OTC Treatments for BV
Written By: Jillian Foglesong Stabile MD, FAAFP
BV is a vaginal infection caused by overgrowth of the bacteria that normally live in the vagina. [1] These bacteria aren’t innately good or bad; they’re just out of balance. Usually, this means there are more anaerobic (non-oxygen-loving bacteria) than aerobic (oxygen-loving bacteria). Getting medical treatment can take time, so you may be wondering about OTC treatments for BV. Read on for current information about these options.
OTC Treatment for BV
You might be wondering about over-the-counter treatment for BV, and if there are any options to avoid antibiotics? Unfortunately, there are currently no OTC treatments approved by the Food and Drug Administration (FDA), however, there are several over the counter treatments that have been examined.
Probiotics
Probiotics are bacterial supplements that are designed to try to replenish the “good” bacteria in the vagina. The bacteria are ingested either through food or supplements. One of the challenges in the use of probiotics for conditions such as BV is that the studies vary in terms of which strains are used. Many different strains have been studied, and the protocols vary widely. [6] Most studies use the bacteria Lactobacillus. Another concern is whether bacteria ingested orally can reach the vaginal microbiome. It is believed that some bacteria may reach the vaginal microbiome through the gastrointestinal tract. The two areas share many common species of bacteria.
Delivering the bacterial supplement vaginally may show some increased benefit over the oral preparations, but the data is limited and, at this time, insufficient to recommend the use of probiotics for the treatment of BV, though they may hold more promise in the prevention of recurrent infection. [6]
Vaginal Microbiome Transplantation
Vaginal microbiome transplantation is based on a concept similar to fecal transplantation for the treatment of infections of the colon. This treatment has primarily been studied for recurrent BV. Limited studies have shown some promise, and they are ongoing. [6]
pH Modulation
The most common bacteria in the vaginal microbiome are Lactobacillus. These bacteria help keep the vaginal pH at an acidic level. The bacteria that overgrow and cause BV infection grow better in a less acidic environment. Researchers have evaluated whether decreasing the vaginal pH would benefit people affected with BV. [6] These studies have not shown any reliable benefit for the treatment of BV.
Biofilm Disruption
Researchers have postulated that recurrent BV may be due to the development of a biofilm in the vaginal mucosa. [6] There have been studies to see whether medications can disrupt this biofilm. The studies show promise, but the medications are not available in the United States. [6]
Boric Acid
Intravaginal boric acid is another treatment under evaluation for treating BV and yeast. This treatment has been studied for use in both recurrent and difficult-to-treat cases. [7] Research is ongoing, but at this time, boric acid is not recommended for routine treatment of BV, although it may have some benefits for recurrent or treatment-resistant infections. [8] The biggest challenge is that studies have not yet determined what dosing and frequency is best to manage recurrent and treatment-resistant infections.
Prescription Treatment for BV
Bacterial vaginosis should be treated with antibiotics if symptoms are present. Asymptomatic vaginosis should be treated in people who are pregnant. [5] The best option for treating BV is antibiotics, which require a prescription from a healthcare provider. Having BV can make you more susceptible to sexually transmitted infections such as gonorrhea, chlamydia, human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV). [5]
There are several treatment regimens that your healthcare provider may prescribe. These include:
- Metronidazole (Flagyl) oral (500mg two times daily for seven days)
- Metronidazole vaginal gel (0.75%, 5grams vaginally daily for five days)
- Clindamycin vaginal cream (2%, 5grams vaginally for seven days)
- Clindamycin orally (300mg orally twice daily for seven days)
- Clindamycin ovules (100mg vaginally for three days)
- Secnidazole (2 grams orally in a single dose)
- Tinidazole (2 grams orally daily for two days or 1 gram orally for 5 days)
If BV is present, the Centers for Disease Control and Prevention (CDC) also recommends testing for sexually transmitted infections such as HIV, syphilis, gonorrhea, and chlamydia. [5]
If BV goes untreated, it can set you up for potentially serious complications. These include [3]:
- Inflammation or infection of the uterus or fallopian tubes
- Increased risk of contracting sexually transmitted infections
- Increased risk of infections after surgery
- Increased risk of preterm labor, premature rupture of membranes, and postpartum uterine infections
- Developing pelvic inflammatory disease
- Increased risk of infections in the newborn
These complications are reasons that it is important to treat symptomatic BV and asymptomatic pregnant people.
Is BV an STD?
