Bacterial vaginosis (BV) is the most common vaginal infection among women between the ages of 15 and 44, affecting 23% to 29% of females of reproductive age. BV occurs when the natural bacterial environment of the vagina becomes imbalanced and leads to an overgrowth of “bad” bacteria and uncomfortable symptoms.

While symptoms may vary from person to person, the most commonly reported symptom is a change in vaginal discharge, described as a thin vaginal discharge with grey or milky coloring and a foul, fishy odor. BV can also cause vaginal discomfort, like itching, burning, or irritation, but some women can also not show symptoms. 

With prompt testing and medication, BV is treatable. Digital pharmacy platforms like TelyRx offer online ordering and delivery, allowing you to receive the treatment you need with discretion and privacy – and without sacrificing your health. In addition, there are also some measures you can take at home to reduce your symptoms, help clear the infection more efficiently, prevent reoccurrence, and manage your overall vaginal health. We’ll discuss how to safely treat BV at home based on current medical guidelines and recommendations.

Can You Treat BV At Home?

Yes, you can treat BV at home with prescription antibiotic medication that you take at home after first receiving a prescription from a healthcare provider. BV treatment is not available over the counter. Supplemental DIY methods may help relieve some symptoms short term, but prescription antibiotics are necessary to completely clear the infection. Any home remedies you use should align with your provider’s treatment recommendations and current medical guidelines.

Bacterial vaginosis is the most common vaginal health condition globally, affecting more than one-quarter of females of child-bearing age, so people who receive a BV diagnosis should not feel ashamed or self-conscious.

However, due to the sensitive nature of BV symptoms, wanting privacy while you treat this condition is understandable. Following the proper guidelines for BV treatment and supplemental remedies at home allows you to keep the matter as discreet as possible while effectively treating the infection and preventing complications.

Getting Diagnosed From Home With at-Home BV Tests

The vagina is moderately acidic and naturally has a balance of “good” and “bad” bacteria that coexist and help maintain a healthy environment to prevent infections. However, BV infections occur when the “bad” bacteria outnumbers the “good” bacteria, creating an imbalance. This imbalance can cause the vagina’s pH level to increase and become less acidic. Measuring the acidity of the patient’s vagina is a way to test for BV.

pH Tests

There are a variety of at-home BV tests available. Some at-home BV tests come with pH strips to measure vaginal acidity, which patients insert into their vagina like a tampon. These tests can yield an accurate pH reading in a matter of minutes.

The normal vaginal pH for women of child-bearing age is 3.8 to 5.0, which is considered moderately acidic. A pH range of 4.5 or higher signals a less acidic environment and is associated with BV. However, if your vaginal pH falls between 4.5 and 5.0, this test alone may not be sufficient for indicating the presence of BV, and further testing may be needed to confirm if BV is present.

Mail-In Tests

Other at-home BV tests, often called a PCR or NAAT test, require patients to collect a swab of their vaginal discharge, seal it, and mail it to a lab for analysis. These tests provide a detailed breakdown of the vagina’s ratio of good and bad bacteria, as well as identify certain organisms that commonly cause BV. 

While these types of tests are more accurate than a pH test alone, they are still not completely reliable for determining the presence of BV. Misleading results can occur if the bacterial overgrowth has not reached certain levels, or if a non-standard bacterial strain is causing the symptoms. Handling and cross-contamination errors can also affect mail-in BV screening results. 

Receiving a Diagnosis

The results of these tests should always be interpreted with a healthcare provider, who can help to determine if BV treatment is right for you. While an at-home pH test or mail-in test can help you determine whether your symptoms are related to BV, consulting a healthcare provider when you suspect you have BV is best for a thorough diagnosis and accurate treatment.  

When To Seek In-Person Care

Always seek medical care in-person if your symptoms change or worsen, as a thorough physical pelvic and vaginal examination may be needed to help accurately diagnose and guide care. Sometimes, untreated BV can cause harmful bacteria to spread deeper into the pelvis and reproductive organs, causing pelvic inflammatory disease or other infections.

