Bacterial Vaginosis Antibiotics and Treatment

Bacterial vaginosis (BV) is a common condition caused by an imbalance of the natural bacteria in the vagina that causes unusual vaginal discharge. This natural bacteria is essential for good vaginal health, but too much or an imbalance can lead to BV, which can be uncomfortable and may require treatment.

BV can occur at any age, but it’s more common for sexually active people. While having sex can make it easier to develop BV, it is not considered a sexually transmitted infection (STI) as it is not spread directly through having sex.

Having BV can increase your risk of catching STIs, so it’s important to get it treated if you think you might have it. You should also take an STI test if you’re sexually active.

How common is bacterial vaginosis?

Bacterial vaginosis is a very common condition, with studies showing it may affect up to 29% of women globally.

While it can affect anyone of any age, it’s been found to be significantly more common in sexually active people. It’s also quite common in people who are pregnant, with a study showing around 12% of pregnant women in the UK will get it at some point during their pregnancy.

The main cause of bacterial vaginosis is a change in the balance of the naturally occurring bacteria in your vagina. And while what causes this to change isn’t fully known, it’s been shown to be more likely if:

1.You’re sexually active

Having unprotected sex is thought to affect the balance of bacteria in your vagina, which can lead to BV.

2.You’ve recently changed partner

New partners can introduce new bacteria to your vagina. This can lead to an imbalance and BV.

3.You use a copper IUD

Studies show that people who use copper IUDs have an increased risk of developing BV, with 1 study finding the rate of BV increased from 27% to 44% within 6 months of insertion of a copper IUD.

4.You use scented or perfumed products on your vagina

Scented perfumes and soaps can encourage more bacteria to grow, which can lead to an imbalance, causing bacterial vaginosis.

While less common, BV is also thought to be triggered by:

• tight clothing
• sweating
• smoking
• bubble baths
• underwear cleaned with strong detergents

The main symptoms of bacterial vaginosis are:

1. Unusual vaginal discharge: This often has a strong fishy smell, which is more common after sex.
2. Changes to the colour and consistency of your discharge: This may become a greyish-white colour and become thin and watery.

It’s also important to remember that nearly half of all women who get bacterial vaginosis won’t show any symptoms at all, so you may not realise you have it right away. The symptoms of bacterial vaginosis can also be similar to some STIs, like chlamydia and gonorrhoea, so you may also want to consider getting tested for an STI if you have these symptoms and you’re concerned.

Bacterial vaginosis does not usually cause any itching or soreness. If you're experiencing symptoms like this, you may have a different infection or condition and may need a test.

How long does bacterial vaginosis last?

Without treatment, bacterial vaginosis can last weeks or even months before it clears up, and even then, it may continue to reoccur. Whereas, with appropriate treatment, most cases of BV clear up within 5 to 7 days.

While BV can be treated very effectively, it’s also likely to return if you are susceptible to it or continue doing things that may trigger it. Around half of women who treat their BV get it again within a year. Some women also experience chronic or recurrent BV, which can continue to return a few weeks after treatment. Your doctor can provide an antibiotic gel that you can use for a few months to stop it from coming back if you get it more than 4 times in a year.

The best way to be certain you have bacterial vaginosis is to get it diagnosed by a doctor. Bacterial vaginosis can cause symptoms such as changes to:

• colour and consistency of discharge
• smell of discharge (it may smell ‘fishy’)

You might also experience burning during urination.

Your doctor should be able to help rule out any other conditions that could be causing your symptoms or suggest further testing if you need it.

It’s important to remember that while there are some tell-tale signs of BV, these can be similar to other conditions, so it’s best to get a diagnosis from a professional to be sure.

Bacterial vaginosis is usually treated with antibiotics. These can be in the form of tablets, pessaries (a tablet inserted directly into your vagina), creams and gels.

Metronidazole

This is a common antibiotic used to treat bacterial vaginosis but is also used to treat other types of infections like trichomoniasis. It works to eliminate the bacteria imbalance causing your BV. Metronidazole is very effective, working for over 90% of people who take it, clearing up their BV within 7 days.

Dalacin cream

Dalacin cream is a vaginal cream applied using an applicator for 7 nights. It contains clindamycin, which works to eliminate the bacteria that cause BV. Dalacin cream has been found to treat 75% of BV cases, clearing up symptoms within a few days. It can also help prevent the chance of recurrence.

