Adult BV Treatment (Bacterial Vaginosis)
Fast MD-only BV care for adults in California by secure online video visit, $49 flat-fee, no insurance required.
Thin gray or white vaginal discharge with a strong fishy odor is classic for bacterial vaginosis (BV). Our board-certified MDs use guideline-based criteria to distinguish BV from yeast infections, sexually transmitted infections (STIs), and other causes of discharge, then prescribe safe, effective treatment when telehealth is appropriate for adults located in California.
- $49 flat-fee visit, no hidden costs
- MD-only care, no mid-level providers
- No insurance required or accepted
- Available for adults in California (and 25+ states)
- Secure, encrypted video visits from home
Online BV Care by California-Licensed MDs
- Typical visit length: 10–15 minutes
- Distinguish BV from yeast and STIs
- Oral and vaginal treatment options
- No urgent care waiting room or exposure
For adults only (18+). You must be physically located in California at the time of your video visit. We do not manage BV in pregnancy by telehealth and do not prescribe controlled substances.
What Is Bacterial Vaginosis (BV)?
Bacterial vaginosis is a common vaginal condition caused by an imbalance in the normal vaginal flora. Instead of protective lactobacilli dominating, there is an overgrowth of other bacteria, which leads to a characteristic thin gray or white discharge and a strong fishy odor, especially after intercourse or during menses.
BV is not a classic sexually transmitted infection, but sexual activity and new or multiple partners can increase risk. Many adults have no symptoms at all, while others notice bothersome odor and discharge without significant itching or irritation. Untreated BV can increase the risk of certain complications, especially in pregnancy and before gynecologic procedures.
TeleDirectMD focuses on treating uncomplicated BV in non-pregnant adults. We screen carefully for signs of pelvic inflammatory disease, STIs, pregnancy-related complications, or recurrent or complicated infections, and direct you to in-person evaluation if a video visit alone is not safe.
Common BV Symptoms and Red Flags
During your visit, the MD will review your symptoms, sexual history, and medical history to decide whether an uncomplicated BV episode can be treated by telehealth or whether you need in-person pelvic exam and testing.
| Symptom | What It Suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Thin gray or white vaginal discharge | Classic discharge for BV, especially if uniform and coating vaginal walls | Yes, if no significant pain, bleeding, or systemic symptoms | Bloody discharge, clots, or heavy bleeding suggesting other pathology |
| Strong fishy vaginal odor | Typical for BV, often worse after intercourse | Yes | Severe odor with fever and pelvic pain suggesting pelvic infection |
| Mild vaginal irritation or burning | Can occur with BV or overlapping conditions | Yes, if mild and no ulcers or severe pain | Painful sores, ulcers, or blistering lesions concerning for herpes or other conditions |
| Minimal itching | BV often has little or no itching compared with yeast | Yes | Intense itching suggesting yeast or other dermatitis requiring different treatment |
| Pelvic or lower abdominal pain | Less typical for isolated BV | Maybe, requires careful triage | Significant pelvic pain, fever, or tenderness concerning for pelvic inflammatory disease |
| Fever ≥ 100.4°F (38.0°C) | Uncommon in uncomplicated BV | No | Needs urgent in-person or ER evaluation |
| New bleeding between periods or after sex | May suggest cervical, endometrial, or structural causes | No, not for first evaluation | Requires in-person pelvic exam and further testing |
| Pregnancy with BV-like symptoms | Higher-risk group; BV can affect pregnancy outcomes | No for TeleDirectMD | Prompt in-person OB or primary care evaluation recommended |
| Recurrent BV episodes | Recurrent imbalance of vaginal flora | Limited telehealth management only | Frequent recurrences requiring in-person evaluation and long-term plan |
| Severe immunosuppression | Higher risk for complicated or atypical infections | Often no; depends on case details | In-person evaluation and possible lab testing recommended |
Conditions That Can Mimic BV
Several other conditions can cause vaginal symptoms similar to bacterial vaginosis. Part of your TeleDirectMD visit is carefully screening for these possibilities and directing you to the right level of care when needed.
- Vaginal yeast infection: Thick white clumpy discharge with intense itching and less odor, unlike BV.
- Trichomoniasis: Sexually transmitted infection that can cause frothy yellow-green discharge and odor.
- Chlamydia or gonorrhea cervicitis: May cause discharge, bleeding after sex, and pelvic discomfort with few other symptoms.
- Pelvic inflammatory disease (PID): Pelvic pain, fever, and cervical motion tenderness; requires urgent in-person care.
