Treatment FAQ

bacterial vaginosis what treatment

by Dr. Edmond Eichmann DDS Published 2 years ago Updated 2 years ago

To treat bacterial vaginosis, your doctor may prescribe one of the following medications: Metronidazole (Flagyl, Metrogel-Vaginal, others). This medicine may be taken as a pill by mouth (orally). Metronidazole is also available as a topical gel that you insert into your vagina.Jul 21, 2021


Bacterial vaginosis is an infection of the vagina. Females of any age can have it and you do not have to be sexually active to get bacterial vaginosis. This infection is not a sexually transmitted infection (STI). It is an overgrowth of bacteria in the vagina and can be treated with antibiotics.


Bv or bacterial vaginosis for short often clears up on its own. This is particularly true in case of women who are healthy and young. This is because as we age our body’s natural defense mechanism will not be as strong as it used to be when we were younger. As we age we become susceptible to infections fast.


To help prevent bacterial vaginosis:

  • Minimize vaginal irritation. Use mild, nondeodorant soaps and unscented tampons or pads.
  • Don't douche. Your vagina doesn't require cleansing other than normal bathing. ...
  • Avoid a sexually transmitted infection. Use a male latex condom, limit your number of sex partners or abstain from intercourse to minimize your risk of a sexually transmitted infection.

What is bacterial vaginosis and can it be cured?

You can also use garlic to help fight the infection. Garlic is considered one of nature's "natural antibiotics", therefore this can treat BV. You simply need to drink two garlic supplements daily to ward off the dangerous bacteria. Tea tree oil and vinegar will also do the trick.

Can bacterial vaginosis clear up on its own?

How to cure vaginal bacteriosis?

How to get rid of BV without antibiotics?


What is a good treatment for BV?

The three best treatments for Bacterial Vaginosis include: Metronidazole 0.75% vaginal gel once a day for 5 days. Metronidazole (Flagyl) 500 mg pills twice a day for 7 days. 2% clindamycin vaginal cream once a day for 5 days.

Do you need antibiotics to cure bacterial vaginosis?

While the infection may go away on its own, most doctors use antibiotics to treat it. You may have been prescribed pills or vaginal cream. With treatment, bacterial vaginosis usually clears up in 5 to 7 days.

How do I get BV to go away?

A healthcare provider can treat BV with antibiotics. If you have symptoms, you should be checked and treated by a healthcare provider. It is important to take all the medicine your provider prescribes, even if your symptoms go away. Treatment also may reduce the risk for getting other STDs.

What does BV smell like?

Keep in mind, urine smelling strongly of ammonia is a sign of dehydration. Bacterial vaginosis. It's also possible a chemical-like smell is a sign of bacterial vaginosis. “A chemical smell often falls under the category of fishy,” says Minkin.

Can I buy metronidazole over the counter?

No, you cannot buy metronidazole over the counter because you need a prescription to buy it.

What happens if BV goes untreated?

Most often, BV does not cause other health problems. However, if left untreated, BV may increase your risk for: Sexually transmitted diseases (STDs) like herpes, chlamydia, gonorrhea, and HIV. Pelvic inflammatory disease where BV bacteria infect the uterus or fallopian tubes.

Why do I keep getting bacterial vaginosis?

Bacterial vaginosis is caused by a change in the natural balance of bacteria in your vagina. What causes this to happen is not fully known, but you're more likely to get it if: you're sexually active (but women who have not had sex can also get BV) you have had a change of partner.

Does bacterial vaginosis smell?

Symptoms of BV may include: watery, white or grey discharge from the vagina. a strong or unusual odour from the vagina, often described as a 'fishy smell'.

How to diagnose BV?

BV can be diagnosed by using clinical criteria (i.e., Amsel’s diagnostic criteria) ( 999) or by determining the Nugent score from a vaginal Gram stain ( 1000 ). Vaginal Gram stain, considered the reference standard laboratory method for diagnosing BV, is used to determine the relative concentration of lactobacilli (i.e., long gram-positive rods), small gram-negative and gram-variable rods (i.e., G. vaginalis or Bacteroides ), and curved gram-negative rods (i.e., Mobiluncus) characteristic of BV. A Nugent score of 0–3 is consistent with a Lactobacillus -predominant vaginal microbiota, 4–6 with intermediate microbiota (emergence of G. vaginalis ), and 7–10 with BV. Clinical diagnosis of BV by Amsel criteria requires at least three of the following four symptoms or signs:

What is the best test for BV?

