Bacterial vaginosis (BV) treatment online in Puerto Rico

Bacterial vaginosis (BV) happens when the vagina’s "good" bacteria (lactobacilli) drop and other bacteria overgrow. According to the CDC, it is the most common vaginal condition in women ages 15 to 44, and many women who have it notice no symptoms.

The risk goes up with a new partner or several partners, with douching and without condoms. It rarely affects people who have never had sex. The CDC says it still does not fully understand how BV spreads.

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BV is handled in a doctor visit, with no membership. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. We do not bill insurance; the lab and the pharmacy charge separately. See all prices.

Many women have no symptoms. When there are symptoms, the most common are:

• Thin white or gray vaginal discharge
• A strong fishy smell, especially after sex
• Burning or itching in the vagina
• Burning when you urinate

Symptomatic BV is treated with an antibiotic, as pills or as a vaginal gel or cream, following the CDC treatment guidelines. The doctor chooses the treatment for your case. If you are prescribed one, finish it even if you feel better. BV can come back even after treatment; if it does, book again.

According to the CDC, routine treatment of male sex partners is not recommended. But BV raises the risk of getting chlamydia, gonorrhea and HIV, so the doctor may offer STI testing by lab order, for example for chlamydia.

Itching with thick white discharge and no bad smell points more to a yeast infection. That is why, when the picture is unclear, the doctor orders a test before prescribing.

In pregnancy, untreated BV is linked to preterm birth and low birth weight. If you are pregnant and have symptoms, the doctor coordinates with your OB-GYN.

If you are under 21, a parent or legal guardian must sign the consent, stay on camera for the whole visit and show photo ID.

Metronidazole is one of the CDC-recommended antibiotics for bacterial vaginosis. The CDC’s 2021 guidelines recommend it as pills for 7 days or as a vaginal gel for 5 days; clindamycin vaginal cream is the other recommended option. The CDC also recommends metronidazole for trichomoniasis, an STI that can cause similar discharge.

Alcohol and metronidazole. MedlinePlus, following the drug label, says not to drink alcohol or use products with alcohol or propylene glycol while taking metronidazole and for at least 3 days after the last dose, because it can cause nausea, vomiting, stomach cramps and headache. The CDC’s 2021 guidelines conclude that the warning came from laboratory experiments and that avoiding alcohol is unnecessary; because the label still says it, follow the doctor’s instructions.

Common side effects, according to MedlinePlus, are a sharp metallic taste, nausea, vomiting, diarrhea and an upset stomach. The CDC advises avoiding sex, or using condoms every time, during treatment. If you are prescribed clindamycin vaginal cream, the CDC warns it can weaken latex condoms and diaphragms for 5 days after use.

In pregnancy, the CDC says metronidazole poses low risk and studies have not found birth defects linked to it. Still, tell the doctor: she coordinates with your OB-GYN.

The doctor decides whether metronidazole or another treatment is appropriate for you based on your symptoms, your history and the medicines you use. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.

The CDC suggests:

• Don’t douche.
• Limit your number of sex partners.
• Use condoms every time you have sex.

These signs are not simple BV. For your safety, go to the emergency room or call 911.

• Severe lower belly pain with fever
• Sudden severe pain, vaginal bleeding or fainting if you could be pregnant
• Pregnancy with leaking fluid, bleeding or early contractions