infection.

Treating a male sexual partner for BV isn't needed - it doesn't cause symptoms in men, and doesn't seem to reduce the risk of BV recurring in women.

Treating female sexual partners, though, may be helpful in reducing the risk of BV coming back.

Complications of bacterial vaginosis

BV usually doesn't cause serious complications. However, BV has been linked with some problems, such as:

• Sexually transmitted infections. Women with BV have a higher risk of getting sexually transmitted infections, such as Chlamydia, Gonorrhoea, HIV, and genital herpes.

• Infections after gynaecological procedures or surgeries, including termination of pregnancy. Treatment for BV is recommended if you're about to have one of these procedures, to reduce the risk of infection.

• A small increased risk of problems in pregnancy:

  • Premature rupture of membranes (waters breaking too early).

  • Preterm birth (having the baby too early).

  • Late miscarriage.

  • Low birthweight of the baby.

  • Infection of the womb after birth (endometritis).

• Premature rupture of membranes (waters breaking too early).

• Preterm birth (having the baby too early).

• Late miscarriage.

• Low birthweight of the baby.

• Infection of the womb after birth (endometritis).