How is Bacterial Vaginosis Treated?

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Question: How is Bacterial Vaginosis Treated?

Answer: Bacterial vaginosis treatment is usually with one of several antibiotics / antifungals. Multiple treatments may be necessary.

Bacterial vaginosis is usually treated topically. In other words, creams or gels are applied to the vagina. However, BV can also be treated using oral medications.

Follow-up is not necessary if symptoms go away with treatment.

However, people with BV often relapse after treatment. If symptoms recur, you should return to your doctor. Additional treatment may be necessary, or you may need to be treated with a different regimen.

Sexual partners of women with BV are not usually treated for the condition. This is because bacterial vaginosis is thought to be a sexually associated disease rather than a sexually transmitted one. However, there is evidence that BV can be sexually transmitted between women. Evidence for transmission in heterosexual couples is less clear. (Some women think BV is caused by sperm. However, it's just that the presence of semen makes symptoms more noticeable.)

The drug regimens below are taken from the Centers for Disease Control 2015 STD treatment guidelines. Remember that only your doctor can say which treatment is right for you.

Recommended Regimens for Non-Pregnant Women with BV
Metronidazole 500 mg orally twice a day for 7 days
Metronidazole gel, 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days
Clindamycin cream, 2%, one full applicator (5 g) intravaginally at bedtime for 7 days

Alternative Regimens for Non-Pregnant Women with BV
Clindamycin 300 mg orally twice a day for 7 days
Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days
Tinidazole 2 g orally once daily for 2 days
Tinidazole 1 g orally once daily for 5 days

Recommended Regimens for Pregnant Women with SYMPTOMATIC BV
Metronidazole 500 mg orally twice a day for 7 days
Metronidazole 250 mg orally three times a day for 7 days

Note: If you are treated with metronidazole, you should not drink alcohol during treatment and for 24 hours after treatment is completed. Also, clindamycin cream can weaken latex condoms and diaphragms for up to 5 days after treatment is completed. Therefore, if you are relying on these barriers for contraception, take note. You should wait a week after treatment to resume sexual intercourse.

Pregnant women should be followed up one month after treatment to make sure that the condition has not recurred. BV is associated with preterm birth. However, it is unclear whether treating asymptomatic BV affects the risk of preterm birth. Therefore, if you do not have symptoms, your doctor may choose not to retreat you.


CDC (2015) "Sexually Transmitted Diseases Treatment Guidelines, 2015" Accessed (2/25/16) from

Fethers KA, Fairley CK, Hocking JS, Gurrin LC, Bradshaw CS. Sexual risk factors and bacterial vaginosis: a systematic review and meta-analysis. Clin Infect Dis. 2008 Dec 1;47(11):1426-35. doi: 10.1086/592974.

Nygren P, Fu R, Freeman M, Bougatsos C, Guise JM. Screening and Treatment for Bacterial Vaginosis in Pregnancy: Systematic Review to Update the 2001 U.S. Preventive Services Task Force Recommendation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Jan. Available from

Vodstrcil LA, Walker SM, Hocking JS, Law M, Forcey DS, Fehler G, Bilardi JE, Chen MY, Fethers KA, Fairley CK, Bradshaw CS. Incident bacterial vaginosis (BV) in women who have sex with women is associated with behaviors that suggest sexual transmission of BV. Clin Infect Dis. 2015 Apr 1;60(7):1042-53. doi: 10.1093/cid/ciu1130.

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