Whether you just received a diagnosis of bacterial vaginosis (BV) or have struggled with recurrent bouts of BV for ages, you’re likely on the hunt for a fix. BV is a vaginal infection caused by an imbalance in the bacteria that make up your vaginal microbiome. Essentially, healthy vaginal bacteria are replaced by disruptive “bad” bacteria, creating an infection.
“Okay, easy”, you may be thinking. “I just need to kill off the bad bacteria and everything will go back to normal!”
Unfortunately, it’s not quite that simple. With the many BV treatment options on the market, it’s hard to know what will help: will this new medication or that new supplement shift your vaginal microbiome to a healthier, protective state, or will it keep you stuck in the endless cycle of having BV over and over again?
Read on to learn about the most common pharmaceutical treatments for BV and how they affect your vaginal health.
Brand name: Flagyl®
Type of medication: antibiotic
Administration route: oral (pills taken by mouth) or intravaginal (gel applied internally)
Antibiotic medications are commonly prescribed to treat bacterial infections, and BV is no exception. Metronidazole is an antibiotic used to kill anaerobic bacteria (bacteria that don’t require oxygen to survive) and other microbes that can cause infections.
It’s been tested and found to be effective against a number of bacterial species that are associated with BV, including:
No antibiotic medication can always wipe out every bacterial species at once. Some BV-related bacteria are resistant to metronidazole (i.e., metronidazole won’t kill them), including:
However, here’s some good news: Lactobacilli species, the “good” bacteria that are the most common in healthy vaginas, are also resistant to metronidazole. This means that treatment with metronidazole will get rid of the disruptive, or “bad”, bacteria, while sparing your healthy Lactobacilli.
CDC guidelines currently recommend that metronidazole be given either orally (as pills) or via intravaginal administration to treat BV. If your healthcare provider prescribes metronidazole for your BV, they may recommend one of the following courses:
- 500 mg pills taken twice a day for 7 days
- A full applicator of 0.75% gel applied inside the vagina once daily for 5 days
While these are common recommendations, recall that your healthcare provider must take your unique medical history and sensitivities into account when determining the correct treatment regime for you.
Brand name: Cleocin®
Type of medication: antibiotic
Administration route: oral (pills taken by mouth) or intravaginal (tablets inserted or cream applied internally)
Clindamycin is another antibiotic commonly used to treat BV. It works by slowing and sometimes stopping the growth of bacteria. Similar to metronidazole, clindamycin has been shown to be effective against a number of bacterial species that can cause BV, including:
Despite this list, clindamycin isn’t a silver bullet against BV-related bacteria. For example, it is not as effective against Prevotella species that can contribute to BV. Clindamycin can also kill off the protective (Lactobacilli) bacteria along with the disruptive bacteria, which may contribute to BV coming back again later.
Clindamycin can be taken orally as a pill or applied intravaginally as a cream, typically for 7 days in either case. Alternatively, your provider may recommend using clindamycin “ovules”, which are basically little pills you place inside the vagina and allow to dissolve. Ovule treatment takes just 3 days.
Brand name: Tindamax®
Type of medication: antibiotic + antiprotozoal
Administration route: oral (pills taken by mouth)
Tinidazole is an antibiotic that can kill protozoa (microscopic single-celled animals). It belongs to the same class of antibiotics as metronidazole, and is also effective against many of the bacteria involved in BV.
However, less is known about how well it works against other specific BV-related species. As the research on BV treatments progresses, we may learn that tinidazole can also act against other problematic bacterial strains.
Like metronidazole, tinidazole does not kill Lactobacilli, the protective bacteria of a healthy vaginal tract. Researchers have also shown that it may cause fewer negative side effects on the GI tract, making it an attractive alternative to metronidazole in some cases.
To treat BV, your provider may prescribe tinidazole to be taken orally for two or five day courses. Though less convenient, longer courses of treatment appear to be more effective against BV than shorter ones.
