Bacterial Vaginosis Treatment

Bacterial vaginosis (BV) is an infection caused by the bacteria in your vagina. An imbalance in the vaginal bacteria will mean some bacteria grow faster than others. This bacterial overgrowth can cause inflammation and lead to symptoms of BV.

BV is not a sexually transmitted infection (STI) but it can be more common if you are sexually active. Getting BV can also make it more likely for you to get an STI, like chlamydia. It’s better to get treated as soon as you think you have the symptoms of BV.

An imbalance of bacteria causes bacterial vaginosis.

The natural bacteria in your vagina protects you against other infections and harmful bacteria. There are different types of bacteria found in your vagina. These include lactobacilli and Gardnerella vaginalis.

An overgrowth in one of these bacteria means your natural defence against other infections is weakened. BV can also change your vaginal pH (how acidic the vaginal environment is). This makes you more vulnerable to STIs.

Anything that disrupts the natural balance of vaginal bacteria can give you BV. This includes:

• using feminine hygiene products like vaginal perfumes or deodorants
• being sexually active
• having an IUD (intrauterine device)

Getting BV when you’re pregnant can carry a small risk of being harmful to your baby. It can lead to premature birth or miscarriage. If you’re pregnant and think you have BV, speak to your midwife or doctor.

You may not always notice the symptoms of bacterial vaginosis (BV). And some women do not feel symptoms at all. The most common symptom of BV is thin and watery vaginal discharge with a fishy odour. This odour may be more pronounced after sex.

Sometimes BV can be mistaken for thrush, another common vaginal infection. This is because they can coexist.

While BV is caused by bacteria, thrush is a yeast infection. The biggest difference between BV and thrush is the type of vaginal discharge you’ll have. If you have thrush, you may notice a thick, white discharge with no smell.

Metronidazole tablets

Metronidazole is a commonly used antibiotic that comes in different forms, and you can take it to treat bacterial vaginosis. Metronidazole tablets are taken by mouth with a glass of water. It’s best to take oral metronidazole with or after food.

Metronidazole acts by killing the overgrowth of bacteria in your vagina. You should start to feel better within the first few doses. It’s important to finish the whole course of antibiotics to make sure the infection is completely treated.

Metronidazole can be taken in 2 different ways:

• 1 tablet twice a day for 7 days
• 5 tablets taken as a single dose

Both are usually equally as effective.

You should avoid drinking alcohol while taking metronidazole and for 2 days after finishing the course. Alcohol can react with metronidazole and make you feel unwell.

Metronidazole gel

Metronidazole is also available as a vaginal gel called Zidoval and is just as effective as tablets for treating bacterial vaginosis. Zidoval gel contains metronidazole 0.75% w/w. This means for every 1g of gel, there is 7.5mg of metronidazole.

Each pack of Zidoval contains 5 disposable applicators. You should apply Zidoval as your doctor has advised you to. In general, you should insert 1 tube of Zidoval gel into your vagina for 5 days.

It’s best to use the gel at night for ease of application. You should never swallow Zidoval gel as it is designed for use in the vagina only.

You can use metronidazole even if you are allergic to penicillin.

Clindamycin cream

Clindamycin cream is used as a vaginal cream to treat bacterial vaginosis (BV). Clindamycin cream is also known as Dalacin cream.

Clindamycin works by preventing certain bacteria from growing in your vagina. Dalacin cream specifically kills the bacteria that cause BV.

You can use Dalacin cream by inserting a tube of cream into your vagina using the disposable applicator. Dalacin cream is usually used for 7 days to provide a whole treatment course.

If you are pregnant, you should speak to your midwife or doctor before using Dalacin cream.

Keep in mind that Dalacin cream can damage latex condoms or diaphragms. It’s best to avoid having sex while being treated for BV or you can use an alternative method of contraception.

You can prevent getting bacterial vaginosis (BV) by following a few simple steps:

• only use water or soap free products to wash your genitals
• use gentle detergents to wash your underwear and clothes
• quit smoking
• take showers instead of baths
• if you do have a bath, do not use soapy or foamy bubble bath liquid or shower gel

As your vagina is self cleaning, you do not need to use vaginal deodorants, washes, douches or soaps to keep it clean.

If you get BV, there’s a chance you’ll get it again within a few months. So your doctor may recommend a longer treatment course. By following the above steps, you can lower the chance of getting recurrent BV.

Metronidazole tablets have very few common side effects. You may feel sick when you first take the tablets, but this will be temporary. You should not drink alcohol if you are taking metronidazole tablets or using metronidazole cream to treat bacterial vaginosis.

If you are taking any other medications, speak to your doctor or pharmacist to check if you can take metronidazole tablets.

When using Zidoval gel or Dalacin cream, you may experience some side effects such as:

• vaginal discomfort
• itching or irritation around the vagina or vulva (outer part of your genitals)
• stomach cramps
• thrush (yeast infection)
• headache or dizziness

These side effects should not last a long time and will usually disappear after a few hours.

For more information on side effects, read the patient information leaflets that come with your treatment pack.