Signs of persistent or worsening BV may include worsening vaginal discharge/odor, vaginal irritation, urinary symptoms, and can sometimes progress into severe lower abdominal or pelvic pain, a fever, chills, and nausea/vomiting. 

An in-person doctor’s visit is always the most accurate and often fastest way to get a thorough diagnosis. Your doctor may perform an exam, collect vaginal swab samples, and/or use additional diagnostic tools. These may include:

  • Microscopic analysis: Also called a “wet mount”, this is when a sample of vaginal discharge is placed onto a glass slide and analyzed in office for bacteria under a microscope. The bacterial ratio and presence of certain white blood cells in the sample can be signs of an infection. 
  • Whiff test: As part of the whiff test exam, technicians mix a sample of vaginal discharge with chemical agents to see which type of smell it produces. A strong or fishy odor can indicate the presence of BV.
  • PCR test: A polymerase chain reaction (PCR) test uses a vaginal discharge sample to check for genetic material from harmful bacteria. A PCR test also can be used to diagnose other vaginal infections, such as yeast infections or STIs. While this test provides the most information and accuracy, it can cost significantly more than other tests available, which is why other alternative testing methods may be used.

Prescription BV Treatment You Can Use At Home

There are prescription oral and topical options for treating BV.

Currently, there are no treatments for BV that are available over-the-counter, and the only treatment for BV requires an antibiotic prescription from a medical provider. These prescriptions are available in either an oral pill form or as a vaginal gel/suppository, which the provider will prescribe based on your preference and pregnancy status. The most common and first-line prescribed medications for treating BV include:

  • Metronidazole (oral pill or vaginal gel): Metronidazole is a prescription-strength antibiotic and antiprotozoal medication used to treat various bacterial and parasitic infections, and is one of the most common treatments for BV. It works as a prodrug to enter bacterial and parasitic cells, release chemicals that break DNA strands, and kill the cells. This can be given as an oral pill that you take twice a day for 7 days, or as a vaginal suppository gel that you insert once nightly before bed for 5-7 days. Both are just as effective and depend on preference and tolerance. 
  • Clindamycin (vaginal cream): Clindamycin is a lincosamide antibiotic used to treat serious bacterial infections. It works by binding to bacterial ribosomes and blocking protein synthesis, which prevents the bacteria from multiplying and producing toxins. It is available in both a pill form as well as a vaginal cream.

Metronidazole and clindamycin are the most commonly prescribed medications for treating BV, but they are not the only options. Your provider may suggest alternative regimens with other medications, such as secnidazole or tinidazole, based on your health history and severity of the infection. However, these medications are typically used as second or third-line options. 

Ordering your prescribed BV treatment online is a quick, convenient process and allows for discretion in getting your treatment. The digital pharmacy platform you choose will ship the medication directly to your door, so you won’t have to wait in line to pick it up, and many platforms offer simple refill options to assist with ongoing medical needs. 

Oral Metronidazole vs. Vaginal Gel vs. Clindamycin Cream

The three first-line and recommended regimens by the CDC for the treatment of BV are: oral metronidazole, intravaginal metronidazole gel, or intravaginal clindamycin cream. All of these options have shown to be equally as effective in treating BV, but the choice of medication is individualized based on the patient’s preference, tolerance, cost, and medical history. 

  • Oral metronidazole: The standard course for metronidazole oral capsules is 500 mg, taken two times a day for 7 days. This formulation is systemic, meaning medication enters the bloodstream and travels throughout the body. While this helps ensure efficacy, it also increases the risk of whole-body side effects, and commonly can cause stomach upset, like nausea, diarrhea, vomiting, and stomach cramps. Metronidazole can also cause a severe adverse reaction if taken with alcohol, so standard guidelines recommend limiting or avoiding alcohol during the course. This may be an important consideration if you consume alcohol or are sensitive to GI upset with medications.
  • Metronidazole vaginal gel: Per standard guidelines, 0.75% metronidazole vaginal gel is administered directly into the vagina with a tampon-like applicator once a day (usually before sleeping) for 5 days. This topical medication provides direct local treatment without the systemic effects that the oral metronidazole pill may cause, and the treatment course is shorter compared to oral pills, which can be desirable for patients. However, some patients may not feel comfortable with vaginal medication insertion, or may report mild burning or irritation after application.
  • Clindamycin vaginal cream: For treating BV, doctors typically recommend administering 2% clindamycin cream into the vagina with an applicator at bedtime for 7 days. Like metronidazole vaginal gel, the cream is a topical medication that provides direct local relief without entering the bloodstream and causing systemic side effects. It is also a suitable alternative for people who cannot tolerate oral medications, or have allergies to metronidazole. Users should note that the cream can weaken latex condoms and diaphragms, so a backup birth control method is recommended.

