Bacterial vaginosis (BV) is a common condition resulting from an imbalance in the bacteria population of the vagina. It occurs when the dominant Lactobacillus bacteria are overgrown by other types of anaerobic bacteria. This shift in the vaginal microbiome often leads to noticeable symptoms, prompting people to seek a prescription. Common indicators of BV include a thin, gray or off-white vaginal discharge, often accompanied by a distinct, fishy odor that may become more pronounced after intercourse. BV requires a prescription antibiotic for effective treatment and will not reliably clear up with over-the-counter remedies.
The Necessary Step of Diagnosis
Obtaining a prescription for BV requires a clinical diagnosis from a licensed healthcare provider. This evaluation is necessary because BV symptoms can easily be confused with other vaginal infections, such as a yeast infection or trichomoniasis, and the correct medication must be prescribed. The diagnostic process typically begins with a pelvic examination and a review of the patient’s medical history and current symptoms.
During the exam, the provider usually takes a sample of the vaginal discharge for laboratory testing. This sample is often examined under a microscope (wet mount) to look for “clue cells,” which are vaginal cells coated in bacteria, a definitive sign of BV. The provider may also perform a “whiff test” by adding potassium hydroxide to the sample; a strong, fishy smell confirms BV-associated compounds. Additionally, the acidity of the discharge is checked, as a vaginal pH level of 4.5 or higher is strongly suggestive of BV.
Choosing a Healthcare Provider for Treatment
Traditional In-Person Care
Accessing a prescription begins with selecting a qualified medical professional, such as a doctor, nurse practitioner, or physician assistant. The traditional route involves scheduling an appointment with a primary care physician or an obstetrician-gynecologist (OB-GYN). This option is beneficial for those with recurrent infections, complex medical histories, or those who require a thorough in-person examination.
Urgent Care and Walk-in Clinics
For immediate care, urgent care centers or walk-in clinics represent a convenient option for getting a rapid diagnosis and prescription. These facilities often accommodate same-day visits, which is helpful for quickly addressing uncomfortable symptoms.
Telehealth and Virtual Care
The most accessible option is using telehealth or virtual care platforms. Telehealth providers can review a patient’s symptoms and medical history through an online questionnaire, a video call, or a phone consultation. If the patient meets specific clinical criteria and has no complicating symptoms, a diagnosis can be made and a prescription issued electronically. This method is the quickest way to obtain a prescription, with many services sending the medication directly to a local pharmacy for immediate pickup.
Available Prescription Medications
Once a diagnosis is confirmed, the treatment for BV involves a course of antibiotics. The most commonly prescribed antibiotic is metronidazole, which is effective against the anaerobic bacteria that cause the imbalance. Metronidazole is available in both oral tablets, typically taken twice daily for five to seven days, and as a topical gel inserted into the vagina, often for a period of five days.
Another frequently used option is clindamycin, which also comes in multiple forms. Patients may be prescribed oral clindamycin tablets or a topical cream or ovule (a suppository) that is inserted vaginally. The vaginal cream is generally used once daily for seven days, while the ovules may be used for a shorter duration.
Patients should be aware of specific administration instructions to maximize the treatment’s effectiveness. Clindamycin cream and ovules are oil-based and can weaken latex condoms and diaphragms, meaning barrier birth control methods should not be relied upon during treatment and for a few days afterward. A key instruction for those taking oral metronidazole is avoiding alcohol entirely during the course of treatment and for at least 24 hours after the final dose, as the combination can cause nausea and stomach pain. Finishing the full course of antibiotics, even if symptoms disappear early, is necessary to prevent the infection from returning.