Brand name: Solosec®
Type of medication: antibiotic
Administration route: oral (granules taken by mouth)
Secnidazole is an antibiotic in the same class as metronidazole and tinidazole, and it, too, works by stopping bacterial growth. However, unlike its cousins, it’s typically taken orally in a single dose.
Secnidazole is effective (and ineffective) against similar sets of bacterial species as metronidazole and tinidazole. It also spares the beneficial Lactobacilli strains that help maintain vaginal health.
The only non-prescription option on this list, boric acid is a white powder made from borax, a naturally occurring mineral. It’s composed of the elements boron, hydrogen, and oxygen.
Boric acid has antimicrobial and antifungal properties, suggesting that it may be a useful addition to the treatment regime for people with recurrent BV. Boric acid hasn’t been studied as much as the medications we’ve discussed so far, so we don’t have a reliable breakdown of the BV-related bacterial species it can and can’t impact.
However, some research suggests that boric acid may help break down the biofilms which protect bad bacteria and allow BV to come back after antibiotic treatment. By breaking down these biofilms, boric acid may then allow an antibiotic like metronidazole to be more effective. When used to help treat BV, the CDC recommends that boric acid be placed intravaginally as a suppository (in capsule form). Boric acid cannot be taken orally (by mouth).
Additionally, a new boric acid-based medicine called TOL-463 is currently in development. TOL-463 combines boric acid with a chemical called EDTA that can help break down biofilms further to improve treatment effectiveness.
Initial results are promising, though additional research will be necessary to determine the most effective way to use TOL-463 to help treat recurrent BV.
FYI, generally, boric acid prescribed by a doctor tends to be more pure and less likely to cause adverse reactions than boric acid purchased OTC or on Amazon. So if you're going to use boric acid, always try to get it prescribed by a healthcare provider.
Treating BV: Timeframes and Expectations
As we’ve discussed, the initial treatment timeframes for the various BV medications vary, though most can be completed in a week or less. It’s important to complete the entire treatment you’re prescribed for BV, even if your symptoms go away before you complete it. This is one way to help prevent BV from coming back.
If your BV symptoms return after an initial round of treatment, it’s important to consult with your medical provider. If this is the first time your BV has recurred, or if the first round of treatment simply didn’t work, they may recommend a second round of the same course of medication.
However, if your BV keeps coming back, it’s typically time to try an alternative medication and/or administration route (i.e., an intravaginal gel instead of oral pills).
While additional rounds of pharmaceutical treatment can be effective in knocking out recurrent BV, they often require much longer courses lasting several weeks or months. Additionally, the protection these medications provide often disappears when you stop taking them, and the BV can come right back, again.
How Evvy Can Help with BV
What’s a person with BV to do?! First things first: if you’re struggling with stubborn, recurrent BV, take a deep breath and know: you’re in the right place. Evvy is working to break down barriers in our understanding of the vaginal microbiome and its role in recurrent BV.
Whether or not you have BV, taking an Evvy test will help you understand the make-up of your vaginal microbiome, which can help you determine if your vaginal microbiome is dominated by bacteria associated with BV, and if so, which types. This can help you and a healthcare provider choose the most effective type of treatment (including an antibiotic) against your microbes based on existing research and your health history.
Our vaginal healthcare platform will always provide you with a clear plan of next steps for your care. If you’re eligible for clinical care, it can connect you to an Evvy-affiliated healthcare provider who is trained to review your test results and select the best care for you, tailored to your specific symptoms. They may also recommend research-backed supplements to restore your microbiome to a protective state.
With an Evvy Membership, you can easily monitor changes in your microbiome and track your body’s response to different treatment regimes. Knowledge is power: the better you understand your unique microbiome, the more accurately you can tailor your care to keep it healthy.
We know that searching for an effective care for vaginal symptoms can be overwhelming. We’re here to provide you with up-to-date research on treatments and personalize your care so you feel supported every step of the way.