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How Is BV Treated in the UK? Prescription and OTC Options
The treatment for bacterial vaginosis (BV) in the UK is a prescription antibiotic, metronidazole or clindamycin, as a week of tablets or a vaginal gel or cream, from a GP, a sexual health clinic or an online prescriber. No antibiotic for BV is sold over the counter; the vaginal gel is prescription-only too. What a pharmacy can sell is a lactic acid gel, which in a UK trial of 518 women settled symptoms within two weeks in 47%, against 70% for metronidazole tablets.1, 2 BV returned in 58% of women within a year in the best-known study, so partners and live cultures get their own sections.3 This is the treatment page of the Wellgard guide to what causes BV.
How is BV treated in the UK?
With an antibiotic, after a swab or examination. The NHS lists metronidazole tablets, metronidazole vaginal gel and clindamycin vaginal cream; the UK sexual health specialists' guideline (BASHH) uses the same three, tablets first.1 If BV returns more than four times a year, the NHS says a vaginal antibiotic gel may be prescribed for several months while a clinician helps you find the trigger.1
What is prescription-only, and what can I buy over the counter?
Prescription-only: metronidazole tablets and gel, clindamycin cream, and boric acid pessaries, which a clinician directs. Older articles, including some on this blog, said the gel was sold over the counter; it is not. Over the counter: lactic acid or "pH" gels, painkillers, and thrush treatments, which do nothing for BV. Of 95 women buying a thrush product, 34% had thrush alone, 19% BV and 21% both.4 Is it thrush, BV or something else? sets them side by side.
Where should I go: GP, sexual health clinic, pharmacy or online pharmacy?
| Route | What they can do for BV | Speed and cost |
|---|---|---|
| Sexual health (GUM) clinic | Examines, reads the swab while you wait, prescribes, tests for STIs | Walk-in or same week; no referral; free |
| GP surgery | Examines or swabs, prescribes; laboratory results in days | Appointment or phone triage; prescription charge in England |
| High-street pharmacy | Advice and lactic acid gel; no antibiotics for BV | Same day; you pay for the gel |
| Regulated online pharmacy | A prescriber reviews a questionnaire and posts metronidazole or gel; no examination | One to three days; you pay |
Out of hours, NHS 111 routes you to a prescriber. You can ask for a female clinician and many clinics let you take the swab yourself. A first episode needs that swab whichever route you choose: in the thrush-aisle study only a third of self-diagnoses were right.4
How fast does treatment work, and can I fix BV right away?
The NHS says most people feel better within a few days of starting metronidazole; in the UK trial, 70% had their symptoms resolve within two weeks.2, 5 A lactic acid gel may ease the smell while you wait, but it is a bridge, not the treatment. What happens if you leave BV too long? has the risks of waiting.
What kills the bacteria in BV?
The antibiotic. Metronidazole and clindamycin kill the anaerobes that have outgrown the lactobacilli. What they do not do is restore the lactobacilli; that gap is what the live-culture trials address. In ten randomised trials of 1,234 women, pooled in 2022, live cultures taken after a course of antibiotics were associated with BV recurrence of 14.8% against 25.5%; the trials used a range of strains and the figure is reported as evidence for live cultures after treatment, not as a result for any one product.7 On live cultures instead of antibiotics, a Cochrane review found insufficient evidence either way, and no trial has compared products.8 Anyone immunocompromised, seriously ill or with a central line reviews live cultures with a pharmacist or GP first. Can I get rid of BV by taking probiotics? has the trials.
Does anything besides antibiotics work for BV? Home remedies graded
| Remedy | What the evidence shows | Verdict |
|---|---|---|
| Lactic acid gel (pharmacy) | UK trial, 518 women: symptoms resolved in 47% vs 70% on metronidazole; six-month recurrence about 70% in both; far fewer side effects2 | A bridge while you wait; not a substitute. Stinging is reported |
| Vitamin C vaginal tablets | One manufacturer-run trial: recurrence after antibiotics 16% vs 32% over six months9 | Acidifying, like the gel; not a UK pharmacy product |
| Live cultures | After antibiotics, recurrence 14.8% vs 25.5% in ten trials; instead of them, insufficient evidence7, 8 | After, not instead |
| Boric acid pessaries | In UK and US guidelines for recurrent BV after antibiotics, clinician-directed; no randomised trial, only chart reviews; never swallowed, never in pregnancy10 | A clinic conversation, not a purchase |
| Yoghurt on a tampon, garlic clove, tea tree oil | No trial for any; yoghurt's bacteria are not the vagina's lactobacilli, and garlic and tea tree irritate | No |
| Vinegar or peroxide douche | The NHS lists douching as a trigger; in the daily-swab study, douching in the previous three days halved spontaneous clearance (aHR 0.45) among women whose flora was dominated by Lactobacillus iners1, 6 | No; it makes BV more likely |
"What naturally kills BV?" Nothing here has been shown to.
