Bacterial Vaginosis: Treatment Overview

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Treatment Overview

Treatment options for bacterial vaginosis include:

• Watchful waiting. In about 1 out of 4 women, bacterial vaginosis symptoms resolve on their own.¹ This happens when the vaginal lactobacilli organisms increase to their normal levels, and other bacteria levels drop.
• Antibiotic medicine (oral or vaginal). Antibiotics can kill the problem bacteria causing bacterial vaginosis symptoms but sometimes don't reverse the underlying cause. Therefore, symptoms recur in about 1 out of 3 of women after antibiotic treatment.²

For some women, bacterial vaginosis goes away without treatment. But when it does not go away even with treatment, bacterial vaginosis is frustrating and troublesome. And, it can lead to preterm labor if you have it during pregnancy. If present during pelvic surgery or invasive vaginal procedures, bacterial vaginosis makes the reproductive tract vulnerable to infection or inflammation, which has been linked to such problems as pelvic inflammatory disease (PID).⁴ So your doctor will test and treat you with antibiotics for bacterial vaginosis if you are:

• Having persistent symptoms.
• Pregnant and have symptoms.
• Pregnant with no symptoms, but have a history of preterm labor (before 37 completed weeks of pregnancy) that may have been related to infection.⁶
• Planning to have a hysterectomy or surgical abortion. Treating bacterial vaginosis with antibiotics beforehand greatly lowers your risk of getting a serious infection afterward. Other procedures linked to bacterial vaginosis-related infection include endometrial biopsy, intrauterine device (IUD) placement, cesarean section, dilation and curettage (D&C), and hysterosalpingography, an X-ray test that examines the inside of the uterus, the fallopian tubes, and surrounding area.⁴

Talk to your doctor about whether screening is right for you.

What To Think About

If you are planning to become pregnant and have symptoms or a history of bacterial vaginosis, talk to your doctor about screening and treatment before you start a pregnancy.

Women should not breast-feed while taking tinidazole or for 3 days after they are finished taking this medicine.

For decades, some women have used Lactobacillus acidophilus in yogurt or supplements to treat bacterial vaginosis. But experts now know that dairy lactobacillus is not the kind that normally lives in the vagina. This is why dairy lactobacillus does not work for bacterial vaginosis. But researchers have found that two different types of lactobacillus—L. crispatus and L. jensenii—are most commonly found in a healthy vaginal environment. Research is now focusing on using these types of lactobacilli in capsules.⁷

If your doctor finds other problems during the exam, such as a possible sexually transmitted disease (STD), appropriate treatment will be recommended.

Since it probably is not passed between a man and woman, treating a male sex partner or partners will not help cure bacterial vaginosis.⁴ But for a woman with a female sex partner, it is possible that bacterial vaginosis is passed back and forth, although this is not yet proven. In this case, treating both partners may help.

Last updated:	March 17, 2008
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Kathleen Romito, MD - Family Medicine, Jeanne Marrazzo, MD, MPH - Infectious Disease
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC