By EKalman October 24, 2023 - 2:41am

Bacterial vaginosis (BV) is a common vaginal infection characterized by itching, discharge, and a distinct "fishy" odor. The majority of cases are straightforward and can be treated with prescription antibiotics taken orally or topically. BV infections are known to recur frequently, usually within three to twelve months, necessitating additional or alternative forms of treatment.

During pregnancy, treatment may also be prescribed to reduce the risk of complications such as low birth weight and premature membrane rupture.

Prescriptions
All women experiencing bacterial vaginosis symptoms should receive antibiotic treatment. This not only aids in the eradication of the infection, but also lowers a woman's risk of contracting a sexually transmitted disease such as gonorrhea, chlamydia, or trichomoniasis.

Preferred Drugs
The Centers for Disease Control and Prevention (CDC) recommends three antibiotic drug regimens for the treatment of BV:
- For seven days, take 500 milligrams of metronidazole orally (by mouth) twice daily.
- Take Metronidazole 0.75 percent gel using a 5.0-gram disposable intravaginal applicator once a day for five days.
- Apply a Clindamycin 2.0% cream once at bedtime for seven days with an intravaginal applicator.

Don’t use all three at once. Before using, consult your gynecologist.

Alternative Drugs
Certain treatments are only used as a last resort if symptoms reoccur or if a person has a known resistance to a preferred antibiotic. Alternative therapies include the following:
- Clindamycin 100-milligram suppositories applied at bedtime for three days
- Clindamycin 300 milligrams taken orally twice daily for seven days
- Tindamax (tinidazole) 1.0 grams taken orally once daily for five days
- Tindamax (tinidazole) 2.0 grams taken orally once daily for two days

Proper Prescription Usage
Whatever treatment you are given, you must complete the course even if your symptoms improve. If this is not done, the risk of antibiotic resistance increases.

To avoid exposure to bacteria and other harmful microbes, you should either avoid sex or use condoms during treatment. While BV is not a sexually transmitted infection, potentially harmful microorganisms can be found on the male penis, particularly under the foreskin.

Even a female sex partner can be dangerous due to skin-to-genital or genital-to-genital contact. Despite these risks, treatment of a sexual partner is rarely required.

Common Side Effects
Most side effects are relatively mild. Among them:
- Oral medications can cause nausea, stomach upset, cold symptoms (cough, runny nose, sore throat), and a metallic taste in the mouth.
- Topical antibiotics can cause vaginal itching, headaches, nausea, cold symptoms, tingling in the hands and feet, and a metallic taste in the mouth.

Home Remedies
The high rate of recurrence is one of the most frustrating aspects of treating bacterial vaginosis. According to some studies, the rate could be as high as 50%, while others believe it is much higher. This is problematic because repeated antibiotic use may increase the risk of drug resistance.

Many kinds of home remedies have been studied in women with recurrent BV symptoms. Among these are hydrogen peroxide and boric, both of which are relatively cheap and can be obtained without a prescription at the pharmacy.

Here is what we know:
- Boric acid has been used for over a century to treat yeast infections (vaginal candidiasis). A 2015 study investigated its use as a vaginal suppository in women with BV and discovered that the rate of infection clearance after 10 days was comparable to that of antibiotics.
- Hydrogen peroxide, delivered in a 3% intravaginal solution, has also been used to treat BV for generations. However, John Hopkins University research published in 2011 found that the treatment was unable to suppress particular "harmful" bacteria related to a BV infection, undermining its value in women with constant symptoms.

While these remedies are thought to be safe and inexpensive, they should not be used without a full diagnosis and input from your healthcare provider. This is especially true for first-time victims, pregnant women, or those experiencing severe infection symptoms (such as fever, body aches, pelvic and/or abdominal pain, or difficulty urinating).