Active ingredients
Two main antibiotics treat BV: clindamycin and metronidazole. Clindamycin works by preventing the formation of protein bonds, which inhibits protein synthesis. This stops the bacteria from growing. At higher concentrations, it may also kill the bacteria.
Metronidazole, on the other hand, works slightly differently. It enters the bacterial cell and disrupts DNA synthesis, leading to bacterial death.
When clindamycin and metronidazole were compared in a study, both were shown to be similarly effective. The occurrence of side effects in both groups was also similar, with no significant differences between the two treatments.
Lactic acid
Lactic acid is another treatment that may help treat BV. In a healthy vagina, lactic acid is naturally produced by Lactobacillus bacteria. But in BV, the imbalance of bacteria causes the vaginal pH level to rise, creating an environment where harmful bacteria can thrive. Lactic acid helps lower the pH level, helping restore the vaginal microflora.
However, there's limited scientific evidence to support its use as a standalone treatment. When compared with metronidazole, lactic acid was found to be less effective at resolving BV symptoms. While it may not be beneficial as a primary treatment, it can be used alongside antibiotics to help relieve symptoms and as a preventative measure to reduce the risk of recurrence.
Furthermore, lactic acid can be particularly useful in preventing BV in pregnant women, who are more prone to infection due to hormonal changes. BV in pregnancy can cause serious complications, such as preterm delivery. If you’re prone to BV, your doctor may suggest using lactic acid.
Forms
Antibiotic treatment for BV includes pessaries and tablets. Typically, oral metronidazole is the first line of treatment. Since oral antibiotics work throughout your whole body, they are stronger than topical antibiotics, which only work in one particular area.
Alternative choices include intravaginal antibiotics which are taken via the vagina. Depending on the medicine, they contain either metronidazole or clindamycin phosphate, like Dalacin 2% cream.
Some women might find using intravaginal gels/creams uncomfortable, but they offer certain benefits. They tend to work faster than oral ones as they don’t have to be digested and travel through your body. Additionally, you're less likely to experience side effects like stomach discomfort, or any side effects you do get may be milder.
Time to clear
With antibiotics, your symptoms should improve within a few days and your infection should be cleared within a week. If your symptoms persist after a week, or get worse, contact your doctor or healthcare provider.
