Microbiological diagnostic tests may be used to determine which microorganisms are present and differentiate between pathogens requiring different treatments. Similar symptoms may present with gonorrhoea, chlamydia, Mycoplasma genitalium or MG/Mgen (a cause of PID), and trichomoniasis.^6,19

The British Association for Sexual Health and HIV (BASHH) guidelines for BV recommend metronidazole, clindamycin or tinidazole. Metronidazole is less active against lactobacilli which may be regarded as an advantage, but clindamycin has more activity against most of the bacteria associated with BV.¹⁹

First line BV treatment options are:¹⁹

·       oral metronidazole 400mg twice daily for 5-7 days or 2g as a single dose; or

·       intravaginal metronidazole gel 0.75% daily for five days; or

·       intravaginal clindamycin cream 2% daily for 7 days.

Alternatives are:

·       tinidazole 2g as a single dose; or

·       clindamycin 300mg twice daily for seven days.

Women taking metronidazole should avoid alcohol for at least 48 hours after completing the course due to the risk of a disulfiram reaction. Clindamycin may weaken condoms.^19,22