- What is Flagyl?
- Important information
- Before taking this medicine
- How should I take Flagyl?
- What happens if I miss a dose?
- What happens if I overdose?
- What should I avoid while taking Flagyl?
- Flagyl side effects
- What other drugs will affect Flagyl?
- Further information
- More about Flagyl (metronidazole)
- Bacterial Vaginosis vs. Yeast Infection
- Bacterial Vaginosis vs. Yeast Infection: Which Is It?
- What is vaginitis?
- What causes vaginitis?
- What are vaginitis symptoms?
- Yeast Infection and Bacterial Vaginosis Symptoms
- Mayo Clinic Q and A: Vaginal infections have similar symptoms, require different treatments
- What is the Difference between a Yeast Infection and Bacterial Vaginosis?
- Successful treatment of chronic vaginitis
Generic Name: metronidazole (me troe NI da zole)
Brand Names: Flagyl
Medically reviewed by Sanjai Sinha, MD Last updated on Dec 20, 2018.
- Side Effects
What is Flagyl?
Flagyl (metronidazole) is an antibiotic that fights bacteria.
Flagyl is used to treat bacterial infections of the vagina, stomach, liver, skin, joints, brain, and respiratory tract.
Flagyl will not treat a vaginal yeast infection.
You should not use Flagyl if you are allergic to metronidazole, or if you have taken disulfiram (Antabuse) within the past 2 weeks.
Do not drink alcohol or consume foods or medicines that contain propylene glycol while you are taking metronidazole and for at least 3 days after you stop taking it. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting.
Flagyl will not treat a viral infection such as the common cold or flu.
In animal studies, metronidazole caused certain types of cancers or tumors. It is not known whether these effects would occur in people using this medicine. Ask your doctor about your risk.
Before taking this medicine
You should not take Flagyl if you are allergic to metronidazole, or if you have taken disulfiram (Antabuse) within the past 2 weeks.
To make sure Flagyl is safe for you, tell your doctor if you have ever had:
liver or kidney disease;
Cockayne syndrome (a rare genetic disorder);
a stomach or intestinal disease such as Crohn’s disease;
a blood cell disorder such as anemia (lack of red blood cells) or low white blood cell (WBC) counts;
a fungal infection anywhere in your body; or
a nerve disorder.
In animal studies, metronidazole caused certain types of tumors, some of which were cancerous. However, very high doses are used in animal studies. It is not known whether these effects would occur in people using regular doses. Ask your doctor about your risk.
Do not take Flagyl during the first trimester of pregnancy. This medicine can harm an unborn baby. Tell your doctor if you are pregnant.
Metronidazole can pass into breast milk and may harm a nursing baby. You should not breast-feed within 24 hours after using Flagyl. If you use a breast pump during this time, throw out any milk you collect. Do not feed it to your baby.
Do not give this medicine to a child without medical advice.
How should I take Flagyl?
Take Flagyl exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Do not crush, chew, or break an extended-release tablet. Swallow it whole.
If you are treating a vaginal infection, your sexual partner may also need to take Flagyl (even if no symptoms are present) or you could become reinfected.
Flagyl is usually given for up to 10 days in a row. You may need to repeat this dosage several weeks later.
Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Metronidazole will not treat a viral infection such as the flu or a common cold.
Metronidazole can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using this medicine.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include nausea, vomiting, dizziness, loss of balance or coordination, numbness and tingling, or seizures (convulsions).
What should I avoid while taking Flagyl?
Do not drink alcohol or consume food or medicines that contain propylene glycol while you are taking Flagyl. You may have unpleasant side effects such as headaches, stomach cramps, nausea, vomiting, and flushing (warmth, redness, or tingly feeling).
Avoid alcohol or propylene glycol for at least 3 days after you stop taking metronidazole. Check the labels of any medicines or food products you use to make sure they do not contain alcohol or propylene glycol.
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.
Flagyl side effects
Get emergency medical help if you have signs of an allergic reaction to Flagyl: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
painful or difficult urination;
trouble sleeping, depression, irritability;
headache, dizziness, weakness;
a light-headed feeling (like you might pass out); or
blisters or ulcers in your mouth, red or swollen gums, trouble swallowing.
Stop taking the medicine and call your doctor right away if you have neurologic side effects (more likely to occur while taking metronidazole long term):
numbness, tingling, or burning pain in your hands or feet;
vision problems, pain behind your eyes, seeing flashes of light;
muscle weakness, problems with coordination;
trouble speaking or understanding what is said to you;
a seizure; or
fever, neck stiffness, and increased sensitivity to light.