In addition to the Amsel criteria, multiple POC tests are available for BV diagnosis. The Osom BV Blue test (Sekisui Diagnostics) detects vaginal sialidase activity ( 1003, 1004 ). The Affirm VP III (Becton Dickinson) is an oligonucleotide probe test that detects high concentrations of G. vaginalis nucleic acids (>5 x 10 5 CFU of G. vaginalis/ mL of vaginal fluid) for diagnosing BV, Candida species, and T. vaginalis. This test has been reported to be most useful for symptomatic women in conjunction with vaginal pH measurement and presence of amine odor (sensitivity of 97%); specificity is 81% compared with Nugent. Finally, the FemExam Test Card (Cooper Surgical) measures vaginal pH, presence of trimethylamine (a metabolic by-product of G. vaginalis ), and proline aminopeptidase ( 1005 ). Sensitivity is 91% and specificity is 61%, compared with Nugent. This test has primarily been studied in resource-poor settings ( 1005 ), and although it has been reported to be beneficial compared with syndromic management, it is not a preferred diagnostic method for BV diagnosis.

What is the Max Vaginal Panel?

The Max Vaginal Panel provides results by an algorithmic analysis of molecular DNA detection of Lactobacillus species ( L. crispatus and L. jensenii) in addition to G. vaginalis, A. vaginae, BVAB2, and Megasphaera type 1. This test has 90.5% sensitivity and 85.8% specificity for BV diagnosis, compared with Amsel criteria and Nugent score. It also provides results for Candida species and T. vaginalis. The Aptima BV detects G. vaginalis, A. vaginae, and certain Lactobacillus species including L. crispatus, L. jensenii, and L. gasseri, with sensitivity and specificity ranging from 95.0% to 97.3% and 85.8% to 89.6%, respectively (using either clinician- or patient-collected vaginal swabs). The three laboratory-developed tests (NuSwab VG, OneSwab BV Panel PCR with Lactobacillus Profiling by qPCR, and SureSwab BV) have to be internally validated before use for patient care yet have good sensitivity and specificity, similar to FDA-cleared assays. BV NAATs should be used among symptomatic women only (e.g., women with vaginal discharge, odor, or itch) because their accuracy is not well defined for asymptomatic women. Despite the availability of BV NAATs, traditional methods of BV diagnosis, including the Amsel criteria, Nugent score, and the Affirm VP III assay, remain useful for diagnosing symptomatic BV because of their lower cost and ability to provide a rapid diagnosis. Culture of G. vaginalis is not recommended as a diagnostic tool because it is not specific. Cervical Pap tests have no clinical utility for diagnosing BV because of their low sensitivity and specificity.

Can BV be used during pregnancy?

BV treatment is recommended for all symptomatic pregnant women because symptomatic BV has been associated with adverse pregnancy outcomes , including premature rupture of membranes, preterm birth, intra-amniotic infection, and postpartum endometritis ( 989, 991, 1036 ). Studies have been undertaken to determine the efficacy of BV treatment among this population, including two trials demonstrating that oral metronidazole was efficacious during pregnancy by using the 250 mg 3 times/day regimen ( 1037, 1038 ); however, oral metronidazole administered as a 500 mg 2 times/day regimen can also be used. One trial involving a limited number of participants revealed treatment with oral metronidazole 500 mg 2 times/day for 7 days to be equally effective as metronidazole gel 0.75% for 5 days, with cure rates of 70% by using Amsel criteria to define cure ( 1039 ). Another trial demonstrated a cure rate of 85% by using Gram-stain criteria after treatment with oral clindamycin 300 mg 2 times/day for 7 days ( 1040 – 1043 ).

Is BV treatment recommended for women?

Treatment for BV is recommended for women with symptoms. Established benefits of therapy among nonpregnant women are to relieve vaginal symptoms and signs of infection. Other potential benefits of treatment include reduction in the risk for acquiring C. trachomatis, N. gonorrhoeae, T. vaginalis, M. genitalium, HIV, HPV, and HSV-2 ( 971, 986 – 988, 990, 1010 ). No data are available that directly compare the efficacy of oral and topical medications for treating BV.

Can you douch for BV?

Douching might increase the risk for relapse , and no data support use of douching for treatment or symptom relief.

Should women with BV be tested for HIV?

All women with BV should be tested for HIV and other STIs.

What is the best medicine for bacterial vaginosis?

To treat bacterial vaginosis, your doctor may prescribe one of the following medications: Metronidazole (Flagyl, Metrogel-Vaginal, others). This medicine may be taken as a pill by mouth (orally). Metronidazole is also available as a topical gel that you insert into your vagina.

How to diagnose bacterial vaginosis?

Open pop-up dialog box. Close. Pelvic examination. Pelvic examination. In a pelvic exam, your physician inserts two gloved fingers inside your vagina. While simultaneously pressing down on your abdomen, he or she can examine your uterus, ovaries and other organs. To diagnose bacterial vaginosis, your doctor may: ...

