CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Bacterial vaginosis - Management
How should I treat a woman with bacterial vaginosis?
- Oral metronidazole is the treatment of choice.
- A dose of 400 mg twice a day for 7 days is recommended.
- If adherence to treatment is an issue, a single oral dose of 2 g may be used, although this is associated with a higher relapse rate.
- If the woman is breastfeeding, see Metronidazole and breastfeeding.
- Intravaginal metronidazole gel or intravaginal clindamycin cream are alternative choices if the woman prefers topical treatment or cannot tolerate oral metronidazole:
- Intravaginal metronidazole gel 0.75% once a day for 5 days, or
- Intravaginal clindamycin cream 2% once a day for 7 days.
- Oral clindamycin and oral tinidazole are alternatives but are less preferred.
- Oral clindamycin (300 mg twice a day for 7 days) is not widely recommended in primary care because of an increased risk of pseudomembranous colitis.
- Tinidazole (2 g as a single oral dose) has been less well studied than metronidazole in the treatment of bacterial vaginosis.
- If the woman is breastfeeding, see Clindamycin and breastfeeding.
- A test of cure is not required if symptoms resolve.
© NHS Institute for Innovation and Improvement