Side effects may be more likely in older adults.
Flagyl can cause life-threatening liver problems in people with Cockayne syndrome. If you have this condition, stop taking metronidazole and contact your doctor if you have signs of liver failure – nausea, stomach pain (upper right side), dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes).
Common Flagyl side effects may include:
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect Flagyl?
Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.
Tell your doctor about all your current medicines and any you start or stop using, especially:
a blood thinner – warfarin, Coumadin, Jantoven.
This list is not complete. Other drugs may interact with metronidazole, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Flagyl only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2020 Cerner Multum, Inc. Version: 12.02.
- What if you had sex while using metronidazole vaginal gel?
- How long does it take metronidazole to leave your system?
More about Flagyl (metronidazole)
- Side Effects
- During Pregnancy or Breastfeeding
- Dosage Information
- Patient Tips
- Drug Images
- Drug Interactions
- Compare Alternatives
- Support Group
- Pricing & Coupons
- En Español
- 287 Reviews
- Generic Availability
- Drug class: amebicides
- FDA Alerts (3)
- Flagyl Oral, Intravenous (Advanced Reading)
Other brands: Flagyl ER
- Flagyl (AHFS Monograph)
- … +1 more
- Flagyl I.V. Intravenous
- Flagyl 375
Related treatment guides
- Bacterial Infection
- Aspiration Pneumonia
- … +23 more
Bacterial Vaginosis vs. Yeast Infection
Treatment for yeast infections
First-time yeast infections can generally be treated with the over-the-counter anti-fungal medication miconazole (Monistat, Femizol, Vagistat). Recurrent yeast infections may require prescription of an oral antifungal medication.
Treatment for BV
This depends on the particular bacteria identified from the swab sample. Antibiotics such as metronidazole and clindamycin may be prescribed. Because these are powerful medications with known side effects, it is important to establish the diagnosis before starting treatment. Unfortunately, there is a high rate of recurrence after therapy.
Treatment for trichomoniasis
Trichomoniasis infections are treated with the oral antibiotics metronidazole or tinidazole. Sexual partners should receive treatment as well.
Beware of self-diagnosis and treatment. Even among health professionals, the diagnosis is difficult to make based only on clinical signs and symptoms. Proper diagnosis usually requires microscopic examination of the discharge in order to distinguish between the three types of infections described above. In addition, vaginal discharge may be a symptom of more serious gynecological diseases and should be evaluated through a professional examination.
The information contained on www.lifescript.com (the “Site”) is provided for informational purposes only and is not meant to substitute for advice from your doctor or healthcare professional. This information should not be used for diagnosing or treating a health problem or disease, or prescribing any medication. Always seek the advice of a qualified healthcare professional regarding any medical condition. Information and statements provided by the site about dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. LifeScript does not recommend or endorse any specific tests, physicians, third-party products, procedures, opinions, or other information mentioned on the Site. Reliance on any information provided by LifeScript is solely at your own risk.
Bacterial Vaginosis vs. Yeast Infection: Which Is It?
Home remedies, OTC creams and medications, and prescription antibiotics can treat yeast infections.
Prescription antibiotics can only treat BV.
Metronidazole (Flagyl) and tinidazole (Tindamax) are two commonly prescribed oral medications used to treat BV.
Your provider could also prescribe a suppository cream, such as clindamycin (Cleocin).
Although your symptoms should clear up quickly — within two or three days — be sure to finish out the full five- or seven-day course of antibiotics.
Finishing the full course of medication is the only way to clear the infection and reduce your risk for recurrence.
During this time, avoid having vaginal intercourse or inserting anything into the vagina that could introduce bacteria, including:
- menstrual cups
- sex toys
Unless your symptoms continue after your prescription runs out, you probably won’t need a follow-up appointment.
How long does BV typically last?
Once you begin treatment, your symptoms should subside within two or three days. If left untreated, BV may take two weeks to go away on its own — or it may keep coming back.
You can buy suppository creams that kill the Candida fungus, including miconazole (Monistat) and clotrimazole (Gyne-Lotrimin), at your local pharmacy.
If you see a doctor, they may prescribe a prescription-strength suppository cream or an oral medication called fluconazole.
If you experience recurrent yeast infections — more than four per year — your provider may prescribe a different kind of medication.