Zidoval (metronidazole gel)

Zidoval is a vaginal gel that contains the active ingredient metronidazole. It works in the same way as metronidazole tablets, except it’s a gel that you apply daily using an applicator. It’s considered to be a very effective way of dealing with BV, clearing up 91% of cases within 5 days.

How effective is bacterial vaginosis treatment?

Antibiotic bacterial vaginosis treatments are considered the most effective, with treatments like metronidazole working for over 90% of people who take it. These treatments have been shown to effectively deal with bacterial vaginosis within 5 to 7 days of use.

“To get the most out of BV treatment, it’s important to take it as directed. You should also avoid having sex, smoking, using perfumed soap products, and wearing tight clothing while taking your treatment to help restore your vagina's natural balance so the infection can clear up faster.” — Dr Brenda Ikeji, Medical Editor

How to take bacterial vaginosis treatment

If you’re taking a tablet, you can take it as either:

• a single higher-dose taken all at once
• a normal-dose, daily tablet over the course of a week

While both are effective, you may experience fewer side effects on the normal-dose tablets.

If you are using a cream or gel

Administered at home with an applicator, just before you go to bed. The applicator is filled with your treatment and slowly inserted into your vagina. The applicator is then used to deliver the treatment inside your vagina. You will receive full instructions with your treatment on how to take it and use the applicator.

Can bacterial vaginosis go away on its own?

Bacterial vaginosis can go away on its own, but this isn’t always the case.

It may take several weeks or even months before it does and may cause uncomfortable symptoms during this time. By not treating it, you’re also increasing your risk of any complications it might cause. Due to this, it’s better to get it treated quickly rather than hoping for it to get better on its own.

What happens if I leave my bacterial vaginosis untreated?

If you leave bacterial vaginosis untreated, it can lead to complications like:

• an increased risk of contracting STIs like herpes, chlamydia, gonorrhoea, and HIV
• pelvic inflammatory disease (PID), which is caused by the bacteria infecting the uterus or fallopian tubes

If you’re pregnant with BV and do not get it treated, it can lead to complications with your pregnancy like:

• late miscarriage
• preterm labour and delivery
• preterm premature rupture of membranes
• spontaneous abortion
• low birthweight baby
• postpartum endometritis
• post-caesarean delivery wound infections
• post-surgical infections

While these complications are very rare, it’s always better to get BV treated rather than taking a risk. Treatments for BV are considered extremely safe and accessible, so you can get the appropriate treatment and results quickly.

Yes, you can get bacterial vaginosis treatment online, provided you have a suitable prescription for it from a doctor. We can prescribe BV treatment and deliver it to your door if it’s safe and suitable for you.

1.Complete a short online consultation

Here, you’ll detail your symptoms and some important information about your health to make sure treatment is right for you. You can also highlight a preferred treatment for our doctors.

2. A doctor reviews your consultation

One of our doctors will review your answers and health before issuing a prescription for your treatment if appropriate.

3. Get it delivered or collect

You can choose to have your treatment delivered discreetly in unmarked packaging or collect it from your nearest Post Office whenever it suits you.

With ZAVA, you can get your treatment without the need to go to a doctor's surgery or speak to a GP face to face – we do everything online. We also guarantee your privacy and support each of our patients throughout their treatment.

Can I get bacterial vaginosis treatment over the counter?

You can not get antibiotic bacterial vaginosis treatment over the counter as it requires a prescription from a doctor. This is to make sure treatment is safe and suitable for you. There may be other BV treatments and remedies you can explore over the counter, but these may not be as effective, and you should talk to your doctor before taking anything.

Can I get bacterial vaginosis treatment on the NHS?

Yes, you can get bacterial vaginosis treatment on the NHS, provided your GP has prescribed it to you. Depending on your situation, you may still need to pay a prescription charge.

BV can be prevented, however, some people are more likely to get it due to sensitivities. The best way to prevent BV is by making sure you practice good vaginal health and hygiene while avoiding things that are known to trigger it.

