Bacterial vaginosis treatment

As bacterial vaginosis (BV) is caused by an overgrowth of bad bacteria, the main treatments are:

• a course of antibiotics – usually, the antibiotic metronidazole is given, but clindamycin can also be used
• antiseptic treatments, such as Fluomizin

BV medication can be taken as oral tablets or as a cream, tablet, or gel that’s inserted into the vagina using an applicator. No matter what form you use, BV antibiotics and antiseptics help clear up symptoms in a few days, but they may not stop your symptoms from coming back.

If your BV symptoms return, speak to your doctor for advice on other treatments you could try.

To get the full effect of your treatment, you should complete the full course and avoid missing any doses, even if you feel better. If you forget your dose, take the next one as soon as you remember, unless it’s almost time for your next dose, then skip it and take the next one as normal.

If you’re pregnant, it’s important to discuss treatment with a doctor, as not all BV treatments will be suitable for you.

BV antibiotic tablets

Metronidazole is the most commonly prescribed treatment for BV and is a generic antibiotic tablet taken by mouth. It’s usually prescribed at a strength of 400mg, twice a day, for 5 to 7 days. In some cases, a single large dose of 2g of metronidazole may be given.

Metronidazole works by damaging the DNA of the bacteria that cause bacterial vaginosis, causing the bacteria to die and BV symptoms to improve.

Metronidazole tablets are an effective BV treatment. The single-dose (2g option) is 86% effective, while the typical 7-day (400mg twice daily) course is 97% effective.

Do not drink while taking metronidazole and for 48 hours after stopping, as alcohol can interact with metronidazole and cause sickness and vomiting.

BV antibiotic creams and gels

BV creams and gels can be inserted into the vagina to treat symptoms at the source. Some of these creams contain antibiotics to kill the bacteria causing BV while others contain lactic acid to support the good bacteria in the vagina.

You can request Zidoval (metronidazole) vaginal gel and Dalacin (clindamycin) vaginal cream from Asda Online Doctor. Both contain antibiotics.

Zidoval

Zidoval gel contains 7.5mg of metronidazole in every gram of gel. One application of gel is 5g. You’ll use it every night for 5 nights in a row. To use Zidoval, fill the applicator and insert it into the vagina while lying on your back. Release the gel into the vagina by pushing down, remove the applicator, and throw it away.

Zidoval is similarly effective to metronidazole tablets, with 87 to 91% of people treated successfully.

Dalacin

Dalacin cream contains 20mg of clindamycin in every 1 gram of cream, and one dose of cream is 5g. This antibiotic BV cream is also inserted into the vagina using an applicator and should be used every night for 7 days.

Dalacin studies show that 83% of BV cases are successfully treated within 1 month.

Non-antibiotic treatments for BV

Vaginal BV tablets called Fluomizin contain the active ingredient dequalinium chloride, an antiseptic. Fluomizin can clear the bacteria that cause BV by attacking their cell wall so they can no longer survive. Fluomizin tablets are inserted directly into your vagina using an applicator and work directly at the site of infection.

Fluomizin has been shown to cure 97% of BV infections. The usual dose is 1 vaginal tablet every night, for 6 nights in a row. Fluomizin may be a suitable alternative if you cannot take BV antibiotics or would prefer a treatment with a lower risk of side effects.

You should not use an internal treatment like Dalacin, Zidoval, or Fluomizin if you’re on your period. In this case, wait until your period is over or speak to a doctor about an oral tablet.

Although many people take BV treatment without a problem, some people can experience side effects. These are usually mild and can be managed at home, but more serious side effects should be discussed with a doctor. Antibiotics tend to have more side effects than antiseptics like Fluomizin.

Side effects of antibiotic vaginal gels and creams

Common side effects include:

• inflammation or infection of the vulva and vagina
• vaginal discharge
• menstrual disorders
• itching
• stomach cramps, constipation, diarrhoea, feeling sick (nausea), or being sick (vomiting)
• headache and dizziness
• an unpleasant taste in your mouth
• dry skin
• unusual feeling on your tongue
• fungal infections or thrush
• respiratory infections
• UTI (urinary tract infection)
• decreased appetite

Uncommon side effects include:

• allergic reactions
• bacterial infections
• depression
• tiredness or sleeping difficulties
• irritability
• unusual feeling in your toes and fingers
• gurgling or bloated stomach and farting
• metallic taste in your mouth
• vaginal bleeding
• nosebleed
• vertigo
• bad breath
• pain when urinating
• pelvic pain

Side effects of metronidazole tablets

For metronidazole tablets, the most common side effects are gastrointestinal symptoms, such as feeling or being sick. One study found more than 50% of people taking metronidazole tablets had these side effects.

