Bacterial vaginosis (BV) is treated with antibiotics, most commonly metronidazole or clindamycin. These come in oral pills and vaginal forms, and a typical course runs five to seven days. There’s also a single-dose option for people who prefer a one-and-done approach.
Metronidazole: The Most Common Choice
Metronidazole is the go-to antibiotic for BV and comes in two forms. The oral version is a 500 mg pill taken twice a day for seven days. The vaginal gel version (0.75%) is applied once daily for five days using a pre-filled applicator. Both are equally effective at clearing BV, so the choice often comes down to personal preference and side effects.
Oral metronidazole can cause nausea, a metallic taste in your mouth, and stomach upset. The vaginal gel avoids most of those digestive side effects but can cause local irritation. One important rule applies to both: you need to avoid alcohol during treatment and for at least three days after finishing. Mixing metronidazole with alcohol can trigger intense nausea, vomiting, flushing, and rapid heartbeat.
Clindamycin as an Alternative
Clindamycin is the main alternative when metronidazole isn’t a good fit. It’s available as a vaginal cream (2%), typically applied at bedtime for seven days. An oral form also exists. Clindamycin doesn’t come with the alcohol restriction that metronidazole does, which makes it a practical choice for some people.
One thing to know: clindamycin vaginal cream is oil-based, which means it can weaken latex condoms and diaphragms. If you rely on barrier contraception, you’ll need a backup method during treatment and for a few days after.
Tinidazole: A Shorter Oral Course
Tinidazole works similarly to metronidazole but offers more flexible dosing. You can take it as a 2 g dose once daily for two days, or a 1 g dose once daily for five days. Both regimens should be taken with food. Like metronidazole, tinidazole requires avoiding alcohol during and after treatment, because it carries the same risk of a severe reaction.
Secnidazole: The Single-Dose Option
Secnidazole (brand name Solosec) is the only FDA-approved single-dose treatment for BV. It’s a 2-gram packet of granules that you take all at once. The granules don’t dissolve in liquid. Instead, you sprinkle the entire packet onto applesauce, yogurt, or pudding and eat the whole mixture within 30 minutes without chewing the granules. You can drink water afterward to help wash it down.
The appeal here is obvious: one dose and you’re done, no week-long regimen to remember. The downside is cost. Secnidazole tends to be significantly more expensive than generic metronidazole, and not all insurance plans cover it.
What to Expect During Treatment
Most people notice improvement within two to three days of starting antibiotics, but it’s important to finish the full course even if symptoms clear up early. Stopping early increases the chance that BV comes back. Symptoms like unusual discharge and fishy odor should resolve completely by the end of treatment.
You don’t necessarily need a follow-up visit if your symptoms go away. But if they return within a few weeks or months, that’s worth a conversation with your provider, because recurrent BV requires a different approach.
When BV Keeps Coming Back
Recurrence is one of the most frustrating parts of BV. Roughly half of people who get treated will have BV again within 12 months. For recurrent cases, providers often recommend suppressive therapy, which means using a lower dose of medication (usually metronidazole vaginal gel) on an ongoing basis after the initial treatment course to keep the infection from returning.
There’s also growing interest in using probiotics alongside antibiotics. A specific strain of Lactobacillus crispatus (the “good” bacteria that dominates a healthy vaginal environment) has shown promise. In clinical trials, women who used a vaginal probiotic containing this strain after antibiotic treatment had a significantly lower risk of recurrent BV at both 12 and 24 weeks. Colonization did tend to drop off after the probiotic was discontinued, suggesting that longer or repeated use may be needed. These products are still being refined and aren’t yet a standard recommendation, but the science is heading in that direction.
Another shift in how recurrent BV is managed: in 2025, ACOG (the leading organization for OB-GYN practice in the U.S.) recommended for the first time that sexual partners be treated in some cases of recurrent BV. This followed accumulating evidence that sexual activity plays a significant role in BV transmission and recurrence. If you’re dealing with BV that won’t stay away, partner treatment is now something your provider may bring up.
BV Treatment During Pregnancy
Oral metronidazole (500 mg twice daily for seven days) is the standard treatment for BV during pregnancy. Treating BV in pregnancy matters because the infection is linked to preterm birth and other complications. The oral form is generally preferred over vaginal options during pregnancy so that the medication reaches its full systemic effect. Your OB provider will determine the right approach based on your trimester and symptoms.