- Atrophic vaginitis: Thinning and dryness of vaginal tissue after menopause causing irritation and discharge.
- Dermatitis or contact irritation: Reaction to soaps, detergents, wipes, or products leading to itching and redness.
When a Video Visit Is Appropriate vs. When to Go In-Person
When a Video Visit Is Appropriate
- Adult 18–64 with classic BV symptoms (thin gray or white discharge, fishy odor)
- No significant pelvic pain, fever, or heavy bleeding
- Not pregnant or recently postpartum
- No severe immunosuppression or complex gynecologic history
- Symptoms similar to prior diagnosed BV episodes
- Able to use oral or vaginal medications safely
- Physically located in California at the time of the video visit
Red Flags Requiring In-Person or ER Care
- Fever ≥ 100.4°F, chills, or feeling very ill
- Significant pelvic or lower abdominal pain
- New heavy bleeding, bleeding between periods, or bleeding after sex
- Pregnancy with BV-like symptoms or any concerning vaginal bleeding
- Severe vulvar pain, ulcers, or blistering lesions
- Recurrent BV episodes not responding to standard therapy
- Severe immunosuppression or other major comorbidities with new symptoms
Treatment Options for Adult BV
Uncomplicated BV in otherwise healthy, non-pregnant adults usually responds well to short courses of antibiotic therapy targeting the vaginal flora imbalance. At TeleDirectMD, MDs follow guideline-based regimens, discuss oral vs vaginal options, and emphasize avoiding unnecessary antibiotics for other causes of discharge.
Supportive Care
- Avoid douching and scented vaginal products, which can worsen imbalance.
- Use gentle, unscented soap externally only; avoid internal washing.
- Wear breathable cotton underwear and avoid tight, non-breathable clothing.
- Use condoms if advised while symptoms are present to reduce irritation and odor.
Evidence-Based BV Treatment Options (Example Regimens)
The exact medication and duration will depend on symptom severity, prior response, and your medical history. Examples of commonly used regimens for uncomplicated bacterial vaginosis include:
| Medication | Dose | Duration | When used |
|---|---|---|---|
| Metronidazole (oral) | 500 mg by mouth twice daily | 7 days | First-line option for many non-pregnant adults with uncomplicated BV; avoid alcohol during treatment and for at least 24 hours after the last dose. |
| Metronidazole 0.75% vaginal gel | 5 g intravaginal once daily at bedtime | 5 days | Topical option for uncomplicated BV when local therapy is preferred or oral therapy is not ideal. |
| Clindamycin 2% vaginal cream | 5 g intravaginal once daily at bedtime | 3–7 days | Alternative regimen in select patients who cannot use metronidazole or when MD judgment favors clindamycin cream. |
| Clindamycin 100 mg vaginal ovules | 1 ovule intravaginal once daily at bedtime | 3 days | Alternative intravaginal option depending on availability and individual factors. |
| Topical barrier ointments | Thin layer to external vulva as needed | Short term | To protect irritated external skin and reduce friction; used along with BV treatment. |
TeleDirectMD does not treat BV in pregnancy by telehealth and does not prescribe repeated antibiotic courses for recurrent BV without in-person evaluation. If your history suggests a more complicated or recurrent condition, we will direct you to in-person gynecologic or primary care for examination and longer-term planning.
Home Care, Recovery, and Return to Work
Many adults with uncomplicated BV notice improvement in odor and discharge within a few days of starting treatment, though full normalization of discharge can take up to 1–2 weeks. Mild irritation may persist briefly as vaginal flora re-balance.
- Use prescribed oral or vaginal medications exactly as directed and complete the full course.
- Avoid douching, scented products, and unnecessary over-the-counter treatments during and after therapy.
- Consider using condoms while being treated and for a short time afterward, especially if you have had recent new partners.
- Monitor for recurrent symptoms; note patterns that may need in-person evaluation.
Most people can continue working or return to work while being treated, as BV is not typically dangerous, but discomfort or odor may influence your comfort at work. TeleDirectMD can provide a brief work note when medically appropriate as part of your $49 visit.
Seek in-person or emergency evaluation if you develop new fever, significant pelvic pain, heavy bleeding, severe vulvar swelling, or if your symptoms fail to improve or worsen after completing treatment.
What to Expect From Your TeleDirectMD Visit
TeleDirectMD provides adult-only, MD-only virtual urgent care for common vaginal conditions such as BV, yeast infections, and uncomplicated UTIs. Visits are conducted by secure video, last about 10–15 minutes, and cost $49 as a flat cash fee with no insurance involvement. During your visit, the MD will review your symptoms, sexual history, medications, and red flags to decide whether telehealth treatment is safe.