This can typically be managed by eating smaller amounts of plain food and staying hydrated. They should get better after finishing the course of antibiotics.

Other, much rarer side effects include:

• low blood cell count
• psychotic disorders, including confusion or hallucinations
• swelling of the brain
• vision disorders
• jaundice
• pancreatitis
• liver injury or inflammation
• rashes
• itching
• flushing
• muscle or joint pain
• dark urine
• anaphylaxis (allergic reaction)

If you experience any of these rare side effects, speak to a doctor straight away, and call 999 in an emergency, such as if you’re struggling to breathe or are confused.

Side effects of Fluomizin

Common side effects include:

• vaginal discharge, itching, or burning
• thrush

Uncommon side effects include:

• bleeding from the vagina
• bacterial vaginosis
• pain in the vagina
• swelling of the vagina (vaginitis) and vulva
• fungal skin infections
• headache
• nausea

Other side effects include:

• cystitis (inflammation of the bladder)
• bleeding from the urethra (the hole where urine comes out)
• fever
• an allergic reaction with symptoms like rash, swelling, or itching
• vaginal redness or dryness
• ulcers inside the vagina, if the skin inside your vagina was already damaged before treatment

A full list of side effects for each treatment can be found in the patient information leaflet inside the packaging.

It’s important to tell your doctor about any medical conditions you have or medications that you’re taking before taking BV treatment. This will help your doctor make sure it’s safe for you to take the medication.

Bacterial vaginosis can lead to uncomfortable symptoms, increased vaginal discharge, and an unpleasant odour. Although mild symptoms do not necessarily need treatment, they can cause discomfort, and you may feel self-conscious.

Getting treatment helps to restore the natural balance of bacteria in the vagina, giving the good bacteria a chance to flourish. It should improve any symptoms that are bothering you.

Having BV can also increase your risk of catching STIs, as the normal bacteria that protect your vagina are depleted. This means it’s often a good idea to seek treatment if you are sexually active. In some cases, your sexual partner may also need treatment.

If you are terminating a pregnancy or about to undergo a gynaecological procedure, you’ll likely need treatment for BV even if you’re not experiencing symptoms. This is because there’s a risk that the bacteria causing BV could be spread to the womb.

Women who are pregnant are usually also treated for BV, as it can increase the risk of early labour and miscarriage.

You can get BV treatment from your GP, a sexual health clinic, or you can request it online from a reputable service like Asda Online Doctor.

Can you buy BV treatment online?

Yes, you can request bacterial vaginosis treatments from Asda Online Doctor, by:

• completing a short online health assessment for one of our doctors to review
• placing your order

If approved, your order will be dispatched and sent to your home address in discreet packaging, or you can choose to collect it from your local Asda Pharmacy 4 hours after a doctor’s approval. If your order is not approved, one of our doctors will contact you through your patient account with alternative treatment options.

Ordering from Asda Online Doctor makes it quick and easy to get the treatment you need, and there’s no need to work around your GP's opening hours or wait for a face-to-face appointment.

Is BV treatment available over the counter?

No, antibiotics for BV require a prescription, so they are not available to buy over the counter. Other treatments for BV, like lactic acid, can be bought over the counter, but there’s limited evidence as to how effective these treatments are.

Bacterial vaginosis is an infection of the vagina that’s caused by an overgrowth of bad bacteria.

It’s normal for there to be bacteria inside your vagina, but BV happens when there’s too many of the “bad” bacteria and not enough of the “good” bacteria.

This imbalance can cause the pH of the vagina to become less acidic than normal which in turn makes more of the bad bacteria grow.

Although BV does not always cause symptoms, it can cause the normal vaginal discharge to change and become:

• white or grey and more watery
• fishy smelling
• heavier and more fishy after sex or after a period

It’s possible to experience some itching or soreness, but this is not common.

BV is more common if you’re sexually active, especially after a recent change in partner or if you have sex with different partners quite often. You can still get BV even if you’re not sexually active, though.

Other factors that can trigger BV include:

• smoking
• having a copper coil (intrauterine device)
• using bubble bath
• having long or heavy periods
• hormonal changes, like pregnancy or menopause
• taking antibiotics
• too much washing around the vagina
• using scented products around the vagina
• douching or washing inside the vagina

There’s not always a clear trigger for BV, and you may not be able to prevent it all the time. But you can try to avoid doing things that are known to trigger BV as much as you can.

This means:

• showering rather than taking baths
• avoiding scented products near your vagina
• stopping smoking
• changing period products often

If your BV does not clear up after treatment or you get symptoms again soon after, it’s best to get it checked out by a doctor in case there’s another cause for your symptoms. You may need to take antibiotic treatment for longer to stop BV from coming back, usually if you get it more than 4 times in a year.