Bacterial Vaginosis
Commonly treated with Metronidazole & Clindamycin
Bacterial vaginosis (BV) is a common vaginal condition caused by an imbalance in the bacteria that normally live in the vagina. It often causes a thin gray or white discharge with a fishy odor. Prescription bacterial vaginosis treatment is available online after a licensed provider reviews your health information.
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Medically reviewed by David Paul Mackarey, RPh, Pharmacist-in-Charge — Last updated July 15, 2026
Choosing and Using Your Treatment
| Treatment | Choose this if… | How to Take |
|---|---|---|
| Metronidazole 0.75% Vaginal Gel | A first-line vaginal option with a shorter course and fewer whole-body side effects than oral tablets. | Insert one applicatorful (5 grams) vaginally once daily at bedtime for 5 days. |
| Clindamycin 2% Vaginal Cream | A first-line vaginal option for those who cannot take or tolerate metronidazole. | Insert one applicatorful (5 grams) vaginally at bedtime for 7 days. |
| Metronidazole 500mg | A first-line oral option if you prefer taking a tablet over using a vaginal product. | Take 1 tablet by mouth twice daily for 10 days. Do not drink alcohol while taking this medication. |
About Bacterial Vaginosis (BV)
Bacterial vaginosis is the most common cause of unusual vaginal discharge in women of reproductive age. It happens when the normal balance of vaginal bacteria shifts — protective lactobacilli decrease while other bacteria overgrow. BV is not a yeast infection, and the two conditions are treated with different medications. Many people with BV have mild symptoms or none at all, but for others the discharge and odor are bothersome and persistent. While BV sometimes goes away on its own, untreated bacterial vaginosis can raise the risk of sexually transmitted infections and complications during pregnancy. Prescription antibiotics — taken by mouth or applied vaginally — are the standard treatment.
Signs & symptoms
- Thin gray, white, or greenish vaginal discharge
- A strong fishy odor, often more noticeable after sex
- Vaginal itching or irritation
- Burning during urination
- Discharge that coats the vaginal walls
- Some people have no symptoms at all
Causes & risk factors
- An imbalance of the bacteria that naturally live in the vagina
- A drop in protective lactobacilli and overgrowth of other bacteria
- Douching, which disrupts normal vaginal bacteria
- Having a new sex partner or multiple sex partners
- Not using condoms consistently
- Natural lack of lactobacilli in some women
Prevention
- Avoid douching — it disturbs the vagina's natural bacterial balance
- Limit the number of sex partners and use condoms consistently
- Avoid scented soaps, sprays, and washes in the genital area
- Wipe from front to back after using the bathroom
- Finish the full course of any prescribed BV treatment
- See a provider promptly if symptoms return after treatment
When to see a doctor
Online treatment can be a good fit if you have typical BV symptoms — thin discharge with a fishy odor — especially if you have had BV diagnosed before and recognize the symptoms. In-person care is a better choice if this is your first episode, if symptoms could be a sexually transmitted infection, if you are pregnant, or if you have pelvic pain, fever, or bleeding between periods. Seek prompt medical attention for severe pelvic or abdominal pain, fever with vaginal symptoms, or symptoms that persist or worsen after finishing treatment, since these can signal a different or more serious condition.
Oral vs. Vaginal BV Treatment
All first-line bacterial vaginosis treatments are similarly effective when the full course is completed. The best choice usually comes down to personal preference and tolerability.
| Option | How it's used | Considerations |
|---|---|---|
| Metronidazole tablets | Taken by mouth for 7 days | Convenient; avoid alcohol during treatment and for at least 24 hours after; may cause nausea or a metallic taste |
| Metronidazole vaginal gel | Inserted vaginally for 5 days | Shorter course; fewer whole-body side effects than tablets |
| Clindamycin vaginal cream | Inserted vaginally for 7 days | Useful if metronidazole isn't tolerated; oil-based and can weaken latex condoms during use |
What to expect after treatment
Symptoms usually improve within a few days, but it is important to finish the entire course even if you feel better. BV recurs in many people within 3 to 12 months; if symptoms return, contact a provider rather than reusing leftover medication, since a different or longer regimen may be appropriate.
Sources & References
Frequently Asked Questions
What is bacterial vaginosis?
Bacterial vaginosis (BV) is a vaginal condition caused by an imbalance of the bacteria that normally live in the vagina. Protective bacteria decrease while other bacteria overgrow, which can cause discharge and odor. It is the most common cause of unusual vaginal discharge in women of reproductive age.
What causes bacterial vaginosis?
BV develops when the natural balance of vaginal bacteria is disrupted. The exact trigger isn't always clear, but douching, having a new sex partner or multiple partners, and not using condoms are linked to a higher risk. It is not caused by poor hygiene.
Is bacterial vaginosis an STD?
BV is not classified as a sexually transmitted disease, but sexual activity is associated with it. It rarely occurs in people who have never been sexually active, and new or multiple partners increase the risk. Having BV can also make it easier to acquire actual STIs, so testing may be recommended.
Can bacterial vaginosis go away on its own?
Sometimes mild BV resolves without treatment, but it often persists or returns. Untreated bacterial vaginosis can increase the risk of sexually transmitted infections and pregnancy complications. If you have symptoms, prescription treatment is generally recommended.
Can men get bacterial vaginosis?
Men cannot get BV because it is a condition of the vaginal bacterial environment. Male partners are not routinely treated. However, BV can be passed between female partners, so a female partner with symptoms should also be evaluated.
How to treat bacterial vaginosis at home?
There is no proven over-the-counter or home remedy that reliably clears BV. Standard treatment is a prescription antibiotic, such as oral metronidazole, metronidazole vaginal gel, or clindamycin vaginal cream. Avoid douching or scented products, which can make the imbalance worse.
Why do i keep getting bacterial vaginosis?
Recurrence is common — BV returns within a year in a large share of people even after successful treatment. Contributing factors can include douching, new or multiple partners, and the natural makeup of your vaginal bacteria. If BV keeps coming back, talk to a provider, as longer or repeat treatment plans are sometimes used.
Can bacterial vaginosis cause bleeding?
BV does not typically cause vaginal bleeding. If you notice bleeding between periods or after sex along with discharge, see a provider in person, since bleeding can point to another cause such as an infection of the cervix or another gynecologic condition.
Treatments for Bacterial Vaginosis
Find out more information about each treatment.