BV, or bacterial vaginosis, is the most common reason for unusual vaginal discharge in women of childbearing age. It isn't an STI and it isn't dangerous, but the smell and discharge can be miserable, and it often comes back. A short course of antibiotic tablets usually clears it within a week. At MedsRus you can request metronidazole for BV through a quick online consultation. A UK prescriber checks every request before anything is dispensed.
What is BV?
Your vagina normally has a healthy mix of bacteria, mostly a type called lactobacilli. They keep it slightly acidic, which keeps other bacteria in check. BV happens when that balance tips and other bacteria, such as Gardnerella, overgrow.
It's very common. It isn't caused by poor hygiene. In fact, washing too much can make it more likely.
BV symptoms
About half of women with BV don't notice anything. When there are symptoms, they're usually:
- a strong fishy smell, often worse after sex or during your period;
- thin, watery discharge that may look white or grey;
- a change in how your discharge looks or smells compared with normal for you.
BV doesn't usually cause itching or soreness. If you're itchy and sore, with thick white discharge, it's more likely to be thrush. Our guide to BV or thrush explains the differences.
| BV | Thrush | |
|---|---|---|
| Smell | Strong, fishy | Usually none |
| Discharge | Thin, watery, white or grey | Thick, white, like cottage cheese |
| Itching or soreness | Not usually | Yes, often |
| Treatment | Antibiotics (metronidazole) | Antifungals (fluconazole, clotrimazole) |
What causes BV?
Nobody knows exactly why the balance changes, but some things make BV more likely:
- a new sexual partner, or more than one partner;
- douching, or using perfumed soaps, bubble bath or vaginal washes;
- having an IUD (the coil);
- smoking.
You can't catch BV from toilet seats, swimming pools or bedding. Men don't get BV, but having sex with a new partner can still change the bacteria in your vagina. Women who have sex with women can pass it between each other.
How to treat BV
Metronidazole tablets
The most common treatment is an antibiotic called metronidazole. The usual course is one 400mg tablet twice a day for 7 days. Sometimes a prescriber will choose a single larger dose or a 5-day course instead.
- Take the tablets with or just after food, and swallow them whole.
- Finish the course, even if you feel better after a few days.
- Don't drink alcohol during the course or for 48 hours after the last tablet. Together they can make you very sick, flushed and breathless. Our article on drinking alcohol with antibiotics explains why.
Most people notice the smell and discharge improve within 2 to 3 days.
Other options
If tablets don't suit you, a prescriber may suggest a metronidazole gel or clindamycin cream you use inside the vagina. Our comparison of metronidazole and tinidazole covers another antibiotic that's sometimes used.
Can BV go away on its own?
Sometimes, yes, especially if you have no symptoms. But if it's bothering you, or you're pregnant, it's worth treating.
Side effects of metronidazole
Most people are fine, but common side effects include:
- feeling sick;
- a metallic taste in your mouth;
- an upset stomach or diarrhoea.
Stop taking it and get help straight away if you have signs of a serious allergic reaction, such as swelling of your face, lips or throat, or difficulty breathing.
Who might need a GP or sexual health clinic instead?
Our consultation will flag these, but it's worth knowing that you should see your GP, a sexual health clinic or your midwife if:
- you're pregnant or might be;
- you have pelvic or tummy pain, a high temperature, or bleeding between periods or after sex;
- you think you might have an STI;
- you've had BV more than twice in 6 months.
Why does BV keep coming back?
BV returns for more than half of women within a few months of treatment. It's frustrating, but it doesn't mean the treatment failed or that you've done anything wrong. These things can help:
- wash the area with plain water or an unperfumed soap, once a day;
- use showers rather than baths if you can, and avoid bubble bath and vaginal deodorants;
- don't douche;
- use condoms with new partners;
- if you smoke, stopping helps.
Some people try lactobacilli supplements or lactic acid gels. The evidence for them is mixed, but they're unlikely to do harm. If BV keeps returning, your GP can talk to you about longer treatment.
How to order BV treatment from MedsRus
- Fill in a short consultation. It asks about your symptoms, your health and any medicines you take.
- A UK prescriber reviews it. If metronidazole is right for you, they'll write a prescription. If it isn't, we'll tell you why and what to do next.
- Our pharmacy sends it in plain packaging, with nothing on the outside that says what's inside.
We can't supply any medicines through our online service if you're pregnant. Please see your GP or midwife.
BV FAQs
What is BV?
Bacterial vaginosis is a common imbalance of the normal bacteria in the vagina. It causes a fishy-smelling, thin discharge. It isn't an STI.
How do you get BV?
It happens when the "good" lactobacilli bacteria drop and other bacteria overgrow. New partners, perfumed washes, douching, the coil and smoking all make it more likely.
Can I cure BV in one day?
Not quite. A single large dose of metronidazole is sometimes prescribed, but symptoms still take a couple of days to settle. Most people feel better within 2 to 3 days of starting treatment.
Can men get BV?
No. Men don't get BV, and male partners don't need treatment. Female partners may need to be checked if they have symptoms.
Is BV an STI?
No, but it's linked to sex, and having BV can make it slightly easier to catch an STI. If you're worried about STIs, get tested.
Can I have sex while being treated for BV?
You can, but it may be uncomfortable, and you might prefer to wait until the course is finished.
Does BV affect pregnancy?
BV in pregnancy is linked to a higher chance of early labour. We can't supply any medicines online if you're pregnant, so please speak to your midwife or GP.
Can I drink alcohol while taking metronidazole?
No. Avoid alcohol during the course and for 48 hours afterwards.
Can I buy BV treatment over the counter?
Lactic acid gels and pH-balancing gels are sold over the counter and may ease mild symptoms or help stop BV coming back. Metronidazole, the antibiotic that clears BV, is a prescription medicine. A UK prescriber can review your online consultation and prescribe it if it's suitable.
Further reading
Sources: