A healthy vagina naturally contains both “good” and “bad” bacteria. But if there’s an overgrowth of bad bacteria, an infection called bacterial vaginosis can occur.
Bacterial vaginosis is common in people with vaginas. Although it can clear up on its own, getting treatment can lower your risk of certain complications and health risks associated with bacterial vaginosis.
Read on to learn about the best treatments for bacterial vaginosis, plus tips for lowering your risk.
Bacterial vaginosis (BV) is a vaginal infection caused by excess bad bacteria. This throws the vaginal environment out of balance, resulting in symptoms like:
- thin grayish-white discharge, especially after sexual intercourse
- discharge with a fishlike odor
- pain during urination
- pain during or after sexual intercourse
- vaginal itching
In some cases, BV causes no symptoms.
BV commonly affects people with vaginas between ages 15 and 44. Typically, it develops in those who are sexually active.
Experts don’t know exactly what causes BV.
According to the
- douching
- not using condoms
- having multiple sex partners
- having new sex partners
Metronidazole
- Potential side effects: nausea, vomiting, diarrhea, other gastrointestinal symptoms, appetite loss, headache, mouth or tongue irritation
One of the best prescription treatments for BV is an antibiotic called metronidazole. You can take it as a pill or gel.
The
- Pill: 500 milligrams (mg) taken orally twice per day for 7 days
- Gel: 5 grams (g) inserted into the vagina once per day for 5 days
If you have BV that keeps coming back, your doctor may prescribe 500 mg of oral medication for 10 to 14 days. Another option is to use vaginal gel for 10 days, then twice per week for 3 to 6 months.
Pros
- effective treatment
- easy to take
Cons
- can be pricey
- has many potential side effects
Clindamycin
- Potential side effects: nausea, vomiting, joint pain, heartburn, pain when swallowing, vaginal discharge, metallic taste in the mouth, itching or burning of the vagina
Clindamycin is another effective prescription treatment for BV. It’s an antibiotic that you can take as a pill, cream, or ovule suppository. An ovule suppository is a capsule that’s inserted into the vagina.
According to the CDC, the recommended dosages for clindamycin are:
- Pill: 300 mg taken orally twice per day for 7 days
- Cream: 5 g inserted into the vagina at bedtime for 7 days
- Ovule suppositories: 100 mg inserted into the vagina at bedtime for 3 days
Clindamycin cream and ovules contain oil, which may weaken latex products like condoms and diaphragms. This effect can last 72 hours for ovules, and 5 days for cream.
Pros
- effective prescription treatment
- available in several different forms
Cons
- higher risk of colitis than other antibiotics
- Creams and ovules may weaken certain forms of contraception.
Tinidazole
- Potential side effects: metallic taste in the mouth, loss of appetite, vomiting, nausea, constipation, stomach pain or cramping, tiredness, dizziness, headache
It’s possible to develop adverse side effects from metronidazole or clindamycin. In this case, your doctor may prescribe tinidazole instead.
Tinidazole is also an antibiotic that you can take as a pill. For BV, there are two recommended dosages:
- 2 g orally once per day for 2 days
- 1 g orally once per day for 5 days
Pros
- easy to take
- short course
- lower cost than other prescription options
Cons
- potential side effects
Secnidazole
- Potential side effects: nausea and vomiting, diarrhea, headache, metallic taste in the mouth
Another option is secnidazole. This is an antibiotic that you can take in one dose.
Secnidazole is available as granules that you can consume orally. The recommended dose is one dose of 2 g. You can take the granules by mixing them with unsweetened applesauce or yogurt first.
Secnidazole is significantly more expensive than other treatments. However, it may be a good option if you prefer a single-dose treatment.
Pros
- requires a single dose
- easy to mix into food
Cons
- expensive
Probiotics
- Potential side effects: mild gastrointestinal side effects
Probiotics are good bacteria. Taking probiotic supplements may help introduce healthy bacteria into your body.
According to a
And a more recent review from 2021 suggests that oral and vaginal probiotics may be an effective treatment and prevention option for BV. But researchers note that more studies are needed to determine the right dose, strain, length of treatment, and whether probiotics should be paired with antibiotics.
If you have BV, try taking probiotics daily to help treat and prevent future cases of this condition. Probiotics are available in pill or liquid form.
If you’ve been prescribed an antibiotic for BV, bear in mind that antibiotics can kill off the good bacteria as well as the bad. Probiotic supplements and yogurt can help replace good bacteria that’s destroyed by antibiotics.
You can buy probiotic supplements from pharmacies, health food stores, stores that sell supplements, or online.
Pros
- limited side effects
- may help prevent and treat BV
- available in pill or liquid form
Cons
- not as effective as other methods
- cost-effective
Garlic
- Potential side effects: burning if inserted vaginally
Garlic has strong antibacterial properties, and it’s long been used as a home remedy for BV.
