The usual medication prescribed for Bacterial vaginosis is metronidazole (trade name Flagyl). Metronidazole is effective against both anaerobic bacteria and protozoa (organisms like amoebas), so it is used to treat not only Bacterial vaginosis but also trichomonas and amoebic dysentery. The course of treatment usually runs about a week, with a dosage of 250 mg three times a day or 500 mg twice a day.

Though you can take Flagyl with or without food, you should not drink any alcoholic beverages at all while you are taking it, or for twenty-four hours after your last dose. The interaction may cause severe vomiting, nausea, abdominal cramps, headaches, and other unpleasant symptoms. Flagyl acts like Antabuse, a drug given to alcohol abusers to try to wean them from their habit. Our bodies normally produce an enzyme called acetaldehyde dehydrogenase, which is needed to metabolize alcohol. Flagyl blocks this enzyme. So if you drink alcohol, your blood levels of acetaldehyde rise and rise, which eventually produces nausea and vomiting. Some people get stomach upsets from Flagyl even if they do not drink alcohol. Flagyl may also make your mouth dry or metallic tasting.

Metronidazole is also available as a cream, marketed as MetroGel. It is inserted into the vagina with a special applicator that comes with it. Originally the prescribed course of therapy was one applicator twice a day for five days; now the manufacturer recommends just one application before bedtime. This is considerably more pleasant, since vaginal creams can leak out and be messy. Metronidazole is also used to treat rosacea (“adult acne”).

A newcomer to the field of Bacterial vaginosis therapy, clindamycin, is prescribed for acne as well as for vaginal infections (the anaerobic bacteria that cause both conditions are similar). As a treatment for Bacterial vaginosis, clindamycin is marketed as Cleocin Vaginal Cream or as vaginal suppositories; as a treatment for acne, it is called Cleocin T Gel. Cleocin is probably more effective than Flagyl against bacteria that belong to the Mobiluncus family.

As with metronidazole, the therapy time with clindamycin has been shortened. The old recommendation was to apply Cleocin Vaginal Cream once daily before bedtime for a week. The manufacturer has reduced the course of therapy to three nights, for both cream and suppositories.

Is Flagyl safe during pregnancy?

The FDA has given Flagyl a B rating for use during pregnancy, which means that studies done on animals or humans have presented no evidence of risk to the fetus. Some physicians, however, will not prescribe it during pregnancy, especially during the first trimester. If your physician chooses not to prescribe Flagyl, a possible substitute is MetroGel. Like Flagyl, it has received a B rating from the FDA.

Can you have more than one kind ofvaginitis at the same time?

Unfortunately, it is possible to have mixed infections. For this reason a culture of the vaginal discharge can be helpful, because it can be difficult for your doctor to decide from your symptoms alone exactly what kind of infection you have and what medication would best eradicate it.

Vaginitis simply means “inflammation ofthe vagina,” just as appendicitis simply means “inflammation of the appendix.” (Vulvovaginitis means that the vulva — the external genitals — are involved, as well as the vagina.) Vaginitis can be very uncomfortable, but it is rarely serious and can usually be treated easily and effectively.

The three major kinds of vaginitis can be categorized by the microorganisms causing them. Yeast infections are caused by overgrowth of a microscopic fungus. Bacterial vaginosis seems to be caused by bacteria that thrive in the absence of oxygen. Trichomoniasis, discussed in site, is caused by a single-celled amoeba-like organism. The symptoms of these infections vary from itching and burning to an unpleasant vaginal discharge to no manifestations at all. Some of the infections are transmitted sexually; others are not. Since treatments vary, it is important to figure out which infection you have.

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