First line or in pregnancy:

Metronidazole oral 400mg twice daily for 5-7 days

Second line:

Metronidazole oral 2g single dose (avoid if pregnant or breastfeeding)

Third line:

For alternative treatment see WoS guidance on bacterial vaginosis (West of Scotland Sexual Health Managed Clinical Network guidelines).

• This NICE Clinical Knowledge Summary on bacterial vaginosis (BV) contains detailed management advice.
• Patients will report offensive fishy-smelling vaginal discharge, not associated with soreness, itching, or irritation. A vaginal pH >4.5 is consistent with a diagnosis of BV. If empirical treatment is not considered appropriate, or if the diagnosis is uncertain, send a high or low vaginal swab for gram staining and to exclude other causes of vaginal discharge. Routine screening and treatment of male partners is not indicated.
• Any symptomatic patient should be offered treatment. Asymptomatic pregnant women may be considered for treatment^, but the evidence for treatment of BV in pregnancy is conflicting. Asymptomatic patients undergoing gynaecological surgery may require treatment prior to the procedure.
• Advise patients to avoid vaginal douching, use of shower gel in the genital area, and use of antiseptic agents or shampoo in the bath.