Although some medications may only require one dose, others may run a course of up to 14 days. Finishing the full course of medication is the only way to clear the infection and reduce your risk for recurrence.
During this time, avoid having vaginal intercourse or inserting anything into the vagina that could introduce bacteria, including:
- menstrual cups
- sex toys
If your symptoms subside after treatment, you likely won’t need a follow-up appointment.
How long does a yeast infection typically last?
OTC and prescription medication can usually clear up a yeast infection within a week. If you rely on home remedies or opt not to treat the yeast infection, symptoms can last for several weeks or more.
What is vaginitis?
Vaginitis is an irritation of your vagina or vulva. It’s super common and usually easy to treat. Almost everyone with a vulva gets vaginitis at some point.
X in a circle
Think you may have a yeast infection or vaginitis?
Find a Health Center A right arrow in a circle
What causes vaginitis?
Vaginitis is when your vulva or vagina becomes inflamed or irritated. This can happen when there’s a change in the normal chemical balance of your vagina, or if you have a reaction to irritating products.
Many things can cause vaginitis — and sometimes there’s more than 1 cause. Things that lead to vaginitis include:
Common vaginal infections like:
vaginal yeast infections
Lack of Estrogen (atrophic vaginitis):
Lack of estrogen can lead to a type of vaginitis called atrophic vaginitis (also known as vaginal atrophy). Atrophic vaginitis is when you have irritation but no abnormal discharge. Things that can cause low estrogen include:
Damage to your ovaries, or having your ovaries removed
Vaginitis isn’t a sexually transmitted infection. But sometimes sexual activity can lead to vaginitis. Your partner’s natural genital chemistry can change the balance of yeast and bacteria in your vagina. In rare cases, you can have an allergic reaction to your partner’s semen. Friction from sex, or certain types of lubricants, condoms, and sex toys may also cause irritation. Read more about vaginitis and sex.
Allergies and Irritants
Allergic reactions or sensitivity to different products, materials, or activities can also cause vaginitis. Things that can lead to irritation include:
vaginal deodorants, washes, and perfumed “feminine hygiene” products
scented panty liners, pads, or tampons
perfumed bath products
scented or colored toilet paper
some chemicals in laundry detergents and fabric softeners
certain types of lubricants (i.e. flavored or with sugars in them)
sex toys made out of certain materials
latex and rubber in sex toys and condoms (if you have a latex allergy)
tight pants, or underwear/pantyhose that don’t have a cotton crotch
wearing wet bathing suits or damp clothing for long periods of time
hot tubs or swimming pools
Everyone’s body is different, so things that lead to irritation in some people don’t cause problems for others. Read more about keeping your vagina healthy.
Some people get vaginitis a lot. If you have vaginitis 4 or more times in a year, it’s called recurrent vaginitis. You can get recurrent vaginitis if you have conditions like diabetes or HIV that make your immune system weak. You can also get recurrent vaginitis if you don’t finish your vaginitis treatment.
What are vaginitis symptoms?
The signs of vaginitis can vary depending on what’s causing it. But vaginitis symptoms usually include:
Your vagina and/or vulva is red, irritated, swollen, or uncomfortable.
Itching, burning, and pain in your vulva or vagina.
Pain or discomfort during sex.
Feeling like you have to pee more often than usual. Peeing may sting if your vulva is really irritated.
Vaginal discharge that isn’t normal for you:
With yeast infections, discharge is usually thick, white, and odorless. You may also have a white coating in and around your vagina.
With bacterial vaginosis, you may have vaginal discharge that’s grayish, foamy, and smells fishy. (But it’s also common for BV to have no symptoms.)
With trich, discharge is often frothy, yellow-green, smells bad, and may have spots of blood in it.
Vaginitis symptoms can be super obvious, or barely noticeable. Sometimes there are no symptoms at all. It’s a good idea to pay attention to what your vulva and vaginal discharge normally looks, feels, and smells like, so it’s easier to notice any changes that could be signs of vaginitis or other infections.
Was this page helpful?
Help us improve – how could this information be more helpful?
How did this information help you?
You’re the best! Thanks for your feedback. Thanks for your feedback.
Yeast Infection and Bacterial Vaginosis Symptoms
What Causes Yeast Infection and Bacterial Vaginosis?
