Metronidazole gel is a prescription antibiotic treatment for bacterial vaginosis (BV). It is applied inside the vagina, usually once a day for 5 days. It works to stop the growth of bacterial vaginosis-causing bacteria and treat symptoms like:

• unusual vaginal discharge
• strong, fishy-smelling discharge
• burning sensation when going for a pee

Each tube of gel contains 7.5mg/g of the active ingredient metronidazole, a type of antibiotic. It is an alternative to the first-line bacterial vaginosis treatment, metronidazole tablets, for anyone who would prefer a topical medication or cannot take the oral pills.

Metronidazole is a type of antibiotic that works by stopping the growth of the bacteria responsible for causing bacterial vaginosis.

Bacterial vaginosis is caused by an imbalance in the natural bacteria present in the vagina, where harmful bacteria outgrow the healthy ones. Metronidazole gel interferes with the DNA in the infectious bacteria, stopping them from growing and multiplying, restoring the natural balance and relieving symptoms like unusual discharge, odour, and discomfort.

Because the gel is applied intravaginally (inside the vagina) it delivers the active ingredient to the site of the infection and has fewer side effects than oral tablets.

How long does metronidazole gel take to work?

Metronidazole gel usually starts to work within a few days of starting treatment, with most people noticing an improvement in their symptoms within 2 to 3 days. However, you should complete the full course of antibiotics for bacterial vaginosis, which is 5 days, even if you feel better. This will lower the chance of the infection returning.

How effective is metronidazole gel?

Metronidazole gel has been clinically proven to be effective for bacterial vaginosis. One early study found that 87% of people treated with metronidazole gel were free from the infection 9 to 21 days, compared to just 17% given a placebo. The same study found that 91% of people with persistent bacterial vaginosis were free from the infection after 2 weeks.

When compared with metronidazole tablets, a study found that applying the intravaginal gel twice a day for 5 days was similarly effective to the oral treatment. Bacterial vaginosis was eliminated in almost 84% of people given metronidazole gel compared to 85% in the oral tablet group.

Metronidazole gel is applied inside the vagina using an applicator. The usual dose for bacterial vaginosis is 1 full applicator every night for 5 nights.

To apply metronidazole gel, you need to:

1. Wash your hands with soap and water and dry them thoroughly before use.
2. Remove the cap from the tube of gel.
3. Screw one of the disposable applicators to the tube.
4. Carefully squeeze the tube of gel to fill up the applicator. When the plunger stops moving, this signals that the applicator is full.
5. Remove the applicator from the tube and replace the cap on the tube of metronidazole gel.
6. Lie on your back, before parting and bending your knees.
7. Place the applicator tip high in your vagina and begin pushing the plunger. This will release the gel.
8. Take out the applicator gently and make sure it is put in the bin straight away.

You should repeat these steps for 5 nights using a fresh applicator each time.

You should not use metronidazole gel if you have your period, as this can reduce its effectiveness.

If you use too much metronidazole gel, this can increase your risk of side effects. Make sure to speak to your doctor or pharmacist for advice.

What if I miss a dose?

If you forget a dose of metronidazole gel, use it as soon as you remember on the same night. If it’s already the next day, skip the missed dose and apply your next dose at the usual time at night.

Do not take a double dose to make up for a missed one.

Metronidazole gel is a prescription-only treatment, so you will need a doctor’s approval to obtain it. It is available to request online from trusted online doctor services, or you may be able to get a prescription on the NHS.

Can I buy metronidazole gel online?

Yes, you can request metronidazole gel for bacterial vaginosis from Superdrug Online Doctor by:

1. Filling in a brief questionnaire about your health and lifestyle.
2. Ordering your preferred choice of treatment and making payment.
3. One of our doctors will review your order and questionnaire answers.
4. If your order is approved, your treatment will be posted directly to your address or made available for collection at a Superdrug Pharmacy.
5. If your order is not right for you, one of our doctors will contact you via your account with alternative options that are more suitable for you.

Can I buy metronidazole gel over the counter?

No, metronidazole gel requires a prescription from a doctor in order for you to obtain it, so you cannot buy it over the counter.

Can I get metronidazole gel on the NHS?