How long does it take for bacterial vaginosis to recur?

It's common for bacterial vaginosis to recur within three to 12 months, despite treatment. Researchers are exploring treatments for recurrent bacterial vaginosis. If your symptoms recur soon after treatment, talk with your doctor about treatments. One option may be extended-use metronidazole therapy.

How to check for anaerobic bacteria?

Take a sample of vaginal secretions. This may be done to check for an overgrowth of anaerobic bacteria in your vaginal flora. Your doctor may examine the vaginal secretions under a microscope, looking for "clue cells," vaginal cells covered with bacteria that are a sign of bacterial vaginosis.

How to boost the number of good bacteria in your vagina?

A self-help approach is lactobacillus colonization therapy — which attempts to boost the number of good bacteria in your vagina and re-establish a balanced vaginal environment — possibly accomplished by eating certain types of yogurt or other foods containing lactobacilli.

How long does Clindamycin last in vagina?

This medicine is available as a cream that you insert into your vagina. Clindamycin cream may weaken latex condoms during treatment and for at least three days after you stop using the cream. Tinidazole (Tindamax). This medication is taken orally.

Can bacterial vaginosis spread between male and female partners?

It's generally not necessary to treat an infected woman's male sexual partner, but bacterial vaginosis can spread between female sexual partners. Female partners should seek testing and may need treatment. It's especially important for pregnant women with symptoms to be treated to help decrease the risk of premature delivery or low birth weight.

What is the best medicine for a vaginal infection?

These might include: Clindamycin, a cream you use in your vagina. It sells under the brand names Cleocin and Clindesse. Metronidazole, available as a pill you swallow or a gel you insert in your vagina.

What is BV in vagina?

Bacterial vaginosis (BV) is a common vaginal infection caused by too much of a certain type of bacteria in your vagina. Left untreated, it can raise your risk for several serious health problems. Bacterial vaginosis doesn’t always cause symptoms. But if it does, they can include:

What If My BV Comes Back?

It’s common for this infection to come back within a year. If that happens, talk to your doctor about treatments. They may prescribe extended-use metronidazole.

What are the different types of bacteria that grow in the vagina?

There are at least seven types of bacteria that grow in the vagina. Lactobacillus is one of them. BV is linked to a decrease of lactobacillus, which is found in yogurt and acidophilus milk.

How long does it take for BV to come back?

Clindamycin can weaken latex condoms not only while you’re using the medication, but for at least 3 days after you stop.

Does yogurt cause BV?

BV is linked to a decrease of lactobacillus, which is found in yogurt and acidophilus milk. Some studies suggest that eating foods that contain lactobacillus may be beneficial, but more research is needed. Do not douche with yogurt or any other product. Vaginal douching is a risk factor for BV.

How to avoid bacterial vaginosis?

Because bacterial vaginosis (BV) isn’t fully understood, there are no foolproof ways of avoiding it. These steps may reduce your risk: Avoid douching. It changes the natural balance of bacteria in your vagina. Instead, practice healthy vaginal and vulvar care.

What is BV in vagina?

Both bacterial vaginosis (BV) and yeast infections are vaginal infections that increase discharge. Here’s how you can tell the difference:

What is a BV?

Bacterial Vaginosis. Bacterial vaginosis (BV) is a common vaginal infection that happens when some normal bacteria that lives in the vagina overgrows, causing a bacterial imbalance. Symptoms include an off-white or grey vaginal discharge that smells “fishy.”. In some women, BV goes away without treatment, in others, ...

Why does my vagina smell fishy?

Bacterial vaginosis may cause a "fishy" odor and cause vaginal irritation in some women. Others may not have any symptoms. Bacterial vaginosis is associated with poor obstetrics ...

What is the name of the system that produces bacteria in the vagina?

Your vagina is home to multiple types of bacteria (called a microbiome), just like your digestive system. Bacterial vaginosis (BV) happens when some of the vaginal bacteria grow more quickly than others. Too much of one type of bacteria leads to an imbalance.

What age do women get BV?

Bacterial vaginosis (BV) is the most common vaginal problem for women ages 15 to 44. In fact, an estimated one in three American women will get BV. The rate is higher in black women.

How many people with BV don't have symptoms?

Up to 84% of people with bacterial vaginosis (BV) don’t have symptoms. If you do, you may have:

What is the quickest way to treat bacterial vaginosis?

The fastest way to treat BV is to visit your doctor and get a prescription to treat the condition.

What is the best medicine for bacterial vaginosis?

