Gels for the Treatment of Bacterial Vaginosis

Bacterial vaginosis (BV) is a common bacterial infection that affects about 30% of women between the ages of 15 and 44. It's actually the most common vaginal disorder for this age range, and it can occur without symptoms in more than 80% of cases.

The cause of BV is not clear, but researchers do know that it is a result of an imbalance of healthy and unhealthy bacteria in the vagina. Certain activities, such as douching, having sex with new or multiple partners, and not using condoms, can affect the balance of bacteria in the vagina, which can increase one's risk of getting BV.

If you've been diagnosed with bacterial vaginosis, know that the condition is easily treatable, and there are several treatment options available. This article will focus on gel medications that are used in the vagina itself, as well as oral medication options and other treatments.

Close-up of gel / ointment

Anel Havryliuk / Getty Images

Bacterial Vaginosis Gels

Since it is a bacterial infection, BV is treated with antibiotics. These antibiotics are available in a few different formulas, including gels, creams, and capsules that are inserted into the vagina, as well as oral medications.

Metronidazole gel is a topical treatment usually prescribed for BV. It is a 0.75% formulation of metronidazole, administered once daily for five days using an intravaginal applicator (a device that delivers treatments directly into the vagina). Other formulations may also be used, but this is the most common.

When Is a Gel Not Right for Me?

Only your healthcare provider can determine when you should and should not use certain medications. Since the antibiotics used to treat bacterial vaginosis require a prescription, your healthcare provider can discuss the available options with you.

There is no clinical reason to choose one formulation over the other, although topical treatments like gels and creams may work more quickly than oral drugs. Talk to your healthcare provider if there is a reason you cannot or do not want to take a medication vaginally.

Side Effects

Side effects of metronidazole are similar to those of other antibiotics, including:

These side effects can appear with the vaginal gel formula of metronidazole and other formulas. Vaginal irritation and vaginal yeast infections may be more noticeable when using the vaginal gel.

Alcohol use and vaginal intercourse are not recommended while using these products, as both could decrease effectiveness and increase the chance of side effects or complications. Vaginal metronidazole gel may also interact with certain blood thinners.

Effectiveness

When it comes to different treatments for BV, the Centers for Disease Control and Prevention (CDC) reports there is little data to support different outcomes across medication types.

One study found that metronidazole 0.75% gel resolved symptoms in about 25% to 43% of women within the five-day treatment window, but these results were similar when stronger formulas and even other medication types were used.

According to the CDC, recurrences of BV are common, and retreatment or longer treatment doses may be needed to clear the infection.

Oral Medications

There is an oral form of metronidazole that can be used to treat BV. It's given as a 500-milligram (mg) dose taken by mouth twice a day for seven days. The CDC suggests this as an alternative to the gel form of metronidazole and there's usually no preference between either formula.

Other Treatment Options

In addition to vaginal gel and oral formulas of metronidazole, other treatment options for BV include:

  • 2% clindamycin cream inserted vaginally at bedtime for a week
  • 300 mg of oral clindamycin taken twice a day for a week
  • 100 mg of clindamycin ovules inserted vaginally at bedtime for three days
  • 2 grams (g) of Solosec (secnidazole) taken orally with food or drink in a single dose
  • 2 g of Tindamax (tinidazole) taken once a day by mouth for two days
  • 1 g of tinidazole taken once a day by mouth for five days

Which Treatment Is Right for Me?

The choice of which medication to use for BV is one that should be made between you and your healthcare provider. Factors that may be considered when selecting a medication include:

  • Your medical history
  • Other medical conditions
  • Other infections
  • Prior reactions to antibiotics
  • Allergies
  • Sexual health and behaviors
  • Pregnancy
  • Lactation

Metronidazole and other antibiotics are used in pregnant and breastfeeding women, but it's important to discuss the risks and benefits of treatment with your healthcare provider.

You may also want to discuss your preference for formulas when choosing a medication. Although there is some evidence to indicates topical and intravaginal medications may be more effective, some people may prefer oral medications.

Summary

Bacterial vaginosis is a bacterial infection that is fairly common. It's treated with antibiotics, but there are several options when it comes to which antibiotic and what formula is used.

Talk to your healthcare provider about any reactions to antibiotics you've had in the past, and what to expect from these medications.

A Word From Verywell

Metronidazole gel is just one option when it comes to treating BV. It's just as effective as other medications used for this condition, but be aware that recurrence of the condition is common.

The medication you choose may depend on your past history with antibiotics and whether you are comfortable using intravaginal medications. Oral options of this medication are available.

Frequently Asked Questions

  • How long does it take for bacterial vaginosis gel to work?

    Metronidazole gel is given for five days for BV, but it's not uncommon for these infections to return or not clear up completely after initial treatment. You may need another round of antibiotics or a longer course of treatment.

  • What is the most effective treatment option for bacterial vaginosis?

    Antibiotics are the best treatment for BV. There are several formulas to choose from, and your healthcare provider can help you decide which is best for you.

  • What if bacterial vaginosis comes back after treatment?

    It's not uncommon for bacterial vaginosis to require repeated treatment. Talk to your healthcare provider if your symptoms don't clear up or return after you're done with your medication.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Bacterial vaginosis statistics.

  2. Centers for Disease Control and Prevention. Bacterial vaginosis: CDC fact sheet.

  3. Centers for Disease Control and Prevention. Bacterial vaginosis.

  4. National Institutes of Health. Metronidazole vaginal gel USP, 0.75%.

  5. Muñoz-Barreno A, Cabezas-Mera F, Tejera E, Machado, A. Comparative effectiveness of treatments for bacterial vaginosis: A network meta-analysis. Antibiotics. August 2021. 13;10(8):978. doi:10.3390/antibiotics10080978

By Rachael Zimlich, BSN, RN
 Rachael is a freelance healthcare writer and critical care nurse based near Cleveland, Ohio.