Why antibiotics don’t always work on BV

A BV bacteria sits down to a plate full of the antibiotics you're trying to use to kill it. It's smiling. They won't work.

You may have a diagnosis of bacterial vaginosis (BV) with or without symptoms. Either way the problem is the same: disruptive flora have colonised the vagina. Often, these bacteria make a sticky bacterial biofilm​1–3​ on your vaginal cells and to protect their colony.

The usual treatment for BV is antibiotics, however, the three-month success rate of antibiotics is about 50 per cent.​4,5​

In many cases, BV never really goes away; the bacterial biofilm home-grown by vaginal bacteria and pathogens is still in there, stuck to the fabric of your vagina, the epithelial cells.

This biofilm allows the vagina to become less acidic, kills off the Lactobacillus, and causes unpleasant symptoms. Antibiotics merely put a few bullet holes in the biofilm, but they are not effective in dissolving it.

Antibiotics work for some people and are a fantastic option, but if your drugs aren’t working, there are other options (see Killing BV).

Antibiotics most commonly used to treat BV

  • Metronidazole (Flagyl, oral, MetroGel, vaginal) – most commonly prescribed
  • Clindamycin (Cleocin, oral or vaginal, Clindesse, vaginal)
  • Tinidazole (Tindamax, oral)

If you have tried antibiotics, and they haven’t worked, you may be treating the wrong bacteria or have antibiotic-resistant bacteria.

Many microbes aren’t detectable by regular cultures so may remain undetected. Get a comprehensive vaginal microbiome test to get the full story.

References​6,7​

  1. 1.
    Machado D, Castro J, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Cerca N. Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions. Front Microbiol. Published online January 20, 2016. doi:10.3389/fmicb.2015.01528
  2. 2.
    Sousa LGV, Pereira SA, Cerca N. Fighting polymicrobial biofilms in bacterial vaginosis. Microbial Biotechnology. Published online April 12, 2023:1423-1437. doi:10.1111/1751-7915.14261
  3. 3.
    Verstraelen H, Swidsinski A. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment: 2018 update. Current Opinion in Infectious Diseases. Published online February 2019:38-42. doi:10.1097/qco.0000000000000516
  4. 4.
    Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Front Reprod Health. Published online May 31, 2023. doi:10.3389/frph.2023.1100029
  5. 5.
    Muñoz-Barreno A, Cabezas-Mera F, Tejera E, Machado A. Comparative Effectiveness of Treatments for Bacterial Vaginosis: A Network Meta-Analysis. Antibiotics. Published online August 13, 2021:978. doi:10.3390/antibiotics10080978
  6. 6.
    Khedkar R, Pajai S. Bacterial Vaginosis: A Comprehensive Narrative on the Etiology, Clinical Features, and Management Approach. Cureus. Published online November 10, 2022. doi:10.7759/cureus.31314
  7. 7.
    Muzny CA, Sobel JD. The Role of Antimicrobial Resistance in Refractory and Recurrent Bacterial Vaginosis and Current Recommendations for Treatment. Antibiotics. Published online April 9, 2022:500. doi:10.3390/antibiotics11040500


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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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