Up to 75% of women will experience an inflammatory condition of the vagina at some point in their lives. Medically known as vaginitis, inflammation in the vaginal area is a common condition resulting from multiple causes. Two of the most common causes of vaginitis are yeast infection and bacterial vaginosis.
Bacterial vaginosis refers to an overgrowth of certain types of bacteria that are normally present in the vagina and is not a sexually-transmitted infection (STD). The condition used to be referred to as Gardnerella vaginitis; because Gardnerella is a type of bacteria that sometimes causes the infection. While symptoms are not present in about half of women with bacterial vaginosis, those who do experience symptoms will have vaginal discharge, usually with an unpleasant odor. The discharge is usually gray to white in color but can be of any color.
Another common type of vaginitis results from vaginal yeast infections. Candida albicans is the type of fungus most commonly responsible for vaginitis. Yeast is believed to be present in the vagina of 20%-50% of healthy women. Vaginal yeast infections occur when new yeast is introduced into the vaginal area or when there is an overgrowth of the yeast already present in the vagina, for example, when the normal protective bacteria are destroyed by antibiotics taken to treat another infection. Yeast can also overgrow and cause infections in women with suppressed immune function.
“You have a vaginal infection.” These words will strike fear into the heart (and vaginas) of most women. After all, no one likes having a vagina that’s itchy, irritated, or producing discharge. But if you do find that you have a vaginal infection, what does this mean for your health — and your sex life?
There are two main types of vaginal infections, explains Dr. Alyse Kelly-Jones, an OBGYN: a yeast infection or bacterial vaginosis. While they’re different, they do have some similarities in terms of symptoms, she says. “Both have colored discharge, both can cause odors, and both can cause itching and irritation.”
Most healthy vaginas have a balance of yeast and other kinds of bacteria. A yeast infection is when the yeast cells in the vagina multiply, throwing off the balance of the vaginal flora (which are the bacteria that live in the vagina). For many people, this results in seriously uncomfortable symptoms like itching, redness, and even a whitish, clumpy discharge. Sometimes, a yeast infection will also produce a yeasty smell, like bread or beer.
Bacterial vaginosis is another type of common vaginal infection, according to Dr. Kelly-Jones. Like a yeast infection, it happens when the balance of bacteria in the vagina changes, causing an overgrowth of “bad” bacteria vs healthy bacteria (lactobacillus is one of the most well-known healthy bacteria found in the vagina… and yes, it’s the same bacteria you can find in yogurt or a probiotic). Some research has demonstrated that BV (as it’s commonly abbreviated) can be triggered by sexual activity, especially when that involves sex with a new partner. People with BV often have a higher vaginal pH than people without the infection.
BV typically has fewer symptoms than a yeast infection, and many people with BV don’t have any symptoms at all (some report a whitish or yellowish discharge with a fishy smell). It’s possible to have BV for quite a while and not even know it, until you start to see or feel symptoms or if you are tested for it at an appointment. Often, BV goes away by itself, within a few days or weeks.
Both infections are treated in two common ways, either with a local treatment (a medication you apply directly to the vagina) or a systemic treatment (a medication you take orally), explains Dr. Kelly-Jones. You can talk with your healthcare provider about which would be better for you, based on your symptoms, preferences, and lifestyle.
Bacterial vaginosis is most often treated with an antibiotic medication, while a yeast infection is treated with an antifungal medication like fluconazole or clotrimazole (delivered orally or vaginally). Dr. Kelly-Jones says she often prescribes medications for patients over the phone based on their symptoms, so that may be an option if you can’t snag an in-office appointment — but this may not be possible if you’re a new patient. There are also over-the-counter medications, like Monistat, available for yeast infections — just check out the feminine health aisle at your local drug or grocery store.
Regardless of what type of infection you’ve got, it’s probably a good idea to refrain from intercourse until symptoms have cleared up, says Dr. Kelly-Jones. “Most women are just not comfortable to have intercourse when they have an infection.” If you have a male partner, she adds that the introduction of sperm into the vaginal environment could even worsen symptoms because of the fact that sperm can further alter the vagina’s pH. You can still engage in other types of sexual activity, but receiving oral sex might also be a no-no — it just depends on your comfort level and that of your partner, as some people may be grossed out.
You can’t pass BV to a male partner and it’s very rare that male partner gets any sort of irritation from a yeast infection. If you have sex with women, though, it is possible to pass BV to a partner — the jury is still out on the possibility of passing yeast infections, but that may also be possible.