If your case meets criteria for uncomplicated BV and no red flags are present, we can send an electronic prescription for appropriate oral or vaginal medication to your preferred local pharmacy in California. If you need in-person evaluation, pelvic exam, or lab testing instead, we will explain why and guide you on the safest next step.
We do not prescribe controlled substances, manage pregnancy-related BV by telehealth, or provide complex gynecologic regimens online.
Bacterial Vaginosis (BV) Treatment FAQ
Can BV really be treated through an online visit?
Yes. Many uncomplicated BV episodes in healthy, non-pregnant adults can be safely treated by telehealth. TeleDirectMD MDs confirm classic symptoms, screen for STIs and pelvic inflammatory disease, rule out pregnancy concerns, and ensure no red flags are present before prescribing medication. If anything suggests a more serious condition, you will be directed to in-person care instead of receiving treatment online.
How do you know if it is BV and not a yeast infection or STI?
We pay close attention to your symptom pattern, including the type of discharge, presence or absence of itching, strength of odor, pelvic pain, bleeding, and sexual risk factors. Thin gray or white discharge with a strong fishy odor and minimal itching is more typical of BV, while thick clumpy discharge with intense itching points toward yeast. Concerning pelvic pain, bleeding, or STI risk may prompt a recommendation for in-person pelvic exam and testing.
Do I need a pelvic exam or swab before starting BV treatment?
Not always. Adults with classic BV symptoms, no red flags, and sometimes prior diagnosed BV may be treated empirically without immediate in-person testing. However, if this is your first episode, if symptoms are atypical, if you have pelvic pain or bleeding, or if there is concern for STIs or other conditions, we may recommend an in-person pelvic exam and vaginal swabs before or in addition to telehealth treatment.
What medications do you usually prescribe for BV?
Common options include oral metronidazole 500 mg by mouth twice daily for 7 days, metronidazole 0.75% vaginal gel once daily for 5 days, or clindamycin 2% vaginal cream or 100 mg ovules in select cases. The MD will help choose between oral and vaginal therapy based on your history, preferences, medication interactions, and recurrence pattern.
Can I drink alcohol while taking metronidazole?
It is generally recommended to avoid alcohol while taking oral metronidazole and for at least 24 hours after the last dose because combining alcohol with metronidazole can cause unpleasant reactions such as flushing, nausea, and vomiting. Your MD will review this and other safety instructions before prescribing.
Is BV a sexually transmitted infection?
BV is not considered a classic sexually transmitted infection, but sexual activity, new partners, and lack of condom use are associated with higher risk of BV episodes. It reflects a change in the vaginal flora rather than a single transmitted organism. We may still discuss STI testing depending on your history and risk factors.
Does my partner need treatment for BV?
Routine partner treatment for BV is not generally recommended, especially for male partners. In female partners, evaluation may be appropriate if they have symptoms. TeleDirectMD focuses on treating the patient who has booked the visit; partners with symptoms should seek their own evaluation rather than receiving empiric treatment through your visit.
Can BV affect pregnancy?
BV has been associated with certain pregnancy complications, so evaluation and treatment decisions in pregnancy should be handled in person with your obstetric or primary care team. TeleDirectMD does not manage BV in pregnancy by telehealth and will recommend in-person care if you are pregnant or might be pregnant.
What if BV keeps coming back?
Recurrent BV, especially frequent episodes, can be frustrating and may require more detailed in-person evaluation and longer-term management strategies. TeleDirectMD can offer initial guidance and treat occasional episodes, but persistent or frequent recurrences are best addressed with an in-person clinician who can perform exams and consider extended treatment plans.
Can you give me a work note for BV?
If your symptoms significantly affect your comfort or ability to work, TeleDirectMD can provide a brief work note as part of the $49 visit, typically for a short period aligned with symptom severity. We do not complete long-term disability, FMLA paperwork, or complex occupational forms for BV.
What if my odor or discharge does not improve after treatment?
If your symptoms fail to improve or return soon after treatment, or if you develop new fever, pelvic pain, bleeding, or severe irritation, you should seek in-person care. Persistent or worsening symptoms can indicate recurrent BV, another vaginal condition, or an STI that requires examination and testing.
Are you available outside California for BV care?
TeleDirectMD currently serves adults located in California and in more than 25 additional states, offering MD-only video visits for common vaginal conditions such as BV, yeast infections, and UTIs. During booking, you will confirm that you are physically located in a licensed state at the time of your visit so that our physicians can safely and legally provide care.