- Antibiotics can be used to treat BV but they might also increase the chances of its recurrence.
- Antibiotics might cause dysbiosis in vaginal microflora, kill good bacteria, and eventually might lead to bacterial resistance.
- Metronidazole, Clindamycin, and Tinidazole are the first line of treatment options for BV.
- Some alternatives for BV prevention; Boric acid, Probiotics+Prebiotics, avoiding douching, avoid unprotected sex.
Scientists often say that bacteria residing on earth can easily outnumber the stars shining in our galaxy. Some also give an estimated number of 5 trillion and one can only imagine the exposure we have with these microorganisms. Therefore, antibiotics can be a blessing especially for those who are suffering from acute life threatening infections.
However, antibiotics are often referred to as weapons of mass destruction in the pharmaceutical world. Why? Because they might not differentiate between good and bad bacteria, they might increase the risk of bacterial resistance, and might also cause adverse reactions. Let’s see how antibiotics aren’t always the best choice when it comes to treating BV infection.
What is Bacterial Vaginosis or BV
Bacterial Vaginosis is defined as the dysbiosis of good and bad bacteria in your vagina. This condition can be characterized by thin and milky white to grayish discharge. The discharge has a foul unusual odor which is a clear indicator that you might have contracted BV.(1) If you want to know more about BV, here’s our ultimate guide.
Under normal conditions, your vagina hosts millions of good bacteria called Lactobacilli. However, females with BV have low Lactobacilli concentrations and an increased number of harmful bacteria.
According to studies, women who suffer from BV have increased strict facultative bacteria in their vagina such as Gardnerella sp. (2)
Hard to grasp? Just remember that Lactobacillus Acidophilus is your vagina’s best friend and bacteria like Gardnerella are harmful for your vagina’s health.
How do you treat BV
About 84% of women remain asymptomatic, what that means is that they do not show any symptoms at all. If you’re lucky enough to be among that 84 % of women, then you might not require treatment. (3)
If you tend to fall into the remaining 16% then you should visit your OB/GYN to seek medical advice. Your doctor may prescribe you antibiotics such as clindamycin and/or metronidazole. Both of these can be taken orally or applied as a gel. They’re also safe to be used during pregnancy, however, you should first ask your gynecologist.
If your BV is unresponsive to this treatment, alternatives are always an option. Tinidazole is given to women who are unresponsive to metronidazole.
There are two key aspects of treating a BV infection:
- Killing the bad bacteria, and making sure that you don’t kill the good ones while doing so.
- Secondly, replenishing your stores of good bacteria such as Lactobacillus Acidophilus.
Even though antibiotics can be used for treating chronic BV infections they are not suitable for treating your acute BV.
This is because most of the antibiotics are non specific in nature or in other words they cannot differentiate between good and bad bacteria and the chances of recurrence are pretty high.
However, there are other OTC or over the counter options available to treat your recurring BV such as boric acid and probiotics.
Current traditional treatment options for BV
1. Metronidazole (Flagyl, MetroGel)
Metronidazole belongs to the class of antibiotics. These antibiotics work against anaerobic bacteria and is a drug of choice for the treatment of BV. (4)
According to the CDC’s treatment guidelines:
- Metronidazole can be taken orally for 5 days at a dose of 500mg twice a day.
- It can also be applied as a gel once a day for 5 days.
- Most common brands of metronidazole are Flagyl and Metrogel – a gel for BV treatment. (5)
2. Clindamycin (Cleocin, Clindesse)
Clindamycin is an antibiotic used to treat a number of bacterial infections. Clindamycin is notorious for causing the overgrowth of bad bacteria. (6)
According to the CDC’s treatment guidelines:
- Clindamycin cream for BV treatment can be applied intravaginally. It should be applied at bedtime for at least 7 days.
- Clindamycin can be taken orally as an alternative treatment. The dose should be 300mg taken twice daily for 7 days. (5)
3. Tinidazole (Tindamaz)
Tinidazole is considered an alternative antibiotic for the treatment of BV.
CDC suggests two treatment strategies with tinidazole.
- 2g of tinidazole orally for 2 days only.
- 1g orally for 5 days. (5)
What do antibiotics do to your body and your vagina’s ecosystem?
Antibiotics are the drugs which are specifically targeted to kill disease causing microorganisms. Some antibiotics are smart enough to target bad bacteria only.
Unfortunately, most antibiotics are non-specific in action i.e. they kill both bad and the good bacteria. In the absence of good bacteria, harmful bacteria can grow back in number easily. Moreover, your vaginal microbiome keeps shifting rapidly after receiving antibiotic treatment. This explains why BV keeps recurring… You should try to treat your BV without antibiotics and more naturally whenever you can. (7)
How you can get rid of BV without antibiotics?
If you’re wondering how to get rid of BV without antibiotics, here’s a list of alternatives you can try.
1. Boric Acid
Boric acid is most commonly used as an OTC BV medication. It is easily available at your local medical store and is inexpensive too. A clinical study was conducted to evaluate the effectiveness of boric acid as a treatment for BV. The results concluded that 88-92% of the women were cured within 7 to 12 weeks of treatment. (8)
According to the guidelines of CDC, boric acid can be applied for 21 days at a dose of 600mg per day to avoid the recurrence of BV. (5)
2. Prebiotics + Probiotics
Probiotics are live microorganisms which are good for your health. You can take them as supplements or naturally from yogurt with live cultures.