If you find that you have recurring yeast infections or BV, it’s worth visiting with your doctor to discuss causes and treatment, as well as to troubleshoot why the infections keep coming back. For some people, diet changes (like reducing carbohydrates or sugar) can make a difference in symptoms, Dr. Kelly-Jones says. “What we eat is important to our overall well-being and health. Let’s look at the overall system and what’s going on.”
Carrie Murphy is a freelance writer and doula in Albuquerque, NM. Read more on her website, carrie-murphy.com.
Mayo Clinic Q and A: Vaginal infections have similar symptoms, require different treatments
DEAR MAYO CLINIC: What is the difference between bacterial vaginosis and a yeast infection? I’ve had painful itching for two weeks but have not been to see a doctor yet. Are over-the-counter medications effective in treating both?
ANSWER: Bacterial vaginosis, or BV, and vaginal yeast infections may have some symptoms that seem similar, but they have different causes and require different treatment. Over-the-counter remedies are available for a yeast infection. BV typically requires prescription medication. See your doctor to get an accurate diagnosis. Then he or she can help you decide on the best treatment.
BV and yeast infections both fall under the broad category of vaginal infections, called vaginitis. These infections are quite common in women. They usually can be treated effectively without any long-term problems. You need to know which type of infection you have, however, to make sure you get the right treatment.
BV is the result of an overgrowth of one of several organisms normally present in your vagina. Usually, the “good” bacteria, called lactobacilli, outnumber the “bad” bacteria, called anaerobes. If anaerobic bacteria become too numerous, they upset the natural balance of microorganisms in your vagina, resulting in bacterial vaginosis.
One of the most common reasons for an overgrowth of anaerobic bacteria is douching — rinsing out your vagina with water or a cleansing agent. In most cases, douching is not recommended because it disrupts the vaginal environment and can lead to BV, as well as other types of vaginitis, including a vaginal yeast infection.
In contrast to BV, a vaginal yeast infection is caused by a fungus called candida. Candida is a microorganism that’s normally present in your vagina. Your vagina naturally contains a balanced mix of yeast and bacteria. Lactobacillus bacteria produce acid, which discourages overgrowth of yeast in the vagina. But disruption of the balance between the two can result in an overgrowth of yeast.
A number of factors can result in an overgrowth of vaginal yeast. You may be at higher risk for a yeast infection if you take antibiotics regularly. Antibiotic use can cause a decrease in the amount of lactobacillus bacteria in your vagina, allowing yeast to overgrow. Women who take birth control pills containing estrogen, who are pregnant, who have uncontrolled diabetes, or whose immune systems are weakened are also at an increased risk for yeast infections.
Symptoms of BV and a yeast infection both usually include vaginal discharge. BV typically causes discharge that’s thin and gray or yellow. A yeast infection causes discharge that is thick and white, with a cottage-cheese type appearance. BV is associated with a foul, “fishy” vaginal odor, while most women don’t notice an odor with a yeast infection. A yeast infection also typically causes itching, particularly in younger women, and may include a burning sensation, especially during urination. In general, BV doesn’t cause itching or burning.
You can treat a yeast infection with over-the-counter medication. But if you aren’t sure if that’s what is causing your symptoms, see your doctor first. To make a diagnosis, your doctor likely will perform a pelvic exam and take a sample of vaginal secretions to be examined under a microscope.
Prescription medications such as metronidazole, clindamycin and tinidazole often can effectively treat BV. For yeast infections, antifungal creams, ointments, tablets or suppositories usually are all that’s needed to restore the vaginal balance of bacteria and yeast and eliminate symptoms. If a yeast infection is causing severe symptoms, or if the infection comes back multiple times, additional treatment may be necessary to keep the yeast in check.
If your symptoms don’t improve with treatment, it’s important to contact your doctor. It’s possible that a yeast infection or BV may not be the problem, and further evaluation is needed. — Mary Marnach, M.D., Obstetrics & Gynecology, Mayo Clinic, Rochester, Minn.
What is the Difference between a Yeast Infection and Bacterial Vaginosis?
Did someone say vaginal infections? Ugh, talk about no fun! Unfortunately, vaginal infections are a fact of life that most women will experience some time or another. Even with such common occurrences, we often make wrong assumptions and purchase products we do not actually need due to a lack of knowledge. The problem is, no one teaches us the facts! Well, no worries ladies.The RepHreshing Truth is here to empower you with the truth about vaginal infections. We are finally going to answer your burning question: What is the difference between a Yeast Infection and Bacterial Infection or Bacterial Vaginosis (BV)?