Do I really need metronidazole? Side effects, alcohol and "antibiotics make it worse"
In a UK study of 155 women on a week of metronidazole tablets, 64% reported at least one side effect and 47% a stomach one, mostly over within five days; 8% stopped the course, 3% because of side effects.11 A metallic taste affected 18% in the main trial against 1% on the gel.2 Alcohol: the NHS says none while taking the tablets and for two days after, because the combination can cause sickness, flushing, palpitations and headache.5 Pregnancy: the NHS says treatment is important in pregnancy, and in pooled studies metronidazole was not associated with birth defects; your midwife or GP prescribes it.1, 12 "Antibiotics make BV come back worse": BV returned in 58% of women within a year because the triggers carry on.3 If it keeps returning, the plan is Why do I keep getting BV?
Should my partner be treated?
If your partner is a woman, the NHS says she may need treatment too.1 For male partners, a 2025 trial in the New England Journal of Medicine randomised 164 couples: when the man took a week of oral antibiotics plus an antibiotic cream on the penis while the woman had her course, BV returned in 35% of women within 12 weeks, against 63% when she was treated alone.13 Earlier trials of oral antibiotics alone for men, and a 2016 Cochrane review of them, found no benefit, so ask at a sexual health clinic.14 Can a man give a woman BV? explains the exchange.
What not to do when you have BV
No douching or washing inside the vagina, perfumed soap, bubble bath, vaginal deodorants, intimate washes, antiseptic in the bath or strong detergent on underwear; water and plain soap on the vulva, showers rather than baths, and no smoking.1 No thrush cream for a fishy smell, no antibiotics from a website that asks no questions, and no stopping on day two when the smell goes.
When do I need a GP or sexual health clinic rather than self-care?
For a first episode, for the swab. For any unusual discharge in pregnancy. For fever or pelvic pain. If you are no better three days into treatment or still have symptoms a week after starting. For more than four episodes a year. With a new partner, for an STI test. For a first episode under 16 or over 50, or any bleeding, sores or skin changes. Clinics need no referral.1 After the menopause a "musty" smell is often not BV: see vaginal health after the menopause.
Frequently asked questions
Can BV go away overnight, or on its own?
Not overnight. Spontaneous clearance happens but no reliable proportion exists, and the NHS advises treatment.1, 6
Do I need to restore my pH, and does drinking water help?
The pH falls as lactobacilli recover after antibiotics; a lactic acid gel lowers it only while used. Water does nothing to vaginal pH.
Do antibiotic gels and creams clear up BV?
Yes: metronidazole gel and clindamycin cream are two of the three NHS options, on prescription, with recurrence similar to tablets.1
Can boric acid help BV?
Guidelines list clinician-directed pessaries for recurrent BV after antibiotics, on chart reviews only; never by mouth, never in pregnancy, not a purchase.10
Can BV be cleared for good?
Antibiotics are the treatment; live cultures taken after a course are studied for recurrence, not as a treatment. Change the triggers you can, ask about partner treatment, and go back if it returns more than four times a year; the recurrence plan linked above has the detail.3, 7, 13
Sources
- NHS. Bacterial vaginosis. nhs.uk/conditions/bacterial-vaginosis.
- Ross JDC, et al. Intravaginal lactic acid gel versus oral metronidazole for women with recurrent bacterial vaginosis: the VITA randomised controlled trial. BMC Women's Health, 2023. PubMed 37161454.
- Bradshaw CS, et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy. Journal of Infectious Diseases, 2006. PubMed 16652274.
- Ferris DG, et al. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstetrics and Gynecology, 2002. PubMed 11864668.
- NHS. Metronidazole: side effects and common questions. nhs.uk/medicines/metronidazole.
- Tamarelle J, et al. Factors associated with incidence and spontaneous clearance of molecular-bacterial vaginosis. Sexually Transmitted Diseases, 2022. PubMed 35969846.
- Chieng WK, et al. Probiotics, a promising therapy to reduce the recurrence of bacterial vaginosis in women? A systematic review and meta-analysis. Frontiers in Nutrition, 2022. PubMed 36204368.
- Senok AC, et al. Probiotics for the treatment of bacterial vaginosis. Cochrane Database of Systematic Reviews, 2009. PubMed 19821358.
- Krasnopolsky VN, et al. Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis. Journal of Clinical Medicine Research, 2013. PubMed 23864922.
- Mittelstaedt R, et al. Data on safety of intravaginal boric acid use in pregnant and nonpregnant women. Sexually Transmitted Diseases, 2021. PubMed 34561373.
- Ayinde O, Ross JD. The frequency and duration of side-effects associated with the use of oral metronidazole. International Journal of STD and AIDS, 2023. PubMed 37395087.
- Kahwati LC, et al. Screening for bacterial vaginosis in pregnant adolescents and women: updated evidence report. JAMA, 2020. PubMed 32259235.
- Vodstrcil LA, et al. Male-partner treatment and recurrence of bacterial vaginosis. New England Journal of Medicine, 2025. PubMed 40043236.
- Amaya-Guio J, et al. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database of Systematic Reviews, 2016. PubMed 27696372.
This article is general information, not medical advice. See a GP or sexual health clinic for a first episode, for any discharge in pregnancy, and whenever treatment has not worked; live cultures are a food supplement, not a treatment.
