Luckily, BV is easily treated with simple antibiotics. In some women, the infection comes back, and they have to take antibiotics for longer to get rid of the infection completely.
We’ll run through the best treatments for BV here—and whether you need treatment at all.
How do I know I have BV?
Many women don’t know that they have BV. That’s ok. One-third of women get better with no treatment at all.
You might have BV if you have watery, milky-colored fluid coming from your vagina, which smells very strong, especially after sex. An itchy or burning feeling down below could be another sign of BV.
Who needs treatment for BV?
If you have symptoms, you need treatment. Simple.
If you are pregnant and have symptoms of BV, you also need treatment, and treatment is safe.
If you are about to have gynecologic surgery, such as a hysterectomy, or an abortion, you will be checked for BV. If you test positive, you need to be treated–whether you have symptoms or not. Getting treated will lower your risk of getting complications after your surgery.
What is the best treatment for BV?
These are the 3 best treatments for BV:
- Metronidazole (Flagyl) 500 mg pills twice a day for 7 days
- 0.75% metronidazole vaginal gel once a day for 5 days
- 2% clindamycin vaginal cream once a day for 5 days
These treatments have been around a while, and are proven to work: 80% of women treated for BV using one of these methods are clear of the infection one month after treatment.
What treatment is best for me?
This depends on your preference (pills or cream) and the side effects you might get.
Pills usually give more side effects than creams, and for metronidazole pills, these might include a headache, nausea, or stomach pain. Both metronidazole pills and creams can give you a metallic taste in your mouth.
There is a risk of C. diff (Clostridioides difficile) diarrhea with both metronidazole and clindamycin.
Precautions
If you are taking metronidazole (Flagyl), drinking alcohol will make you violently ill. We do not recommend it at all (and if you try it, you won’t either). Wait one day after your treatment ends before you start drinking alcohol again.
If you are using clindamycin vaginally, you’ll need to be careful using latex condoms for protection. Clindamycin cream can weaken condoms to the point that they break.
My BV symptoms came back. What now?
Unfortunately, this is pretty common:
- 30% of BV comes back within 3 months.
- 50% of BV come back within 12 months.
Doctors aren’t really sure why this happens, but it’s probably related to the antibiotics wiping out the healthy bacteria in your vagina, which protect you from unhealthy bacteria that cause diseases such as BV or yeast infections. (This is why we don’t recommend antibiotic treatment for BV if you don’t have symptoms.)
If your BV comes back and you have symptoms, you will be treated with a longer course of antibiotics, and usually with a different antibiotic than the first time. After that, you can take a longer preventative treatment for 4 to 6 months to prevent it from coming back again.
Does my partner need treatment if I had BV?
If you have sex with a man, he does not need treatment. Good to know: You’ll have a lower chance of getting recurrent BV if your male partner regularly uses a condom during sex with you, or if you abstain from sex altogether.
If you have sex with a woman, then you should tell your partner. There is a 25% to 50% likelihood they will also have BV, so they should be made aware of the symptoms. If your partner starts getting symptoms, they will need a test and treatment to feel better—just like you did.
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