Though bacterial vaginosis is often grouped into discussion with sexually transmitted diseases, it is not a sexually transmitted infection. [2] BV is simply an imbalance of the normal vaginal flora. BV is also not a yeast infection. Yeast infections occur when the yeast is out of balance with the bacteria, whereas BV occurs when the bacteria are out of balance. [1]
Who is at Risk for BV?
Bacterial vaginosis is an extremely common infection. Bacterial vaginosis may occur in up to 35% of women and people assigned female at birth(AFAB). This makes the condition the most common vaginal problem for this population. [1] Other factors that increase your risk for BV include:
- Pregnancy
- Intercourse without the protection of condoms or dental dams
- Having an intrauterine device (IUD)
- Having sex with multiple partners
- Having sex with a new partner
- Having a partner AFAB
- Use of douches
- Use of antibiotics
For some people, the use of sex toys, especially if not sanitized, may increase the risk of BV. [2]
What are the Symptoms of BV?
Many people with BV have no symptoms. This is the case for more than 80% of people. [2,3]
For people who do have symptoms associated with BV, The most common symptoms include [1]:
Vaginal discharge, usually greenish or gray Vaginal itching, burning, or irritation Burning or pain with urination Fishy odor from the vaginal area, especially after having sex
Many of the symptoms of BV can mimic the symptoms of other infections, such as sexually transmitted infections and yeast infections. This can make it more difficult to diagnose BV, and the treatment varies based on the cause of the infection. [4]
How is BV Diagnosed?
Bacterial vaginosis can sometimes be diagnosed based on history and symptoms, but it can be difficult to make this determination because the symptoms are so similar to other infections. Confirming a diagnosis of BV often requires an exam and laboratory testing.
If your healthcare provider feels it necessary to do a pelvic exam, they will examine the skin around the vagina and possibly the vaginal mucosa. This may mean putting a speculum inside the vagina to evaluate the amount of discharge as well as look for any irritation of the vaginal tissues. The exam may also include putting gloved fingers inside the vagina to palpate the uterus and ovaries.
Your healthcare provider may also take a sample of the fluid to examine under a microscope or send to a laboratory to evaluate the types of bacteria present in the fluid. They may also perform a whiff test during which they smell the discharge to determine if a fish-like smell is present. [1]
Take Control of Your Vaginal Health With Everlywell
Bacterial vaginosis disrupts your normal vaginal balance. The symptoms can significantly impact your quality of life and lead to long-term complications. The symptoms of bacterial vaginosis can also mimic other infections.
At Everlywell, we’re here to support you in your healthcare journey. With our bacterial vaginosis online treatment option, you can seek care from a licensed healthcare provider from the comfort of your home without the hassle of driving to your healthcare provider or having an invasive exam. You simply fill out a form submitting your medical information and symptoms. One of our healthcare providers will review the information and provide a clinical evaluation. If appropriate, a prescription will be sent to your pharmacy.
Have more vaginal health concerns? Consider scheduling a virtual care visit to discuss your health with one of our certified healthcare professionals.
References
- Bacterial vaginosis. Cleveland Clinic. Published May 1, 2024. Medical Citation URL.
- What is Bacterial Vaginosis? Causes and Symptoms of BV - Blog | Everlywell: Home Health Testing Made Easy. Medical Citation URL.
- Kairys N, Carlson K, Garg M. Bacterial vaginosis. StatPearls - NCBI Bookshelf. Published May 6, 2024. Medical Citation URL.
- About Bacterial vaginosis (BV). Centers for Disease Control and Prevention. Published December 11, 2023. Medical CIation URL.
- Bacterial Vaginosis - STI Treatment Guidelines. Centers for Disease Control and Prevention. Medical Citation URL.
- Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Frontiers in Reproductive Health. 2023;5. doi:10.3389/frph.2023.1100029. Medical Citation URL.
- Müller ML, Petersen CD, Saunte DML. Boric Acid for the Treatment of Vaginitis: New Possibilities Using an Old Anti‐Infective Agent: A Systematic review. Dermatologic Therapy. 2024;2024(1). doi:10.1155/2024/2807070. Medical Citation URL.
- Powell A, Ghanem KG, Rogers L, et al. Clinicians’ use of intravaginal boric acid maintenance therapy for recurrent vulvovaginal candidiasis and bacterial vaginosis. Sexually Transmitted Diseases. 2019;46(12):810-812. doi:10.1097/olq.0000000000001063. Medical Citation URL.