There are many different treatment options on the market and at times it can be a daunting decision to determine which option to go with when treating bacterial vaginosis.

You have a choice between intravaginal gels, creams or oral formulations. Your doctor or pharmacist can help you decide what type of treatment is most suitable for you. 1

Topical formulations  

  • Topical metronidazole is an antibiotic and is one of the recommended treatments options for bacterial vaginosis based on medical guidelines 2,3,4
  • Metronidazole gel has demonstrated a clinical clearance rate of more than 80% in women with bacterial vaginosis when checked two weeks after treatment was commenced5
  • Intravaginal gels have a lower systemic absorption than oral formulations and therefore less gastro-intestinal side effects 3,5(Side effects are explained under oral formulations)

Oral formulations

  • Oral formulations may cause digestive side effects e.g. nausea vomiting, abdominal cramping and an unpleasant taste. Intravaginal gels and creams are as effective as oral treatment, but they have less of these digestive side effects 3,5,6,7
  • Oral formulations have a longer treatment period compared to topical preparations 3


It’s common for bacterial vaginosis to recur within 3 to 12 months, despite treatment.8

If your symptoms recur soon after treatment, talk with your doctor. One option may be extended-use metronidazole therapy. 9

Take your medicine or use the cream or gel for as long as your doctor prescribes it — even if your symptoms go away. 9

Antibiotics are important for fighting off infections. It is therefore important to always complete the full prescription, even if you feel better. Stopping treatment early promotes the growth of drug-resistant bacteria which will render antibiotics less effective. 10,11

Bacterial vaginosis is a common vaginal infection. Do not be shy to speak to your doctor or healthcare provider, the sooner you treat the infection the better.  12

DISCLAIMER: This editorial has been commissioned and brought to you by iNova Pharmaceuticals. Content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional

Name and business address of the holder of the certificate of registration: iNova Pharmaceuticals (Pty) ptd,. Co. Reg. No. 1952/001640/07, 15e Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za. For further information, speak to your healthcare professional. Further information is available on request from iNova Pharmaceuticals. IN2973/18


  1. Bacterial Vaginosis Medication/ [online] 25 October 2018 [Cited] 7 November 2018. Available from URL: https://emedicine.medscape.com/article/254342-medication
  2. Cullins VA, Dominguez L, Guberski T, et al. Treating vaginitis. Nurse Pract 1999;24(10):49-50.
  3. Hainer BL and Gibson MV. Vaginitis: Diagnosis and Treatment. Am Fam Phys 2011;83(7):807-815.
  4. Owen MK and Clenney TL. Management of Vaginitis. Am Fam Phys 2004;70(11):2125-2132.
  5. Hanson JM, McGregor JA, Hillier SL, et al. Metronidazole for Bacterial Vaginosis A Comparison of Vaginal Gel vs Oral Therapy. JRM 2000;45(11):889-896.
  6. Urfa TA, Javeria M, Hanif A. Comparison of Intravaginal Versus Oral Metronidazole in the Treatment of Bacterial Vaginosis in Obstetrical Patients. PJMHS 2017;11(2):519-522.
  7. Ferris DG, Litaker MS, Woodward L, et al. Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream. J Fam Pract 1995;41(5):443-449.
  8. Austin MN, Beigi RH, Meyn LA, et al. Microbiologic Response to Treatment of Bacterial Vaginosis with Topical Clindamycin or Metronidazole. J Clin Microbiol. 2005 Sep;43(9):4492-7.
  9. Mayo Clinic. Bacterial vaginosis. Diagnosis. [online] 29 July 2017. [Cited] 5 November 2018. Available from URL https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285?p=1
  10. Experts: End ‘complete the course’ for antibiotics. [online] 27 July 2017 [Cited] 12 November 2018. Available from URL: https://www.webmd.com/drug-medication/news/20170728/experts-end-complete-the-course-for-antibiotics?print=true
  11. World Health Organization. How to stop antibiotic resistance? Here’s a WHO prescription. [online] 20 November 2015 [Cited] 12 November 2018. Available from URL: http://www.who.int/mediacentre/commentaries/stop-antibiotic-resistance/en/
  12. S. Department of Health & Human Services. Bacterial vaginosis. [online] 3 February 2015 [Cited] 13 November 2018. Available from URL: https://www.womenshealth.gov/a-z-topics/bacterial-vaginosis