Yes, metronidazole gel may be available on the NHS to treat bacterial vaginosis, but you will need to make an appointment with your doctor to find out.

Common metronidazole gel side effects include:

• feeling or being sick
• diarrhoea
• a metallic taste in your mouth or a furry tongue
• itching, burning, or irritation in the vagina
• headache
• dizziness
• tiredness
• irritability

How long do metronidazole gel side effects last?

Most mild metronidazole side effects will get better within a few days of stopping the medication. If they continue beyond this or you are finding them difficult to manage, contact your doctor for further advice.

What to do if you get metronidazole gel side effects

Most mild side effects can be managed at home in the following ways:

Feeling or being sick – get plenty of rest until you feel better and avoid eating rich or spicy foods, instead opting for simple and easy-to-digest meals. If you are sick, drink frequent sips of water to stop you from becoming dehydrated.

Diarrhoea – drink lots of fluids, like water, squash, or herbal tea, to avoid dehydration. If it occurs for more than 24 hours, speak to your doctor for more advice.

Metallic taste – drink plenty of water and eat plain foods you enjoy to help get rid of the taste.

Furry tongue – a furry tongue can be a sign of thrush, so speak to your doctor or pharmacist for advice.

Headache – get some rest and if needed, take over-the-counter painkillers, like paracetamol or ibuprofen, to manage the pain. If you have been drinking less than usual or are being sick or have diarrhoea, take frequent sips of water to avoid dehydration.

Although rare, if you experience any of the following serious side effects, call your doctor or 111 straight away:

• the whites of your eyes or skin turn yellow, which could be a sign there is a problem with your liver or gallbladder
• you get unexpected infections, mouth ulcers, bruising, bleeding gums, or extreme tiredness, which could be a sign of a blood issue
• stomach pains that reach through to your back (pancreatitis)
• blurred or double vision

Get someone to take you to A&E or call 999 immediately if:

• your lips, mouth, throat, or tongue suddenly swell
• you are breathing very fast or struggling to breathe
• your throat is very tight and you’re having difficulty swallowing
• your skin, tongue, or lips turn blue, grey, or pale
• you suddenly become very confused, drowsy, or dizzy

Before using metronidazole gel, tell your doctor if you:

• are allergic to metronidazole or any other ingredients listed in the patient leaflet
• are pregnant or breastfeeding
• have liver problems
• drink alcohol regularly
• think you may have vaginal thrush
• are due on your period during treatment

You should also let your doctor know before using metronidazole gel if you are taking any prescription, over-the-counter, or herbal medications, including:

• warfarin
• lithium
• 5-fluorouracil
• cyclosporin

Pregnancy and breastfeeding

You should speak to your doctor before using metronidazole during pregnancy or breastfeeding. It is only recommended to be used during pregnancy or breastfeeding under the guidance of a doctor.

Can I use metronidazole gel if I’m on my period?

No, it’s generally not recommended to use metronidazole gel during your period because it can interfere with its effectiveness. However, metronidazole tablets can be taken if you are menstruating and have bacterial vaginosis.

How long should I wait to pee after using metronidazole gel?

Ideally, you should wait at least 30 minutes before urinating to allow enough time for the gel to be absorbed properly and start working without it being washed away or diluted. The best time to apply the gel is before bed, after you have had your last pee.

What happens if you drink alcohol with metronidazole gel?

Although it’s less common with topical forms of metronidazole, there is still a risk of interaction between metronidazole and alcohol. It can cause side effects like headaches, flushing, feeling or being sick, and a rapid heartbeat. You should avoid alcohol while taking metronidazole and for 2 days after you have finished your treatment.

How long after using metronidazole gel can I have intercourse?

You should avoid sex until you have finished your treatment with metronidazole gel.

What does discharge look like after using metronidazole gel?

After using metronidazole gel, you may get a white, clumpy discharge that looks similar to cottage cheese. Some people may get a white, thick discharge that may or may not smell. These effects should go away once you have finished your treatment.

Can I use metronidazole gel if I have high blood pressure?

You should let your doctor know before using metronidazole gel if you have high blood pressure, so that they can assess if it is safe and suitable for you.