As with any antibiotic, there is a risk of developing a secondary infection because while the antibiotic clears the infection-causing bacteria, it can also clear good, protective bacteria. This can lead to secondary infections. 

Both metronidazole and clindamycin treatments for BV can equally disrupt the protective bacteria flora in the vagina and may cause a vaginal yeast infection. Be sure to monitor your symptoms and let your provider know if you develop signs of a vaginal yeast infection during or after your treatment, which may include thick, white curd-like vaginal discharge, severe itching, and vaginal irritation. 

DIY Home Remedies For Treating BV

At-home methods may help soothe BV symptoms, but they do not replace prescription care to clear the infection.

For people experiencing a BV infection, symptoms can be extremely bothersome, and relief from symptoms cannot come soon enough. While some mild or asymptomatic BV cases can resolve on their own without medical intervention, most cases require prescription-strength antibiotics, and delaying medical intervention can make the infection harder to clear. 

If you are struggling with BV symptoms, there are a few supplemental DIY methods you can employ at home to get relief, prevent complications, and prevent recurrence while your prescription medication works on clearing the infection. Any home remedies you use should align with your doctor’s recommendations.

Supplements For BV

Unlike prescription medications, supplements do not require a prescription, but are also not FDA-approved to treat or cure specific conditions. However, when used in accordance with provider instructions, many supplements have been shown to complement prescription treatments. These include:

  • Probiotics
  • Boric acid
  • Garlic tablets

Probiotics

Because antibiotics kill both good and bad bacteria, helping to restore the good levels of bacteria can help prevent complications and recurrent infections. As an add-on to prescription antibiotics approved by your doctor, probiotic supplements can help with BV and prevent recurrence by restoring the level of Lactobacillus bacteria, which is the main “good” bacteria that helps maintain an acidic pH and healthy environment in the vagina. Probiotics used for this purpose are available as oral capsules or vaginal suppositories.

You can also find natural probiotics in foods, such as yogurt and kefir. Current research suggests taking probiotics consistently for at least 1 to 3 months may help prevent BV symptoms from returning. Keep in mind that when taking antibiotics, it’s best to wait a few hours before taking probiotics so that your medication does not kill the beneficial in from the probiotic.

Boric Acid

Boric acid works as an intravaginal suppository to lower the vaginal pH and break down the protective biofilm around bacteria. While there is some evidence that boric acid supplements may be effective as an adjunct treatment to antibiotics and help prevent recurrent BV infections, they are not recommended as a substitute to antibiotic treatment.

Instead, boric acid supplements may help prevent recurrent BV once the initial infection has been cleared. These are available over-the-counter, and standard regimen recommend taking a 600mg boric acid vaginal suppository daily for 14 days. Boric acid should only be taken intravaginally because it is toxic if taken orally. Inform your doctor if you are expecting or planning to conceive before beginning boric acid supplements.

Garlic Tablets

Some small study research suggests that taking oral garlic tablets can help clear BV. Garlic contains allicin and other bioactive compounds with natural antibacterial and antimicrobial properties. However, these tablets are not meant as an alternative or replacement for prescription antibiotics recommended by your doctor.

In addition, despite what you may see recommended online, do not insert raw garlic into the vagina because it can harm the delicate tissues. Speak with your provider to determine whether or not you should take the tablets based on your medical history, as garlic supplements can increase bleeding risk and interact with certain medications.

