Clindamycin for BV: What You Need to Know

Your vaginal microbiome is home to millions of protective and disruptive bacteria. When certain types of disruptive bacteria (generally, anaerobic bacteria) overgrow and cause an imbalance in your vaginal microbiome, that can lead to bacterial vaginosis (BV). The first line of treatment for BV is antibiotics in the form of a vaginal cream or oral therapy, including one called clindamycin. 

Bacterial vaginosis symptoms

Not all people with bacterial vaginosis have symptoms, but when they do, the most common symptoms of BV are:

• abnormal vaginal discharge that is thin, watery, and gray
• A foul or fishy vaginal odor that gets worse after sexual intercourse
• Pain, discomfort, or vaginal itching during sex or when peeing

Can clindamycin get rid of BV?

Since bacterial vaginosis happens when there’s an overgrowth of disruptive bacteria, clindamycin treats BV by slowing or stopping the growth of bacteria. It’s effective against several harmful bacteria linked to BV, including:

• Gardnerella
• Atopobium  
• Some Mycoplasma species
• Megasphaera

That said, clindamycin isn’t effective against all BV-related bacteria. For example, it’s not as effective against Prevotella species which can lead to bacterial vaginosis. It’s also worth noting that clindamycin, like many other antibiotics, can also kill off the protective bacteria (lactobacilli) along with the disruptive bacteria, which may contribute to bacterial vaginosis coming back.

How to take clindamycin 

Your healthcare provider will give you precise instructions on how to take clindamycin, but generally, it can be taken orally as a pill or applied vaginally as a cream. Both vaginal clindamycin cream and oral clindamycin are taken once a day for seven days. 

Alternatively, your healthcare provider may recommend using clindamycin “ovules”, which are suppositories you insert in the vagina and allow to dissolve. Treatment with clindamycin ovules takes just three days.

FAQ

What is better for BV clindamycin or metronidazole?

Both clindamycin and metronidazole are effective treatments for bacterial vaginosis and have a similar success rate. Some research found that using vaginal clindamycin ovules for three days was as effective as using oral metronidazole for seven days for treating bacterial vaginosis. However, each antibiotic has a better effect on some strains of bacteria than others. So, diagnosing bacterial vaginosis and knowing which specific bacteria are present in the microbiome is especially important in choosing clindamycin versus metronidazole, especially if you're dealing with recurrent BV. 

What is the success rate of clindamycin for BV?

Clindamycin has a 70-85% success rate for bacterial vaginosis. One randomized controlled trial found that treatment with single-dose 2% clindamycin vaginal gel had a success rate of 70%, including in women with recurrent BV. Annoyingly, treatment failure is pretty common with bacterial vaginosis. If you didn't have any luck with the initial treatment, your healthcare provider might recommend a different dose, administration route, or treatment altogether.

How long does it take to see results from clindamycin for BV?

It depends on the treatment course. Symptoms resolve within a week if you take vaginal or oral clindamycin. Treatment with clindamycin ovules should work within three days, while treatment with single-dose clindamycin gel should work within a day. That being said, bacterial vaginosis has a nasty habit of resisting treatment, and clindamycin isn’t effective against all species of BV-causing bacteria. Plus, more than 50% of women with bacterial vaginosis experience recurrent BV within six months of treatment.