Prebiotics are the fibers which remain undigested in the body until they reach your large intestine where they ferment. Their fermentation provides food for beneficial bacteria or probiotics.
As you know, the imbalance of the vaginal microbiome is one of the major causes of BV. So, in order to balance your microflora, you need to add the combination of both Probiotics and Prebiotics to your diet. They are meant to enhance, build and maintain the good microbial community in your body. (9)
You can find natural sources of prebiotics in bananas, onions, garlic, artichokes and skin of apples etc. Probiotics can be obtained from natural sources (yogurt, kimchi, sauerkraut etc.) and supplements.
3. Lifestyle changes
In order to treat BV without antibiotics you need to make a few healthy lifestyle changes such as:
- Clean eating – Avoid the three S’s (Salt, Sugar and Saturated fats)
- Change pads or tampons more frequently
- Reduce alcohol intake and more (10)
All these steps can not only reduce your chances of contracting BV but will also help you avoid its recurrence.
4. Avoid douches, vaginal soaps and cleansers
Your vagina is capable of cleaning itself, so you don’t need to go the extra-mile to keep it clean.
You might think washing your vagina with fancy vaginal washes can make it smell like roses? However, that’s not totally accurate because your vagina has its own scent and is not meant to smell like flowers or a summer’s breeze.
Feminine products intended for vaginal cleansing and washing are loaded with harsh chemicals that can destroy your vaginal health. These chemicals can disturb your vaginal pH and can also wash out the good bacteria thus making it a risk factor for developing infections. Avoid using scented soaps, shampoos and vaginal cleansers too!
5. Avoid unprotected sex
The ideal pH for your vagina is less than 4.5 and it needs to stay that way. Your vagina will shift out of balance if pH goes up or down.
On the other hand, semen is basic in nature so your vagina is prone to pH changes if you’re having an unprotected sex. Here’s what you can do about it:
- Rinse your vaginal area with water after having an intercourse.
- Pee right after having sex (to wash off any unwanted organisms)
- Use latex free condoms – Latex condoms can be irritating for your vaginal mucosa.
- Use paraben-free lube – most lubes contain harsh chemicals that can irritate your vagina and vulva and may cause vaginal infections to occur.
6. Wear breathable cotton underwear
It’s hard for your vagina to breathe in air because of its anatomical location. Moreover, if you like to wear satin or silk panties, you’re making it absolutely impossible for your vagina to breathe. Silk or satin provides ideal conditions for bacterial growth i.e. moist and warm.
According to WebMD, wearing cotton undies lowers your risk of getting BV. Cotton is light and breathable for your skin. Try switching to cotton undies, you can thank us later.
Bacterial resistance – Ability of bacteria to resist the action of medication intended to kill or stop it.
Dysbiosis – Imbalance in microbial flora
Facultative bacteria – Bacteria that can grow with or without oxygen
Anaerobic bacteria – Bacteria that can grow in the absence of oxygen and are capable of causing disease.
- Van den Munckhof, E. H., van Sitter, R. L., Boers, K. E., Lamont, R. F., te Witt, R., le Cessie, S., … & Leverstein-van Hall, M. A. (2019). Comparison of Amsel criteria, Nugent score, culture and two CE-IVD marked quantitative real-time PCRs with microbiota analysis for the diagnosis of bacterial vaginosis. European Journal of Clinical Microbiology & Infectious Diseases, 38(5), 959-966.
- Mårdh P. A. (1993). Définition et épidémiologie des vaginoses bactériennes [The definition and epidemiology of bacterial vaginosis]. Revue francaise de gynecologie et d’obstetrique, 88(3 Pt 2), 195–197.
- Centers for Disease Control and Prevention. Bacterial vaginosis statistics. https://www.cdc.gov/std/bv/stats.htm
- Sonja Löfmark, Charlotta Edlund, Carl Erik Nord, Metronidazole Is Still the Drug of Choice for Treatment of Anaerobic Infections, Clinical Infectious Diseases, Volume 50, Issue Supplement_1, February 2010, Pages S16–S23, https://doi.org/10.1086/647939
- Centers for Disease Control and Prevention. Bacterial vaginosis treatment guidelines. https://www.cdc.gov/std/tg2015/bv.htm
- NIH. U.S. National Library of Medicines. Medline Plus (Clindamycin). https://medlineplus.gov/druginfo/meds/a682399.html
- Mayer, B. T., Srinivasan, S., Fiedler, T. L., Marrazzo, J. M., Fredricks, D. N., & Schiffer, J. T. (2015). Rapid and Profound Shifts in the Vaginal Microbiota Following Antibiotic Treatment for Bacterial Vaginosis. The Journal of infectious diseases, 212(5), 793–802. https://doi.org/10.1093/infdis/jiv079
- Reichman, O., Akins, R., & Sobel, J. D. (2009). Boric acid addition to suppressive antimicrobial therapy for recurrent bacterial vaginosis. Sexually transmitted diseases, 36(11), 732–734. https://doi.org/10.1097/OLQ.0b013e3181b08456
- Markowiak, P., & Śliżewska, K. (2017). Effects of Probiotics, Prebiotics, and Synbiotics on Human Health. Nutrients, 9(9), 1021. https://doi.org/10.3390/nu9091021
- Bilardi, J., Walker, S., McNair, R., Mooney-Somers, J., Temple-Smith, M., Bellhouse, C., Fairley, C., Chen, M., & Bradshaw, C. (2016). Women’s Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study. PloS one, 11(3), e0151794. https://doi.org/10.1371/journal.pone.0151794