Boric acid capsules can be used to treat bacterial vaginosis.

How long does bacterial vaginosis last?

After seeing your doctor and starting treatment with a prescribed medication, your symptoms will likely start improving within 2 to 3 days.

What is the difference between a yeast infection and bacterial vaginosis?

BV and vaginal yeast infections have similar symptoms but different causes and treatments. Both cause inflammation of the vagina, also known as vaginitis.

What is a vaginal infection caused by an overgrowth of bacteria?

Bacterial vaginosis is a vaginal infection caused by an overgrowth of bacteria.

What to wear for bacterial vaginosis?

According to the University of New Hampshire’s Department of Health and Wellness, to help your bacterial vaginosis heal quickly and to prevent future cases, wear cotton underwear that’s breathable.

Can bacterial vaginosis be prevented?

Bacterial vaginosis is a common condition that many women can get, regardless of whether they’ve had sex. Home remedies can be used to treat and prevent it. Some may be more effective than others.

What is the best treatment for BV?

Currently, the only effective treatments for BV are prescribed antibiotics, including metronidazole (pronounced met-roh-NIH-duh-zohl) and clindamycin (pronounced klin-duh-MY-sin ). 1, 2, 3, 4 These are prescribed as oral medications, which are taken by mouth, or as a gel or cream, both of which are inserted into the vagina with an applicator.

Why is it important to complete the entire course of a prescription for BV?

Even if symptoms start to disappear, it is important to complete the entire course of a prescription for BV because of the likelihood of recurrence.

How much weight can a pregnant woman have with BV?

Risks of BV during pregnancy include delivering an infant preterm (before 37 weeks of pregnancy) and delivering an infant with a low birth weight (generally, 5.5 pounds or less). The CDC recommends that pregnant women be tested—and treated if necessary—if they have symptoms of BV.

Does BV reduce preterm birth?

Some research shows that treating BV in pregnant women does not reduce the risk of preterm birth. Further study is needed to better understand these outcomes. 5

What are the best treatments for BV?

The only interventions proven to reduce development or recurrence of BV are chronic suppressive therapy and circumcision of male partners [ 114,115 ].

How to reduce BV recurrence?

Interventions to reduce recurrence risk — The only interventions proven to reduce development or recurrence of BV are chronic suppressive therapy and circumcision of male partners [ 114,115 ]. A trial that compared treatment of male partners with metronidazole (seven days) or placebo reported trends toward reduced BV recurrence for individuals whose male partners were adherent to the study medication or who used condoms, but the findings did not reach statistical significance [ 106 ]. Consistent and correct condom use may be helpful, but routine treatment of sexual partners is not advised at this time.

How long does a seniconazole antibiotic last?

Secnidazole — Secnidazole is a nitroimidazole antibiotic with a longer half-life than metronidazole (approximately 17 hours versus 8 hours) that is considered an alternative regimen for BV [ 4,45 ].

What are probiotics used for?

Role of probiotics — Probiotics (live microorganisms that confer a health benefit on the host when administered in adequate amounts) have been used alone and as adjunctive therapy to antibiotics for treatment of BV and prevention of relapse . Systemic reviews of trials of probiotics for treatment of BV have not found sufficient evidence for or against efficacy [ 49,50 ]. Although some trials have reported very promising results, particularly for treatment with an L. crispatus strain, we feel the results should be reproduced in more well-designed and larger trials before use of this therapy is considered [ 51 ]. In addition, further investigation is needed to determine the optimum route of administration (oral or vaginal), which strains or combination of strains are most effective (eg, Lactobacillus rhamnosus GR-1, Lactobacillus reuteri RC-14, Lactobacillus acidophilus ), and the dose and duration of use. The regulatory oversight and quality of commercially available probiotics vary worldwide. In the United States, the content of these products is not standardized and often of poor quality. The FDA advises caution in using dietary supplements containing live bacteria or yeast in immunocompromised patients as patient death has been reported [ 52 ].

What is the role of probiotics in BV prevention?

Probiotics — The role of probiotics in BV prevention is not yet known. (See 'Role of probiotics' above.)

Can asymptomatic preterm births be treated?

Asymptomatic infection and screening — Asymptomatic pregnant individuals with previous preterm births may benefit from treatment, but screening and treatment of these individuals are controversial as the available data do not show a consistent benefit to this approach [ 4 ].

Does BV reduce preterm birth risk?

When the Cochrane reviewers separately analyzed the subgroup of women with a history of one or more prior preterm births (ie, women at high risk for preterm birth), the detection and treatment of BV still did not significantly reduce the risk of preterm birth (OR 0.78, 95% CI 0.42-1.48, three trials, 421 women).

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