1.Practice good vaginal hygiene by:

• avoiding douching, which can increase your risk of developing BV
• wiping from front to back after using the toilet
• changing liners, pads, or tampons regularly (every few hours or so, depending on your flow)
• avoiding scented or deodorising vaginal products and only washing your vagina with water and/or unscented soap
• avoiding washing your underwear with strong, scented products

2.Avoid tight-fitting underwear

Underwear can affect vaginal health, and tight underwear has been linked to an increased risk of BV. Try wearing more breathable underwear or going without it at night.

1. Practice safe sex
2. Unprotected sex, changing partners and oral sex have all been linked to an increased chance of developing BV. This is because you are introducing new bacteria to your vagina. By using condoms or other forms of barrier contraception, you can limit this.
3. De-stress

One study in 2018 found links between cortisol (the stress hormone) and BV. While we know stress can be unavoidable, there are strategies you can use to reduce it, like deep breathing and meditation.

3.Try taking probiotics

Some research suggests taking certain probiotics can help reduce your likelihood of developing BV or it recurring after antibiotic treatment.

If you've had BV before, it's worth thinking about what might have caused it or if there's anything you did differently that could have led to it so you can make changes and hopefully avoid it recurring.

Metronidazole

If you’re taking metronidazole tablets or using a metronidazole gel, you may experience side effects like:

• vomiting (being sick)
• nausea (feeling sick)
• diarrhoea
• constipation
• stomach cramps
• loss of appetite
• headaches
• dry mouth
• an unpleasant metallic taste
• mouth or tongue irritation

These side effects are usually mild and should go away on their own, but if they bother you too much or get worse, you should speak to a doctor.

If you experience any of the following rarer and more serious side effects, you should call 111 for immediate advice:

• the whites of your eyes turn yellow, or your skin turns yellow (jaundice)
• you get unexpected infections, mouth ulcers, bruising, bleeding gums, or extreme tiredness
• you have bad stomach pains that radiate to your back
• you get blurred vision or double vision

If you experience any of the following, you may be having a dangerous reaction to metronidazole, such as meningitis and should call 999 or go to your nearest A&E immediately:

• you have a stiff neck
• you have a dislike of bright lights
• you're seeing or hearing things (hallucinating)
• you're confused or having difficulty speaking
• you have a temperature

Dalacin cream

Very common dalacin cream side effects (may affect more than 1 in 10 people) include:

• vaginal thrush

Common dalacin cream side effects (may affect up to 1 in 10 people) include:

• fungal infection (candida)
• headaches
• dizziness
• changes to your sense of taste
• cough, cold, sore throat
• stomach ache
• difficulty emptying your bowels
• diarrhoea
• nausea
• vomiting
• itchy skin
• rash
• back pain
• urinary tract infection
• foamy or frothy appearance of urine
• abnormal labour
• vaginal pain and swelling
• abnormal bleeding, pain, or stress during your period (menstrual disorder)
• vaginal discharge

Uncommon dalacin cream side effects (may affect up to 1 in 100 people) include:

• bacterial infection
• loss of balance
• nosebleeds
• upset stomach
• bad breath
• passing wind
• reddening of the skin
• rash
• hives
• painful urination
• vaginal infection
• pelvic pain

Bacterial vaginosis treatment is recommended for anyone with BV, provided it’s been approved by a doctor to ensure it’s safe and suitable. However, some people have certain conditions or may be taking other medications, meaning they can’t have certain treatments. This will also depend on which bacterial vaginosis medication you’re taking.

To make sure the tablets, liquid or suppositories are safe for you, tell your doctor if you:

• have ever had an allergic reaction to metronidazole
• are pregnant or breastfeeding
• have liver problems
• are having dialysis
• will not be able to stop drinking alcohol while using metronidazole

To make sure Zidoval is safe for you, tell your doctor if you:

• have ever had an allergic reaction to metronidazole or any other medicine
• are pregnant or breastfeeding
• have liver problems
• feel you will not be able to stop drinking alcohol while using Zidoval
• think you may have vaginal thrush
• are due your period while on treatment

If you are taking Dalacin cream, you must let your doctor know if you have any of the following applies to you before using it:

• you have stomach or intestine problems such as colitis
• you’ve had an unusual or allergic reaction to clindamycin, lincomycin, other medications, foods, dyes or preservatives
• you’re pregnant or trying to get pregnant
• you’re breastfeeding