Bacterial vaginosis is one of three common vaginal infections, the other two being yeast infections and sexually transmitted infections.
According to the CDC, around 21.2 million women between the ages of 14 and 49 experience this disease. People looking for treatments may consider azithromycin for bacterial vaginosis. Here is a comprehensive look into azithromycin for BV.
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What Is Bacterial Vaginosis (BV)?
Bacterial vaginosis, also known as BV, is one of the most common vaginal infections in people of childbearing age. Still, anyone with a vagina at any age can get infected. It occurs when there is an overgrowth of bacteria in the vagina, which affects the natural balance and causes inflammation.
BV is not a sexually transmitted infection (STI) but is linked to sexual activity. This is because people with penises can carry the bacterium that causes BV without showing symptoms and pass it on to their partners.
What Are the Signs and Symptoms of Bacterial Vaginosis?
Although BV is usually not serious, it can cause unpleasant symptoms and, in some cases, lead to more severe infections. Some signs associated with this disease include:
Vaginal Discharge: A person could have BV when they notice a thin discharge. There are higher chances of the condition being BV when the release is gray, white, or green.
Vaginal Odor: An individual with a foul-smelling vaginal odor is a sign of them having BV. The strong, fishy smell comes from the vaginal discharge.
Vaginal Itching: The intense fishy discharge from the vagina can also cause a burning or itching sensation when the person urinates. Bacteria buildup causes the vulva to itch due to inflammation.
These shared symptoms do not always manifest when an individual has BV. In some cases, a person will not experience any symptoms at all. According to the CDC, up to 84% of participants in a BV study reported no symptoms. Thus, it highlights the importance of seeing an OB-GYN or primary care physician for regular checkups if a person is asymptomatic.
What Causes Bacterial Vaginosis?
Bacterial overgrowth is the leading cause of BV. There are good and bad bacteria in the vagina. Lactobacilli are good bacteria, and anaerobes are harmful bacteria. A healthy vaginal microbiota will have lactobacilli outnumbering anaerobes. When anaerobic bacteria outnumber lactobacilli, the natural balance in the vagina gets upset. Thus, the overpowering harmful microorganisms cause bacterial vaginosis.
What Are the Risk Factors for Bacterial Vaginosis?
Some factors that may increase the risk of developing BV include:
Having Unprotected Sex: Although BV is not an STI, unprotected sex remains a risk factor for getting this infection. Doctors also continue to study the link between BV and sexual activity.
Multiple Sexual Partners: People with multiple sexual partners are more likely to develop BV. Experts suggest that BV is more likely to occur in women who have sex with women.
New Sexual Partners: BV is likely to occur when someone has a new sex partner. Perhaps the new partner previously had sex with a person with BV and failed to disclose the information. Be sure to confirm their status before engaging in any sexual activity.
Using Intrauterine Devices: An IUD is a long-term birth control option. A foreign object that one inserts into the body increase the risk of developing BV.
Smoking: Constant exposure to cigarette smoke can irritate the vagina and disrupt its natural balance. In addition, experts suggest that individuals may get predisposed to BV because of the anti-estrogenic effect of smoking.
Trichomoniasis History: Trichomoniasis is a common STI. Like BV, most infected people will not know they have it. It can also occur at the same time as having BV. Be sure to practice safe sex to help prevent STIs and BV.
Constant Douching: Douching is a practice that involves using water or other solutions to cleanse the vagina. Although some people think douching protects against vaginal infections, it increases the risk of developing BV because it upsets the natural balance of the vagina.
Constant Scented Soap Usage: Excessively washing the vagina with soaps that use solid perfumes and deodorants can alter the vagina’s natural bacteria environment. Remember that the vagina is self-cleaning, making it unnecessary to wash and douche the vagina constantly.
Natural Vaginal Environment: Some individuals may have a natural lack of lactobacilli in their vaginal microbiota. Thus, there is a constant risk of anaerobic bacteria overpowering the good bacteria and causing BV.
What Is the Treatment for Bacterial Vaginosis?
Doctors usually prescribe specific medications to treat BV that come in two categories, namely:
Oral Medicines
Doctors can prescribe BV treatments that patients can take by mouth as a pill or tablet. Oral BV treatments include:
Metronidazole: This medicine is an antibiotic that helps stop bacterial propagation. Flagyl is the brand that patients can find in pharmacies. Depending on the product, it may require specific instructions and maintenance when taken. Generally, patients must avoid drinking alcoholic beverages when undergoing metronidazole treatment. Otherwise, they risk getting stomach pain, abdominal pain, and nausea.
Tinidazole: This medicine comes from the Tindamax brand. Like oral metronidazole, taking tinidazole could cause nausea. As such, patients must avoid alcoholic drinks throughout their treatment duration. In addition, experts suggest extending their alcohol abstinence at least three days after completing their tinidazole treatment.
Secnidazole: Commonly known as Solosec, this single-dose antibiotic comes in granule form. Patients will take one packet and sprinkle its contents onto soft food. Whether they mix it with applesauce, pudding, or yogurt, they must consume the secnidazole within half an hour. In addition, they must avoid chewing and crunching the granules when eating the food.
Topical Medicines
BV patients can apply BV medicine directly to their vaginas to treat the infection. For example, doctors could prescribe these topical medicines:
Metronidazole: This medicine is also available as a topical gel that patients can insert into their vaginas. MetroGel-Vaginal is the product that a doctor might prescribe to BV patients. This specific product comes with an applicator with plunging technology. Patients would slowly insert the applicator and press the plunger to dispense the medicine into the vagina.
Clindamycin: Cleocin or Clindesse; this medicine usually comes as a cream. Patients must insert one full applicator (100mg) of clindamycin into their vagina once a day for three to seven days, depending on their condition. Most products will suggest taking this medicine before bed. Clindamycin also contains properties that may weaken latex condoms at least three days after treatment. As such, individuals must reconsider having sex during treatment, especially if they have no plans of getting pregnant.
What Is Azithromycin?
Azithromycin is an antibiotic treatment that helps patients with bacterial infections. It is a standard prescription for bacteria affecting the skin, eyes, ears, and respiratory system. Doctors can also prescribe azithromycin for treating bronchitis, pneumonia, pelvic inflammatory disease, and sexually transmitted diseases. Accordingly, it has the potential to treat BV.
This medicine comes from the macrolide class. These antibiotics work by stopping bacterial growth. However, they require a prescription because they tend to cancel the effects of common viral infections, such as colds and flu. In addition, taking azithromycin when unnecessary predisposes patients to the conditions they are trying to avoid.
Azithromycin brand names include:
- Azasite
- Zithromax
- Zmax
Using Azithromycin for BV
Although azithromycin is strictly for specific infections, some experts believe it can potentially treat BV. In particular, a 2006 study by the Department of Medicine at the University of Alabama, Birmingham, explored the efficacy of combining metronidazole and azithromycin.
This study enrolled patients with symptomatic BV in a 4-arm study. It compared metronidazole for 7 days versus 14 days. In addition, some patients also took azithromycin on days 1 and 3. The authors reported a significant difference between the 7-day and 14-day groups at the first follow-up visit.
Generally, BV cure rates were better for the 14-day group that received metronidazole treatment than for the 7-day group. However, they relapsed, and BV reoccurred. At the same time, the study reported that the combination therapy that added azithromycin had no benefit. Although it posted a low Nugent score (which diagnoses BV), it associated the lower scores with less complex vaginal flora and abstinence from douching and sex.
What People Say About Using Azithromycin for BV
Based on 83 user reviews for treating a bacterial infection with azithromycin, the medicine has an average rating of 6/10. Here is a summary of what some people have to say about using azithromycin for recurrent bacterial vaginosis:
One patient took four azithromycin pills to treat their vaginal discharge. They had no known STDs when taking them in less than a month. This patient took the pills after eating dinner but got slightly nauseous for up to two hours. So, they took anti-nausea medicine. However, they became highly sick by bedtime and had stomach pains, prompting them to take two more anti-nausea pills. Their nausea was severe that to feel like vomiting every five minutes. By 4:00 AM, the pills took effect against sickness. However, they experienced diarrhea all day after five days of treatment. Still, they claimed that it solved their discharge.