Yeast Infection: What You Think You Have
Have you ever noticed vaginal odor, itching, burning or discharge and immediately jumped to the conclusion that you have a Yeast Infection? We all have! Before you run to the store to pick up some quick fix medicine, you should know that Yeast Infections are actually the SECOND leading type of vaginal infections, accounting for 29% of all vaginal infections. Many women commonly mistake other vaginal infections for Yeast Infections, believing that it is the most common type.
Vaginal Yeast Infections are caused when there is an overgrowth of yeast, a fungus (ew!) that lives in the vagina. Typically, beneficial vaginal bacteria like Lactobacillus help keep other organisms (like the yeast) under control. But, when the beneficial bacteria cannot keep up and yeast overgrows, you can get a yeast infection. So how do you know if it is a Yeast Infection? Yeast Infections are usually signified by itching and burning in the vagina and around the vulva. A white vaginal discharge that may look like cottage cheese and may be odorless or have a yeasty smell (like bread or beer).
Bacterial Vaginosis: The Most Common Type of Vaginal Infection
If Yeast Infections are the second most common vaginal infection, what is the first? You guessed it, Bacterial Vaginosis (BV). BV is caused when there is too much bad (pathogenic) bacteria. Again, typically, beneficial vaginal bacteria help keep bad bacteria under control. But, when the beneficial bacteria cannot keep up and bad bacteria overgrow, you can get a bacterial infection, or Bacterial Vaginosis (BV). Bacterial Vaginosis is also accompanied by unbalanced pH because the bad bacteria that cause this infection flourish in elevated pH, while beneficial bacteria thrive in a healthy pH environment.
Signs of Bacterial Vaginosis generally include a grayish white vaginal discharge, a bothersome “fishy odor” and elevated pH. Many women describe the discharge as yogurt-like or pasty. Women may also experience vaginal itching and redness as a result of BV.
Make sure you know which type of infection you have BEFORE treating it. Yeast infection treatments will not help a bacterial infection and may further irritate this uncomfortable condition.
Importance of Vaginal pH & Beneficial Bacteria
An important part of keeping everything in balance is the vaginal pH. In healthy women, vaginal pH is typically 3.5 to 4.5. Studies show that vaginal issues often occur when vaginal pH is unbalanced. Healthy pH helps beneficial bacteria to thrive so that it can do its job maintaining vaginal health.
When pH becomes elevated, the environment shifts in favor of the pathogenic bacteria. This can allow pathogenic bacteria to cause vaginal odor, discomfort and even infection. Elevated pH is one of the key factors doctors look for when diagnosing vaginal infections. Maintaining healthy vaginal pH within the healthy range can help reduce risk of vaginal issues.
Unfortunately, elevated vaginal pH can be caused by a number of things including your period, because blood has a pH of 7.4, sexual intercourse (pH of semen is 7.1 to 8), some hygiene products (even “pH-balanced” feminine washes have a pH of 5.5 or higher). The hormone fluctuations that women experience each month are also associated with elevated pH.
What to do if you Think you Have a Vaginal Infection
If you think you have a vaginal infection, your best bet is to see your doctor. Most women opt for a visit to a gynecologist, but a primary care physician can also diagnose infections. Your doctor will do a pH test and assess your symptoms and may take a simple swab for examination under a microscope before providing a diagnosis. If you have a yeast infection, your doctor may prescribe an oral medication or recommend an over-the-counter treatment. If you have a bacterial infection, your doctor will prescribe an antibiotic. Make sure you use all of the medicine your doctor prescribes, even if you start to feel better.
Once your infection is cured and you have returned to normal, you may wish to maintain your vaginal health by ensuring you have an optimal balance of beneficial bacteria and by maintaining healthy vaginal pH. RepHresh Pro-B Probiotic Feminine Supplement is clinically shown to provide healthy beneficial lactobacillus that works with your body to balance yeast and bacteria*. RepHresh Vaginal Gel is clinically shown to maintain healthy vaginal pH. The RepHresh Brand can help you take control of your feminine health – and that is the RepHreshing Truth!
Successful treatment of chronic vaginitis
Gadzooks! In preparing for the morning office practice session you notice that two patients with chronic vaginitis have been scheduled back to back in 15-minute slots.
