# Bacterial vaginosis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Vaginitis - disease-level clinical article (vaginitis-nonspecific-clinical.txt) · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens (2% cream) and Alternative Regimens (300 mg oral) - Verified date: 2026-08 ## Verified against - Vaginitis - disease-level clinical article (vaginitis-nonspecific-clinical.txt) - CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens - CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens (2% cream) and Alternative Regimens (300 mg oral) ## Treatment metadata - Metronidazole — 500 mg — oral.solid - Clindamycin — 300 mg — oral.solid - Secnidazole — oral.solid - Tinidazole — 500 mg — oral.solid ## Complete treatment card ```text BACTERIAL VAGINOSIS Sources: Vaginitis - disease-level clinical article (vaginitis-nonspecific-clinical.txt) · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens (2% cream) and Alternative Regimens (300 mg oral) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Foul-smelling vaginal discharge is the most common complaint [vaginal discharge] - The odor tends to get stronger after intercourse - Painful urination, painful sex, or vaginal itching can accompany the discharge [burning on passing urine · itching] - Many affected women have no symptoms at all SIGNS - what you find (3) - On exam the discharge looks thin and grayish-white, spread evenly along the vaginal walls - Checking cervical friability and motion tenderness helps exclude other causes of discharge - Fever or pelvic pain on exam should prompt a look for a more serious cause [abdominal pain · fever · pelvic pain] TESTS (10) - A vaginal fluid pH reading over 4.5 supports the diagnosis - Finding clue cells on a wet-mount slide is a reliable diagnostic sign - A fishy odor after adding potassium hydroxide to the sample is a positive whiff test - At least 3 of the 4 Amsel criteria must be met to confirm the diagnosis - A modified version accepting only 2 of the Amsel findings has been shown to be equally accurate - The Amsel criteria run about 70% sensitive and 94% specific - Wet-mount detection of clue cells covering 20% or more of cells meets one Amsel criterion - Gram stain scoring (Nugent method, 0 to 10) is mainly a research tool and rarely used clinically - Self-collected swabs, or any swab taken without a speculum exam, give unreliable results - Relying on culture, history alone, or a Pap smear to make the diagnosis is discouraged IF NOT THIS - what else fits (8) - Atrophic vaginitis - Candidiasis - Cervicitis - Chlamydia infection - Desquamative inflammatory vaginitis - Gonorrhea - Trichomoniasis - Pelvic inflammatory disease Source StatPearls "Bacterial Vaginosis" - disease-level clinical article Status traced to the source above Rx: Main treatment | Alternative when a nitroimidazole cannot be used | Alternative oral nitroimidazole MAIN TREATMENT 1. METRONIDAZOLE [1st line] Adult 500 mg BID orally x 7 days Peds Pre-pubertal bacterial vaginosis is rare; evaluate for child abuse Source Vaginitis - disease-level clinical article (vaginitis-nonspecific-clinical.txt), Recommended Regimens According to the Centers for Disease Control and Prevention, Bacterial vaginosis: "Metronidazole 500 mg orally twice daily for 7 days". This is the held copy of the CDC 2021 regimen; the CDC guideline itself is not cached here. Why Gold-standard oral nitroimidazole regimen with high cure rate Caution Common side effects include metallic taste, nausea, and dark urine. PREGNANCY - the CDC 2021 guideline puts no trimester restriction on it: "Pregnant women can be treated with any of the recommended regimens for nonpregnant women", and "metronidazole therapy poses low risk during pregnancy" because "no evidence of teratogenicity or mutagenic effects among infants has been reported". Two trials proved 250 mg three times daily effective in pregnancy; 500 mg twice daily "can also be used". BREASTFEEDING - lower doses "are considered compatible with breastfeeding", and after a single 2 g dose some clinicians defer the feed for 12-24 hours. ALCOHOL - the CDC 2021 guideline reviewed the evidence and found abstinence unnecessary. It found "no in vitro studies, animal models, reports of adverse effects, or clinical studies providing convincing evidence of a disulfiram-like interaction between alcohol and metronidazole", notes that "Metronidazole does not inhibit acetaldehyde dehydrogenase, as occurs with disulfiram", and concludes: "Thus, refraining from alcohol use while taking metronidazole (or tinidazole) is unnecessary." Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 9.00 EGP (0.45/unit) NITROFECTAZOLE 500 MG 20 F.C. TABS. GYPTO PHARMA 10.50 EGP (0.53/unit) FLAGICURE FORTE 500 MG 20 F.C. TAB KAHIRA 23.00 EGP (1.15/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) FLAGELLAT FORTE 500MG 20 F.C.TABS. MUP 30.00 EGP (1.50/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid ALTERNATIVE WHEN A NITROIMIDAZOLE CANNOT BE USED 2. CLINDAMYCIN [2nd line] Adult 300 mg BID orally (or 2% vaginal cream at bedtime for 7 days) x 7 days Peds Specialist pediatric evaluation required Choice Reach for this one on allergy or intolerance, not on preference. The CDC's wording is that intravaginal clindamycin cream is preferred in case of allergy or intolerance to metronidazole or tinidazole - so if those can be taken, they come first. Source CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Recommended Regimens (2% cream) and Alternative Regimens (300 mg oral) Why Alternative oral treatment for patients allergic or intolerant to metronidazole Caution Vaginal cream formulation may weaken latex condoms. Discontinue immediately if severe diarrhea occurs. There is a risk of Clostridioides difficile pseudomembranous colitis. Egypt ADCOCLINDACE 300 MG 16 CAPS. ARAB DRUG COM... 24.00 EGP (1.50/unit) CLINACYN 300MG 16 CAPS. SIGMA > EGYPT... 31.50 EGP (1.97/unit) CLINDAM 300 MG 16 CAPS. SIGMA > OCTOB... 75.00 EGP (4.69/unit) MEPACLIND 300MG 8 CAPS. MEPACO 38.00 EGP (4.75/unit) CLINDACINE ART 300 MG 12 CAPS. RAMEDA > ART ... 76.00 EGP (6.33/unit) ALFACLINDAMYCIN 300 MG 10 CAPS. ATCO PHARMA >... 69.00 EGP (6.90/unit) DALACIN C 300MG 10 CAPS. PFIZER 114.00 EGP (11.40/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid ALTERNATIVE ORAL NITROIMIDAZOLE - choose one 3. SECNIDAZOLE [2nd line] Adult 2 g by mouth as a single dose - Single dose Peds Bacterial vaginosis is a disease of women of reproductive age; the guideline sets no paediatric dose. Choice Alternatives, and secnidazole is usually the better buy. It finishes in one dose against tinidazole's two to five days, for a few pounds more. Take tinidazole when cost decides it - a course is about 8 EGP - or when secnidazole is not on the shelf. Source CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Alternative Regimens - verbatim: "Secnidazole 2 g oral granules in a single dose" Why One dose, taken in front of you if need be. On a disease whose 7-day courses are often not finished, that is the practical advantage, and a course is a few tens of pounds. Caution The guideline names oral granules. Egypt sells secnidazole as 500 mg and 1 g tablets instead, so the 2 g dose is four 500 mg tablets or two 1 g tablets taken together. Avoid in pregnancy and breastfeeding. The CDC says data are insufficient on secnidazole in pregnancy and that its use should be avoided - metronidazole is the option there. One dose does not shorten the follow-up: symptoms that persist or return need the diagnosis confirmed again rather than a repeat prescription. Egypt SECNIDA-MISR 500MG 4 TAB. MISR 11.00 EGP (2.75/unit) SENIDAL 500MG 4 F.C. TAB. GLOBAL NAPI P... 11.00 EGP (2.75/unit) EUROZOLE 500MG 4 TAB. EUROPEAN EGYP... 11.50 EGP (2.88/unit) FLAGENTYL 500MG 4 F.C. TABS. SANOFI 21.60 EGP (5.40/unit) FLADAZOLE 500MG 4 TAB. AMOUN 26.00 EGP (6.50/unit) OPINIDAZOLE 1000MG 8 F.C.TAB. EL-OBOUR 84.00 EGP (10.50/unit) AMEBAZOL 1 GM 2 F.C. TABS. EGYPHAR 27.00 EGP (13.50/unit) CIPAZOLE FORT 1 GM 2 TAB. SIGMA > ASPIN... 27.00 EGP (13.50/unit) 4. TINIDAZOLE [2nd line] Adult 2 g once daily for 2 days, or 1 g once daily for 5 days x 2 days at 2 g, or 5 days at 1 g Peds Bacterial vaginosis is a disease of women of reproductive age; the guideline sets no paediatric dose. Source CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Alternative Regimens - verbatim: "Tinidazole 2 g orally once daily for 2 days" and "Tinidazole 1 g orally once daily for 5 days" Why The cheapest course on the card - four 500 mg tablets is about 8 EGP - and a shorter one than the seven days of metronidazole. Caution Not in pregnancy. The CDC is explicit that animal data show moderate risk and that tinidazole should be avoided in pregnancy; metronidazole is the one with the safety record there. Egyptian packs are 500 mg tablets, so the 2 g dose is four tablets taken together and the 1 g dose is two. Where metronidazole or tinidazole cannot be used at all, the CDC prefers intravaginal clindamycin cream. Egypt FASIGYN 500 MG 4 TABS. PFIZER 8.35 EGP (2.09/unit) PROTOZOLE 500 MG 12 F.C.TABS. MUP 39.00 EGP (3.25/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)