One pregnant patient reported that their doctor prescribed azithromycin 500mg for their infection. They took two tablets as a single dose and experienced diarrhea and nausea. However, this patient gave the medicine an 8/10 rating, stating that the treatment must have worked despite being concerned about what to eat. They said they could have a safe vaginal delivery.
Another person who suspected an STD took two 500mg azithromycin pills for their bacterial infection. They gave their review without confirming that they had an STD instead of BV. However, they experienced pain during sex and discharge, signs associated with BV. They also cited a clinic’s opinion, stating that they may have had a UTI instead. Still, they tried the azithromycin treatment. Immediately after taking medicine, they experienced drowsiness. Half an hour later, they experienced mild to moderate stomach cramps and gurgling. Despite these signs, they gave this medicine an 8/10 rating.
Other patients with negative experiences rated azithromycin 1/10. They claimed it was the worst antibiotic they used. In particular, one patient used Z-Pak and said it put them in the hospital. They experienced terrible heart palpitations and feared that it would have permanently affected their heart condition if they had not caught it in time.
Another patient with a negative experience using azithromycin for BV cited vomiting and horrible cramps. This patient took three 500mg pills as one dose to help treat their Ureaplasma infection. Experts link Ureaplasma species with BV and pregnancy problems. This person mentioned that their body type may have influenced their negative experience. Perhaps their doctor failed to consider their skinniness when prescribing 1,500mg of azithromycin in one go.
What Are Side Effects Associated With Using Azithromycin?
Patients who are allergic to azithromycin will experience allergic reactions as primary side effects of the medicine. These patients must get emergency medical assistance as soon as they experience:
- Hives
- Difficulty breathing
- Swelling (in the face or throat)
- Fever
- Sore throat
- Burning in the eyes
- Skin pain
- Red or purple skin rash that blisters and peels
These reactions may occur several weeks after the patient starts using azithromycin.
Meanwhile, some users who are not allergic to azithromycin reviewed the medicine. Common side effects among them included:
- Clay-colored stool
- Dark urine
- Fast and pounding heartbeats
- Fluttering in the chest
- Headaches
- Itching
- Liver problems
- Loss of appetite
- Muscle aches
- Nausea
- Severe stomach pain
- Severe weakness
- Shortness of breath
- Sudden dizziness
- Tiredness
- Unusual bruises
- Vomiting
- Watery and bloody diarrhea
- Yellowing skin and eyes (jaundice)
Older adults taking azithromycin are more likely to experience side effects on the heart. They may also be predisposed to a life-threatening fast heart rate and abnormal vibrations.
What Are the Dosages of Azithromycin?
There is no standard dosage for azithromycin. Patients must take medicine exactly as their doctor prescribes. Azithromycin also has different directions on the label, which patients must follow strictly. Taking medication in larger or smaller amounts and longer or shorter times are likely to affect the effectiveness of the specific infections.
Generally, patients can take azithromycin as an oral suspension dose. Zmax is an example brand that patients can take on an empty stomach. They usually take this medicine at least an hour before eating or two hours after their last meal. Patients must mix the contents of each packet into two ounces of water and then drink the mixture immediately.
Patients must store this medicine at room temperature and keep it from heat and moisture. If they fail to use the medicine within ten days, they must toss it. Likewise, any unconsumed azithromycin mixture is useless after 12 hours. Therefore, patients must not save any medication for later after opening.
Skipping doses increases the risk of further infection. These infections could be resistant to the last antibiotics the patient will ingest to treat their condition. Thus, they could develop more complex diseases and illnesses just by failing to use the medicine as prescribed. However, some patients can miss a dose. In such a case, the patient must take it as soon as they remember. They must skip the dose to avoid taking extra if it is almost time for their next dose.
What Other Drugs Interact With Azithromycin?
