Bacterial vaginosis (BV) is a common vaginal infection caused when natural bacteria levels in the vagina are out of balance. It can lead to symptoms such as unusual discharge color, odor, itching, irritation or burning during urination, though some people have no symptoms at all.¹

A common prescription treatment for BV is metronidazole, which is available as an oral tablet and as a vaginal gel. Both forms can be effective, but there are important differences between the two. Here is what to know about metronidazole gel and tablets for BV.²

• Metronidazole is a common treatment for BV.

• The medication can be prescribed as an oral tablet or vaginal gel.

• Tablets can be more convenient but create more risk for gastrointestinal side effects.

• Studies show both forms of metronidazole to be effective in treating BV.

Metronidazole Vaginal Gel for BV

Metronidazole vaginal gel is a prescription treatment that is applied directly inside the vagina using an applicator, usually at bedtime.⁵ The usual dosing schedule is one full applicator of 0.75% gel inserted vaginally once a day for five days. Some people start to notice symptom relief within a few days, but it is still important to finish the full course exactly as prescribed.⁶

In terms of effectiveness, one early study found clinical cure rates of 87% to 91% with intravaginal metronidazole gel.⁷ Other studies have found that vaginal gel and tablets are similarly effective for treating BV.⁸

Some people prefer the gel because it may cause fewer gastrointestinal issues such as nausea or diarrhea. It is also a shorter standard treatment course than oral tablets for BV.⁹

However, vaginal application is not for everyone. Some people find it messier or less convenient than taking a pill, and others may prefer to avoid intravaginal treatment depending on their daily routine or comfort level.

Metronidazole Oral Tablets for BV

Metronidazole oral tablets are taken by mouth. For BV, the standard recommended dose is 500 mg twice daily for seven days.¹⁰

Like the gel, the tablets often start helping within a few days. Even so, you should keep taking the medication for the full prescribed length of time unless your healthcare provider tells you otherwise. Stopping early can make treatment less effective.¹¹

Oral metronidazole has been used for BV for many years, and research has shown that it is similarly effective to the vaginal gel.¹² Some people prefer the oral tablet as a more convenient treatment options, while others prefer the vaginal gel to avoid stomach issues or for a shorter treatment regimen.^13,14

When Doctors Prescribe Metronidazole Gel vs. Tablets for BV

Both metronidazole gel and tablets are recommended options for BV, so the choice often comes down to individual circumstances rather than one option always being better than the other.

A healthcare provider may consider:

• Severity of symptoms: Both forms effective for treating BV, but patients with more severe symptoms or other health issues may want to use the vaginal gel to avoid additional side effects.¹⁵

• Recurrent or persistent BV: If BV keeps coming back, a provider may switch your form of medication to see if results improve. This can happen whether you initially start with the oral or the intravaginal, as both forms are found to be effective.¹⁶ Recurrence is common after treatment.¹⁷

• Tolerance for side effects: Someone sensitive to nausea or stomach upset may prefer vaginal gel, which is associated with fewer gastrointestinal complaints in some studies.

• Medical history and drug interactions: Oral metronidazole may require more consideration of medication interactions and other safety factors, while vaginal treatment may be a better fit for some patients.¹⁸

Metronidazole Side Effects & Safety

Metronidazole is generally safe when used as prescribed, but there can be side effects.

• Common side effects of oral metronidazole tablets include nausea, vomiting, diarrhea, stomach discomfort and a metallic taste. If you experience rare side effects such as dizziness, confusion, itching, hives, rashes or numbness, contact your healthcare provider immediately.¹⁹

• Common side effects of metronidazole vaginal gel include vaginal irritation, itching, discomfort or discharge, as well as rare side effects such as dizziness, confusion, itching, hives, rashes or numbness. Contact your healthcare provider if you experience any of these issues. Because less of the medication is absorbed systemically, vaginal gel typically causes fewer gastrointestinal side effects than oral tablets.²⁰

Other safety tips:^21,22

• Avoid alcohol until a full day after treatment ends when using the gel, and for three days after treatment when using the tablet.

• Do not have sex while using the vaginal gel.

• Always discuss any health issues and other medications you’re taking with your healthcare provider to ensure metronidazole doesn’t cause a negative reaction.

While using metronidazole, you should contact a healthcare provider if symptoms do not improve or get worse, symptoms return after treatment, you experience rare or severe side effects, or you develop signs of an allergic reaction, such as rashes or swelling.

How to Choose for BV: Metronidazole Gel vs. Tablet

Choosing between metronidazole gel and tablets for BV often comes down to personal preference, symptom history and medical guidance. Both options are effective treatments, but one may fit your needs better than the other.

Speak with your healthcare provider to determine the best course of treatment for you. Be sure to consider:^23,24

• Your infection history and the severity of your symptoms: Patients who have had BV before or whose symptoms do not go away after a few days may want to try an alternate approach.

• Which treatment suits your lifestyle: The tablet may be more convenient for some, but others may want to avoid certain side effects by using the gel.

• Sensitivity to nausea or stomach issues: Metronidazole gel may be easier to tolerate for women who have stomach issues or do not react well to oral antibiotics.

• Your medical history: Be sure to mention any allergies you may have to medications.

• Medications or supplements you’re currently taking: Your healthcare provider needs this information to ensure your prescribed treatment doesn’t cause a negative reaction.

How RedBox Rx Can help

RedBox Rx makes receiving treatment for BV with a metronidazole gel or tablet prescription easy and affordable.

Benefits of RedBox Rx include:

• $39 online doctor consult.

• Meds starting at $25 per treatment.

• Fast, free home delivery.

• No insurance required. HSA and FSA eligible.

Start your treatment today with an online BV consultation.