Reproductive health
Medicines for Bacterial vaginosis
A common imbalance in the normal vaginal bacteria — causing a thin grey discharge and a fishy odour rather than itching — that is not thrush and not a sexually transmitted infection, and is usually treated effectively with metronidazole.
Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.
Quick answer
What is Bacterial vaginosis?
Bacterial vaginosis (BV) happens when the natural balance of bacteria in the vagina is disturbed, so that certain bacteria overgrow and the protective ones decline. The typical sign is a thin, greyish-white discharge with a characteristic fishy smell, often more noticeable after sex, usually without the itching or soreness that thrush causes.
- How it is treated: The aim is to restore the normal balance of vaginal bacteria and relieve symptoms, while making sure the diagnosis is right, since BV, thrush and sexually transmitted infections are treated differently.
- Self-care: Avoiding douching, perfumed soaps, bubble baths and vaginal washes, and washing only with water or a plain, unperfumed product, helps protect the natural balance of vaginal bacteria and lowers the chance of bacterial vaginosis returning.
- When to seek help: See a pharmacist, GP or sexual health clinic if you have an unusual vaginal discharge, especially with a fishy smell, so the cause can be confirmed and the right treatment given — BV, thrush and sexually transmitted infections look similar but are treated differently.
What it is
Bacterial vaginosis (BV) happens when the natural balance of bacteria in the vagina is disturbed, so that certain bacteria overgrow and the protective ones decline. The typical sign is a thin, greyish-white discharge with a characteristic fishy smell, often more noticeable after sex, usually without the itching or soreness that thrush causes. BV is very common and is not classed as a sexually transmitted infection, although changes such as a new sexual partner, douching or using perfumed products can upset the balance and trigger it. It is not the same as thrush, which is a yeast problem, or as sexually transmitted infections, so getting the right diagnosis matters because the treatments differ. BV often settles by itself but can also recur, and in some situations — particularly in pregnancy — it is worth seeking advice rather than self-treating.
How it is treated
The aim is to restore the normal balance of vaginal bacteria and relieve symptoms, while making sure the diagnosis is right, since BV, thrush and sexually transmitted infections are treated differently. Mild BV sometimes clears on its own, but when treatment is needed the established choice is the antibiotic metronidazole, which can be taken by mouth or used as a vaginal gel; a topical antibiotic such as clindamycin is an alternative. Because BV commonly comes back, attention is also given to things that disturb the natural balance — avoiding douching, perfumed soaps, vaginal washes and similar products — to reduce the chance of recurrence. In pregnancy, or if symptoms are unusual, do not persist or keep returning, it is better to be assessed rather than to self-treat, so the right treatment is given and other causes are not missed.
For this condition, these medicines
Medicine classes used for Bacterial vaginosis
Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.
Symptom checker
Symptoms that can point to Bacterial vaginosis
Bacterial vaginosis can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:
By active ingredient
Specific medicines used for Bacterial vaginosis
Dose-free guides to individual active ingredients used in bacterial vaginosis — what each is, how it works, how to take it, and its advantages and disadvantages:
Beyond medication
Lifestyle and self-care
Avoiding douching, perfumed soaps, bubble baths and vaginal washes, and washing only with water or a plain, unperfumed product, helps protect the natural balance of vaginal bacteria and lowers the chance of bacterial vaginosis returning.
When to get help
When to see a doctor
See a pharmacist, GP or sexual health clinic if you have an unusual vaginal discharge, especially with a fishy smell, so the cause can be confirmed and the right treatment given — BV, thrush and sexually transmitted infections look similar but are treated differently. Seek advice rather than self-treating if you are pregnant or trying to conceive, if symptoms keep coming back or do not settle with treatment, if you also have pain, fever, bleeding between periods or pain during sex, or if you are not sure what is causing the discharge. Recurrent or unusual symptoms always deserve proper assessment.
Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.
Answers
Bacterial vaginosis: frequently asked questions
What medicines are used for bacterial vaginosis?
The main treatment is the antibiotic metronidazole, which can be taken as tablets or used as a vaginal gel to clear the bacterial overgrowth and restore the normal balance. A topical antibiotic called clindamycin is an alternative, for example if metronidazole is not suitable. If you take metronidazole by mouth, avoid alcohol during the course and for a couple of days afterwards, as together they can cause flushing and sickness. Mild bacterial vaginosis sometimes clears on its own, but if treatment is needed these are the established options. Because it can come back, avoiding things that upset the natural balance — such as douching and perfumed products — is also part of care.
Is bacterial vaginosis the same as thrush?
No. Thrush is caused by an overgrowth of yeast and typically causes itching, soreness and a thick white discharge. Bacterial vaginosis is an imbalance of bacteria and usually causes a thin, greyish discharge with a fishy smell, often without itching. They look similar but are treated differently, so it is worth confirming which one you have — a pharmacist, GP or sexual health clinic can help — rather than assuming, especially if treatment for one has not worked.
Is bacterial vaginosis a sexually transmitted infection?
Bacterial vaginosis is not classed as a sexually transmitted infection, and it can affect anyone with a vagina. However, changes such as a new sexual partner can upset the natural balance and make it more likely. Because the symptoms can overlap with sexually transmitted infections, it is sensible to be checked if you are unsure, so the correct diagnosis is made and anything else is not missed. Routine treatment of partners is not usually needed.
Why does bacterial vaginosis keep coming back?
Bacterial vaginosis often recurs because the natural balance of vaginal bacteria is easily disturbed. Things like douching, perfumed soaps, bubble baths and vaginal washes can upset it, so avoiding these and washing only with water or a plain unperfumed product can help. If it keeps returning despite this, see your GP or a sexual health clinic, as the diagnosis can be confirmed, other causes ruled out, and a longer or different treatment plan considered.
Keep reading
Related articles
Sources
Where this is drawn from
- NICE CKS: Bacterial vaginosis.
- NICE CKS: Bacterial vaginosis.
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