Azithromycin can interact with other drugs. Therefore, patients seeking these antibiotics to treat their BV but taking other medicines must let their doctor know to avoid complications. Generally, the following drugs may interact with azithromycin:
Digoxin: This medicine is for treating irregular heartbeats. Considering that azithromycin can lead to this side effect, some patients might resort to taking this medicine without knowing that it can interact with azithromycin.
Clarithromycin: This medicine is another antibiotic that treats infections in many body parts. It comes as a pill or liquid. Patients may be convinced that taking different antibiotics can increase the efficacy of their azithromycin doses.
Blood Thinner: Patients use these medicines to help the blood flow more smoothly through the veins and arteries. These medicines also help stop blood clot formation. Common names include warfarin, Coumadin, and Jantoven.
Over-the-Counter Medicines: Common OTC medicines that interact with azithromycin are antihistamines, including Benadryl and Claritin. Doctors may advise patients to stop using these medicines before taking azithromycin.
Vitamins and Herbal Medicines: Some listed vitamins that can interact with azithromycin include vitamin B12 (cyanocobalamin), vitamin C (ascorbic acid), and vitamin D3 (cholecalciferol).
Experts have identified at least 333 drugs that interact with azithromycin. These drugs fall into three categories: primary, moderate, and minor. Regardless of the level of drug interactions they have, it’s better to stay on the safe side. Therefore, patients must discuss their situation with their doctor before taking any azithromycin for BV.
What Are Warnings and Precautions for Azithromycin?
According to experts, patients must avoid using azithromycin if they have a history of:
- Jaundice or yellowing of the skin and eyes
- Liver problems caused by taking azithromycin in the past
- Allergies to the medicine or similar drugs (clarithromycin, erythromycin, telithromycin)
- Kidney disease
- Myasthenia gravis or chronic autoimmune disease that weakens the skeletal muscles
- Rhythm heart disorder
- Low potassium levels in the blood
- Long QT syndrome in the family
Patients must disclose their complete medical history to determine whether azithromycin is suited for treating their BV. Otherwise, they could develop more complex conditions by taking this medicine.
How Does Azithromycin Work?
Azithromycin is a macrolide antibiotic. These prescription drugs work by killing bacteria and preventing their growth. However, they do not work on common viral infections, such as colds and cases of flu.
These medicines stay in the system for at least 15.5 days after the last dose. As such, they are likely to appear in a urine or blood test. Therefore, patients with a scheduled test must inform their doctor ahead of time to avoid complications.
Can Pregnant and Lactating Women Use Azithromycin?
Pregnant and lactating women can rest assured when using azithromycin. This medicine has no history of harming unborn babies. Similarly, experts have yet to discover if it passes into breast milk. Regardless, pregnant and lactating individuals must mention their condition to their doctor. In addition, these patients could be taking maintenance medicines that are likely to interact with azithromycin treatments.
When To See a Doctor
Patients seeking azithromycin treatment for their BV can go to a doctor as soon as their previous therapies fail. However, if they are already taking azithromycin for BV, they must also visit their doctor when they experience any symptoms. For example, they could be allergic to the medicine.
Frequently Asked Questions (FAQs)
One study suggested that azithromycin has no significant effect in treating BV. However, more longitudinal studies can contribute to a better understanding of azithromycin’s efficacy in treating this condition.
Antibiotics are the most common and effective partner treatment for STDs. However, there are different classes of antibiotics meant for specific STDs.
There is no evidence of azithromycin decreasing the efficacy of birth control pills. However, avoiding taking azithromycin while taking other medicines is best to prevent the drugs from interacting. Consult a doctor for advice.
Categorically, azithromycin can be used to treat BV. However, there is insufficient clinical evidence to determine how effective it is in treating the specific condition.
There is no strongest antibiotic for BV as different antibiotics work differently on each patient. However, metronidazole is a standard prescription.
There is no evidence of harmful interactions between azithromycin and acyclovir. However, there could be underlying interactions that experts have yet to discover. Therefore, be sure to consult a doctor before starting any azithromycin treatment.