Ms. A has chronic bacterial vaginosis. Ms. B has chronic yeast vaginitis. What are you going to do?
Chronic bacterial vaginosis
The normal vaginal microbiome is dominated by Lactobacillus crispatus and Lactobacillus jensenii. These organisms produce hydrogen peroxide and keep the vaginal pH ≤4.5. When Gardnerella vaginalis and associated anaerobic bacteria gain dominance in the vagina, bacterial vaginosis ensues. This infection is characterized by1:
- homogenous, thin, grayish-white discharge that smoothly coats the vaginal epithelium
- pH >4.5
- fishy odor when potassium hydroxide is added to a sample of the discharge
- clue cells on a saline wet mount.
Why is it prone to recur? If bacterial vaginosis was a simple infection, treatment with metronidazole or clindamycin should be very effective. But in many women the relief from symptoms provided by a single course of antibiotics is short-lived, and many patients experience recurrent bacterial vaginosis in the next few months.
The cause of this resistance to antibiotic treatment may be that G vaginalis and other anaerobes, such as Atopobium species, aggregate in vaginal biofilms that prevent the antibiotic from reaching the organism.2 The biofilm provides a safe haven for the bacteria to regrow following a single course of treatment.3 In addition, the nutrient-limited environment inside the encapsulated biofilm helps the bacteria to resist the toxic effects of the antibiotic.4
Another potential mechanism for bacterial vaginosis recurrence is that women destined to develop repeat infection often harbor G vaginalis encapsulated in biofilms in the mouth. These extravaginal bacteria often are found again in the vagina, suggesting that bacterial vaginosis can be acquired from extravaginal bacterial reservoirs.5 Investigators are developing approaches, such as intravaginal treatment with DNase, to destroy the vaginal biofilm in order to enhance the efficacy of antibiotic treatment.6
Options for initial infection. There are three treatments for an initial occurrence of bacterial vaginosis7:
- oral metronidazole 500 mg twice daily for 7 days
- 0.75% metronidazole gel one applicator intravaginally once daily for 5 days, or
- 2% clindamycin cream one applicator intravaginally at bedtime for 7 days.
Long-term metronidazole for recurrence. Approximately half of women who respond to initial treatment will have bacterial vaginosis again within 1 year. If vaginitis caused by recurrent bacterial vaginosisis diagnosed, a prolonged course of antibiotic treatment is warranted. Treatment starts with an induction regimen of the standard treatments listed in the paragraph above. This is followed by a long-term maintenance regimen using 0.75% metronidazole vaginal gel one applicator twice weekly for 4 to 6 months.8
Recurrent Candida vulvovaginitis
Four or more occurrences of symptomatic Candida vulvovaginitis in 12 months indicates recurrent infection. Recurrence is usually caused by reinfection with the same organism from a vaginal reservoir. For women with such repeat infection, vaginal cultures should be obtained to confirm Candida and to search for treatment-resistant species, such as Candida glabrata. (Many C glabrata organisms are resistant to standard fluconazole treatment.)
Long courses of oral or vaginal antimycotic agents can be effective treatment for recurrent Candida vulvovaginitis.
Fluconazole. One regimen is fluconazole 150 mg orally every 72 hours for 3 doses, followed by fluconazole 150 mg once weekly for 6 months.9 If patients relapse from this regimen, then the vaginitis should be retreated with fluconazole 150 mg orally every 72 hours for 3 doses, followed by fluconazole 150 mg weekly for 12 months.
Boric acid. If C glabrata is thought to be the cause of the infection, it may be difficult to eradicate with fluconazole. A regimen to treat recurrent vaginitis caused by C glabrata is intravaginal boric acid, a 600 mg capsule once nightly for 14 days.10,11This medication is not FDA-approved for this purpose and must be made by a compounding pharmacy. Boric acid can be fatal if swallowed rather than used intravaginally. Care must be taken to avoid access to these capsules by children.
Boric acid vaginal capsules also can be used to treat chronic bacterial vaginosis in combination with antibiotic therapy.12
Flucytosine. An alternative regimen to treat C glabrata is flucytosine vaginal cream one applicator nightly for 14 days. This vaginal cream must be compounded because it is not available as a commercial medication.
You are armed and ready
In retrospect, you realize that the morning office session schedule is going to be fine. You will treat Ms. A with a long course of metronidazole and Ms. B with a long course of fluconazole. Hopefully, they will both find relief from their symptoms.