Good Practices For Soothing and Preventing BV

In addition to supplements you can take at home to alleviate BV symptoms, there are a few habits and lifestyle changes that can make you feel more comfortable and help prevent infections from recurring in the future. 

  • Avoid douches and other scented products. The vagina naturally self-cleans in a way that does not drastically change the pH or cause a bacterial imbalance. Using a douche or scented soaps can wash away “good” bacteria, change the pH balance, and lead to BV. It is recommended to only wash the outside of the vagina with warm water and mild, unscented soap.
  • Wear breathable underwear. Some fabrics trap heat and moisture, creating ideal environments for harmful bacteria to multiply. Breathable undergarments don’t trap as much heat and moisture, so they can help relieve symptoms and prevent recurrence. Pure cotton underwear or loose-fitting styles with a cotton gusset are recommended. It is advised to avoid tight-fitting underwear made of synthetic fabrics, and to change out of damp workout clothing immediately after exercising.
  • Eat more probiotics, like yogurt and kimchi. Probiotic foods like kimchi and some yogurts add “good” bacteria to your gut biome to maintain a healthy pH balance in the vagina and elsewhere in the body. These bacteria produce lactic acid to keep pH on the acidic side. A balanced diet with probiotic food can also contribute to your overall health. 
  • Practice safe sex and avoid sexual contact during treatment. While BV is not considered a sexually transmitted infection (STI) because you can get BV without being sexually active, having unprotected sex with partners of any gender introduces new bacteria and increases your risk of BV infections. It also can make your body more vulnerable to catching other STIs. Using condoms and limiting sexual partners can help prevent BV. It is also important to abstain from sexual activity during BV treatment to prevent recurrence.

Why BV Keeps Coming Back

While proper treatment with antibiotics is highly effective in curing BV, recurrence of BV is very common, with more than half of women reporting a repeat infection within 12 months of treatment. While there are many reasons and factors that can contribute to frequent or recurrent BV infections, not completing the entire prescribed antibiotic course is a common reason for BV recurrence. Standard prescriptions for treating BV with antibiotics involve a course of 5 to 7 days with once- or twice-daily dosages. 

Symptoms may begin to clear up before the planned end date, prompting some people to quit the course early under the belief that the infection has cleared. However, standard guidelines for antibiotic prescriptions, including BV treatment, strictly instruct patients to complete the entire course to ensure all of the bad bacteria is killed. Stopping the medication too early can lead to incomplete treatment and cause antibiotic resistance, which can make antibiotic treatment ineffective or more difficult in the future.

Unprotected sex and resuming sexual activity before treatment is complete can also lead to BV recurrence. Sexual activity exposes the vagina to bacteria and disrupts bacterial balance, which can raise the vagina’s pH and lead to BV. It is important to abstain from sexual activity for the full duration of antibiotic treatment. Other potential reasons include using douches or scented soaps that wash good bacteria out of the vagina, and hormonal shifts due to pregnancy, menstrual cycles, menopause, or birth control that can affect the vaginal pH. 

Getting BV Treatment From Home, Fast and Discreet

Those looking for privacy and discretion in getting their BV treatment may want to consider a digital pharmacy platform. For example, TelyRx offers more than 500 FDA-approved medications, including BV treatments like metronidazole, clindamycin, and other antibiotics. TelyRx also prioritizes your safety and privacy with LegitScript certification and HIPAA-level privacy protections. Our pharmacies in Florida and Texas are also fully licensed, and every prescription is filled by a knowledgeable licensed pharmacist before being shipped to your door. 

Your Next Steps

Dealing with BV can be uncomfortable and stressful, but the condition is treatable with proper care. If you are experiencing symptoms of BV, or you’ve taken an at-home test and the results suggest the presence of BV, it is recommended to schedule an appointment with your doctor as soon as possible for prompt and appropriate treatment. Delaying care can lead to worsening infection and other complications, which may lead to harder treatment in the future. 

When considering complementing your prescription treatment with supplements and at-home remedies, be sure to always check with a healthcare provider for guidance to ensure there are no potential drug interactions with other medications you may be taking.