Bacterial vaginosis (BV) is a common condition in the vagina.
It happens when there is an imbalance of good and bad vaginal bacteria.
Although BV sometimes goes away on its own, having BV increases the risk for sexually transmitted infections (STIs), so it’s best to treat it quickly.
Treatment typically includes prescription antibiotics.
However, because of side effects, some people wish to treat BV with alternative options.
In this article, I’ll discuss how common BV is, over-the-counter (OTC) and prescription treatments, and the side effects of these therapies.
Lastly, I’ll discuss when to seek medical treatment for BV.
Over-the-Counter Medicine for BV
There are no FDA-approved OTC medications for BV.
Below are other options that people often try.
However, it’s not been widely studied in clinical trials.
One study added boric acid to an antibiotic gel used inside the vagina.
After two months of treatment, 88% of the women’s infections resolved.
At this time, medical professionals do not recommend using boric acid suppositories to treat BV.
Pregnant people should not use boric acid, as it can be toxic to fetal development.
Because bacterial vaginosis occurs due to an imbalance of “good” and “bad” bacteria in the vagina, the thought process behind taking a probiotic is to promote healthy bacterial growth to crowd out the bad.
Some studies show lactobacillus acidophilus, lactobacillus rhamnosus GR-1, or lactobacillus fermentum RC-14 may treat or prevent bacterial vaginosis.
However, more research is necessary to confirm the benefits of taking probiotics for BV.
Long known to contain antibacterial properties, some trials suggest garlic may treat BV.
One study compared inserting garlic supplements and metronidazole (an antibiotic) to treat BV.
The garlic supplements performed just as well as metronidazole.
The study also suggests that vaginal creams made from garlic may be a substitute for taking metronidazole.
However, further research is needed on this topic, so using garlic is not recommended.
Prescription Medicine for BV
The gold standard treatments for BV are the antibiotics metronidazole or clindamycin.
However, both have side effects and do not prevent BV’s recurrence.
Since the early 1980s, metronidazole has been widely used to treat BV.
You can take it as a pill or gel.
The Centers for Disease Control and Prevention (CDC) suggests the following dosing:
- 500-milligram (mg) oral tablet twice a day for seven days
- One full applicator (5 grams) 0.75% gel inserted into the vagina once a day for five days
Sometimes people get a candida infection after taking metronidazole for a BV infection.
If you notice vaginal pain, itching, or irregular discharge, tell your medical provider immediately.
Clindamycin is another antibiotic used to treat BV.
It comes in several forms, including a pill, cream, or ovule suppository (a capsule inserted into the vagina).
The CDC suggests the following dosing for treatment:
- 300-mg oral pill twice a day for seven days
- One full applicator (5 grams) 2% cream inserted into the vagina at bedtime for seven days
- 100-mg ovule suppository inserted into the vagina at bedtime for three days
Clindamycin ovules contain products that might weaken condoms or diaphragms, so use other types of contraception if you have sex within 72 hours of treatment.
Tinidazole is an antibiotic used to treat BV in people who cannot tolerate metronidazole or clindamycin.
Tinidazole comes in pill form.
The CDC recommends the following dosages:
- 2 grams (g) orally once per day for two days
- 1 g orally once per day for five days
Common Side Effects of BV Medications
There is the possibility of an allergic reaction with any new medication.
The most typical symptoms of an allergic reaction include skin rashes or hives.
Tell a medical provider if you think you have an allergic reaction.
In rare and more serious cases, you can have a reaction called anaphylaxis.
Anaphylaxis leads to lightheadedness, throat or tongue swelling, and trouble breathing.
This reaction is a medical emergency.
Of the alternative treatments, garlic was the only treatment that caused vaginal irritation for some study participants.
More severe side effects that require medical attention include:
- Peeling or blistering skin
- Vaginal irritation
- Numbness, pain, tingling, or burning in your hands or feet
How Common Is BV?
BV is most common in people with vaginas between the ages of 15-44.
While it’s unclear why, BV is more prevalent in sexually active people.
About 21% of people in the U.S. with vaginas experience BV.
Of those people, 84% do not experience any symptoms.
Symptoms can include:
- Thin white or gray vaginal discharge
- Itching, pain, or burning in the vagina
- Fishy odor, especially after sex
- Itching around the outside of the vagina
When to See a Medical Provider
Untreated BV increases the risk of getting a sexually transmitted infection.
So if you notice unusual vaginal discharge, odor, pain, or itching that you believe indicates BV, contact your gynecologist or medical provider.
They will test your vaginal secretion and prescribe an appropriate course of treatment.
How K Health Can Help
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Frequently Asked Questions
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
BASIC study: is intravaginal boric acid non-inferior to metronidazole in symptomatic bacterial vaginosis? Study protocol for a randomized controlled trial. (2015).
Bacterial Vaginosis (BV). (2021).
Boric acid addition to suppressive antimicrobial therapy for recurrent bacterial vaginosis. (2009).
Comparing the Therapeutic Effects of Garlic Tablet and Oral Metronidazole on Bacterial Vaginosis: A Randomized Controlled Clinical Trial. (2014).
Effects of probiotics on the recurrence of bacterial vaginosis: a review. (2014).
Metronidazole Vaginal. (2017).