For BV treatment, take garlic orally. Taking it vaginally has been known to burn vaginal tissue.
A
Pros
- natural option
- no prescription required
- inexpensive
Cons
- not as effective as prescription options
Boric acid suppository
- Potential side effects: allergic reaction, vaginal irritation
Boric acid vaginal suppositories are commonly used to treat BV, according to a
Please note that boric acid is not edible — it’s toxic to eat. Store it away from children and animals. It’s also not safe to use if you’re pregnant.
However, it’s considered safe to use boric acid in the vagina. A
In a 2009 study, a combination of suppressive antimicrobial therapy and intravaginal boric acid were used to treat recurring BV in 58 women.
Study results showed varying levels of successful treatment, which was defined as achieving remission. The levels of success were categorized based on the makeup of the course of treatment.
Pros
- safe to use as a vaginal suppository
- as effective as some medical treatments
Cons
- potential for allergic reaction or irritation
- not safe to use during pregnancy
According to the
For instance, these steps may lower your risk of BV:
- Avoid using scented tampons or pads, or any other perfumed menstrual products.
- Avoid douching — this can disrupt the natural balance of vaginal bacteria and increase the chance of infection. If you already have an infection, douching can make it worse.
- Wear breathable cotton underwear that isn’t too tight.
- Limit the number of sexual partners you have.
- Use latex condoms or another barrier method every time you have sex.
- Don’t sit around with a wet bathing suit or damp clothes on. BV spreads more easily in moist environments.
- Wipe carefully after a bowel movement to avoid spreading germs from your anus to your vagina.
Although BV can clear up on its own, there are times when it can get worse without treatment. This can increase the risk of health complications, including:
- contracting HIV if exposed to the virus
- contracting sexually transmitted infections (STIs)
- experiencing complications during pregnancy
- premature delivery if you’re pregnant
- developing pelvic inflammatory disease (PID)
- developing fertility problems due to STIs and PID
- having less success with in vitro fertilization (IVF) treatment
If your symptoms haven’t resolved or started to clear up after a week of treatment, make an appointment with your doctor or gynecologist.
Also, contact a doctor if you have:
- recurring BV
- new or worse vaginal discharge
- new or worse itching
- vaginal sores
- fever
Try to make your appointment on a day when you won’t have your period. This allows your doctor to take a swab of your vaginal discharge for testing.
You can book an appointment with an OB-GYN in your area using our Healinggeeks FindCare tool.
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Is bacterial vaginosis contagious?
BV is not considered to be an STI. But sex increases your risk of developing the infection.
If a person with BV has sex with another person with a vagina, the partner may need treatment.
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.
A prescription treatment will likely clear up your symptoms in 2 to 3 days. If you’re pregnant or undergoing any medical procedures, it’s especially important to have your BV taken care of sooner rather than later.
Your doctor may prescribe an oral or vaginal antibiotic, like clindamycin, metronidazole, or tinidazole.
Can bacterial vaginosis go away on its own?
It’s possible for BV to go away on its own, but it’s usually not worth the wait.
If it does go away on its own, it may take around 2 weeks to resolve, and then keep coming back. During that time, you’d be dealing with unpleasant symptoms.
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.
However, it’s important to continue taking your medication for the prescribed period of time, even if your symptoms have gone away. This will help ensure that the infection has completely cleared up, which typically takes about 7 days.
Should you be treated for bacterial vaginosis if you’re pregnant?
If you’re pregnant, get treatment for BV as soon as possible. That’s because BV can increase the risk of early delivery and other complications.
It’s safe to take antibiotics for BV while you’re pregnant.
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.
One of the differences between BV and a yeast infection is that BV produces a foul-smelling, “fishy” odor, while a yeast infection produces no vaginal odor. Additionally, a yeast infection may cause redness and inflammation of the vulva, while BV doesn’t produce such symptoms.
To determine whether a vaginal infection is BV or a yeast infection, a doctor may:
- ask about your medical history, including previous vaginal infections
- perform an examination to look for signs of infection and vaginal discharge
- take a sample of the discharge for analysis, to see whether an overgrowth of harmful bacteria or fungi is present
- test the pH of the vagina — according to a 2018 review, a pH of 4.5 or above can be an indication of BV
Although mild cases of BV may resolve on their own, treatment can help lower the risk of complications. The best options are prescription antibiotics. These include metronidazole and clindamycin, which you may take as a pill or cream.
In some cases, your doctor might prescribe tinidazole or secnidazole. These medications are also antibiotics. Taking probiotics, garlic capsules, and boric acid may also help.
Though your symptoms might get better within a few days, be sure to take all your medication as directed. This will ensure that your infection has completely resolved. If you have recurring BV, work with your doctor to find long-term solutions.
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