Bacterial vaginosis antibiotics guide

Bacterial vaginosis is a common infection of the vagina that can lead to changes in vaginal discharge. It’s usually treated with antibiotics, taken as tablets or inserted inside the vagina.

In this article, we’ll explore the different antibiotics commonly used to treat this infection, how long they take to work, what to do if your symptoms don’t improve after taking antibiotics, and where to get antibiotics for bacterial vaginosis.

What is bacterial vaginosis (BV)?

Bacterial vaginosis (BV) is an infection caused by an imbalance in the bacteria that are naturally found in the vagina. It’s not a sexually transmitted infection, although it is more common in women who are sexually active and who have multiple sexual partners.

This imbalance in bacteria can lead to changes in vaginal discharge. Women may notice an increased amount of watery or thin discharge. They can also notice that their discharge has an unpleasant fishy smell. Some women don’t notice any symptoms at all, and the infection may go away on its own in these cases.

Where symptoms are present or BV poses a health risk, various effective treatments are available.

Treatment for BV

Treatment for bacterial vaginosis focuses on getting rid of the overgrowth of “bad” bacteria and supporting the regrowth of the “good” bacteria found in the vagina.

Antibiotics are the most effective treatment and are recommended by NICE (the national institute of health and care excellence), but there may be a role for other treatments.

Some women choose to use vaginal gels/tablets inserted into the vagina (pessaries) that contain lactic acid, helping the vagina return to a more acidic pH. This reduces the growth of “bad” bacteria that prefer a more alkaline pH and supports regrowth of “good” bacteria like Lactobacillus that prefer things to be more acidic.

There may also be a place for taking probiotics that contain strains of “good” bacteria, helping encourage regrowth in the vagina. However, evidence is mixed about the effectiveness of probiotics for bacterial vaginosis, and they seem to be more useful when combined with antibiotics.

What antibiotic is used to treat BV?

Metronidazole is the standard first line treatment for bacterial vaginosis, but clindamycin can also be effective. Both treatments can be taken as an oral tablet or as a treatment that’s inserted directly into the vagina.

The standard dose of metronidazole is 400 mg twice a day for 5 to 7 days, but it can be taken as a single 2g dose in some cases.

For women who prefer something that’s applied directly to the vagina or are unable to take metronidazole tablets, they can take:

• 0.75% intravaginal metronidazole gel once daily for 5 days

OR

• 2% intravaginal clindamycin cream once daily for 7 days.

If none of these options work, it may be possible to take oral clindamycin or an alternative oral antibiotic called tinidazole.

What is the difference between Metronidazole and Clindamycin for BV?

Although metronidazole and clindamycin are both antibiotics, they work in slightly different ways.

Both have been shown to effectively treat BV, but metronidazole is more selective with the bacteria it targets and is less likely to kill off the “good” bacteria in the vagina. Bacteria are also more likely to become resistant to clindamycin, which is why metronidazole is generally preferred.

There are some differences in how the two antibiotics are taken, and they’re prescribed at different doses for varying lengths of time. Metronidazole is given as a vaginal gel or oral tablet while clindamycin is available in tablet or vaginal cream forms.

When taking metronidazole (either the tablets or the gel), you should avoid alcohol as the two can interact, leading to unpleasant side effects. Both metronidazole intravaginal gel and clindamycin intravaginal cream can weaken condoms, so you should not rely on condoms as your only form of contraception when using either of these medications.

Does doxycycline treat bacterial vaginosis?

No, doxycycline is not an effective antibiotic against bacterial vaginosis. It targets different types of bacteria to those responsible for BV and can actually kill off some of the strains of “good” bacteria found in the vagina.

How long does it take for antibiotics to clear BV?

How long BV antibiotic treatment takes to work depends on which treatment you take, but you should usually see some improvements in symptoms a few days after starting the medication.

You’ll need to take your antibiotic treatment for the whole length of time it’s been prescribed for you to get the best results. This will also help avoid creating antibiotic resistance in the bacteria found in your vagina, which could mean future treatments are less effective.

What if BV does not clear with antibiotics?

If your symptoms continue after finishing your antibiotics, it’s a good idea to speak to your GP.

They’ll likely want to discuss how you took your treatment and lifestyle factors that could be contributing to your BV, and they may decide to run some tests to check whether your symptoms could be caused by something else.

They may prescribe another treatment and give you advice about things to avoid or suggest that you see a specialist.

Where to get BV antibiotics online

Although it’s possible to get antibiotics from your GP, some women prefer the convenience of ordering BV antibiotics online.

Antibiotics require a prescription so it’s important you only purchase them from a reputable online provider, otherwise you risk them not working correctly or being given treatment that’s unsuitable for you.

Quick Meds is a GPhC-regulated UK-based online pharmacy that offers an online bacterial vaginosis clinic, helping you access BV treatment from the comfort of home.

With our online consultations, you can get your symptoms reviewed by one of our prescribing pharmacists and order your chosen BV treatment directly to your home or local collection point. Our team will check your preferred treatment is suitable for you and prescribe it where possible or offer advice on an alternative option if not.