BV treatment: what works and what to skip

Bacterial vaginosis (BV) is common — it affects about 30% of women of reproductive age in many surveys. It usually causes thin gray discharge, a fishy smell, or light irritation. The good news: most cases respond well to simple, well-known treatments. Below I’ll explain the best medical options, sensible home care, and when you should get checked by a clinician.

Medical treatments that actually work

First-line therapy is often metronidazole (Flagyl) — given as an oral course (usually 500 mg twice daily for 7 days) or as a 0.75% vaginal gel for 5 days. Both work well; the gel can mean fewer system-wide side effects. If metronidazole causes bad nausea or you’ve had side effects before, clindamycin (vaginal cream or oral) is a solid alternative. Tinidazole is another oral option sometimes used for recurrent cases.

For people with frequent relapses, doctors may prescribe a longer or suppressive regimen — for example, one dose per week of topical metronidazole for a few months. Don’t try irregular or low-dose antibiotic plans on your own. Incorrect dosing can cause resistance, continued symptoms, or yeast overgrowth.

Home care, prevention, and safe remedies

Avoid douching, scented soaps, and aggressive washes — they disrupt the vagina’s balance and make BV more likely. Wear breathable cotton underwear and don’t stay in wet swimsuits or sweaty gym clothes for long. Using condoms consistently can lower the chance of recurrence in some people.

Probiotics get talked about a lot. Vaginal Lactobacillus products or oral lactobacillus supplements can help restore healthy flora for some people, but results vary. Think of probiotics as supportive, not a replacement for antibiotics when you have symptoms.

Boric acid suppositories are used by some women with recurrent BV that doesn’t respond to antibiotics. They can help, but boric acid is toxic if swallowed and is NOT recommended during pregnancy. Always check with a provider before trying boric acid.

If you’re buying medications online, use a reputable pharmacy and make sure a prescription is required when appropriate. Fake or low-quality antibiotics are real risks.

When to see a doctor? Get checked if you have a new, strong odor, unusual discharge, burning with urination, or pelvic pain. Also see your clinician if symptoms return within a month after treatment or keep recurring. BV in pregnancy needs careful discussion with your provider because it can be linked with preterm birth in some studies.

Quick checklist: get tested if you’re symptomatic, follow a full antibiotic course, avoid douching and scented products, consider probiotics as a supplement, and talk to your clinician about suppressive therapy if BV keeps coming back. Small changes in hygiene and timely treatment can cut down many repeat episodes.

If you want, I can walk you through the typical prescriptions, side effects to watch for, or steps to find a reliable online pharmacy. Which would help most right now?