Metronidazole (Flagyl) is the CDC-recommended first-line treatment for bacterial vaginosis and trichomoniasis. A 7-day oral course or 5-day vaginal gel clears symptoms — discharge, fishy odor, mild irritation — in most women. Bidwell's licensed clinician reviews your intake during business hours and sends your prescription to the pharmacy for a $45 online visit. Medication cost is paid separately at the pharmacy and varies by formulation, quantity, pharmacy, insurance, and discount-card pricing.
Metronidazole is a nitroimidazole — a class of antibiotics specifically effective against anaerobic bacteria and certain protozoa. Inside anaerobic organisms, metronidazole is reduced to reactive intermediates that damage DNA and lead to cell death. Aerobic bacteria lack the reducing enzymes, so metronidazole doesn't touch them. This makes it precise for infections where anaerobes or protozoa are the culprit: bacterial vaginosis, trichomoniasis, giardia, amebiasis, C. difficile colitis, and mixed anaerobic abdominal or pelvic infections. The FDA DailyMed label is the authoritative reference.
For vaginal conditions specifically, the CDC 2021 STI Treatment Guidelines list metronidazole as first-line for BV (oral tablets or vaginal gel) and for trichomoniasis (oral tablets, with longer course for women). Most U.S. gynecologists and primary care providers follow CDC recommendations for initial treatment.
Bidwell's BV intake is designed to screen for uncomplicated bacterial vaginosis in non-pregnant adult women. You can be prescribed metronidazole through Bidwell if you:
Symptoms suggestive of yeast infection (thick white "cottage cheese" discharge with intense itching) are not BV — see our fluconazole page instead. Symptoms suggestive of trichomoniasis or other STI (frothy green/yellow discharge, contact with new partner, partner with symptoms) should be evaluated in person for STI testing.
Use caution — not absolute avoidance — if you're pregnant (updated CDC guidance allows metronidazole in all trimesters for BV and trichomoniasis, but telehealth management of pregnant patients isn't appropriate), breastfeeding (consider timing or briefly interrupting nursing), or have Cockayne syndrome (rare genetic disorder with reported severe hepatotoxicity on metronidazole). The NIH StatPearls monograph is a useful clinical reference.
| Indication | Regimen | Notes |
|---|---|---|
| BV (oral) | 500 mg by mouth twice daily × 7 days | CDC first-line. Take with food to reduce nausea. |
| BV (vaginal gel) | 0.75% gel, 1 applicatorful intravaginally daily × 5 days | CDC first-line alternative. Less systemic side effects; still avoid alcohol. |
| Trichomoniasis (women) | 500 mg by mouth twice daily × 7 days | Single 2-g dose is less effective in women; 7-day regimen preferred per 2021 CDC. |
| Trichomoniasis (men) | 2 g single dose orally | Men respond to single dose; women require 7-day course. |
| Giardiasis | 250 mg three times daily × 5–7 days | Typically managed by primary care or travel medicine. |
For BV, Bidwell most commonly prescribes oral metronidazole 500 mg twice daily for 7 days — the regimen with the largest evidence base and lowest cost. Take with food; space doses about 12 hours apart. For patients who can't tolerate oral metronidazole or prefer topical therapy, vaginal gel is a solid alternative with equivalent cure rates and fewer systemic side effects.
Metronidazole is generally well tolerated at BV doses. Common side effects of oral therapy:
Vaginal gel has far fewer systemic side effects — mostly local irritation or yeast overgrowth. For details, see our metronidazole side effects guide.
Rare but serious: seizures, peripheral neuropathy (with very long courses), severe allergic reactions, Stevens-Johnson syndrome (very rare), hepatotoxicity, and aseptic meningitis. Stop the medication and seek urgent care for neurologic symptoms (numbness, tingling, weakness, confusion), seizure activity, or severe rash.
| Formulation | Common fill | Pharmacy cost note |
|---|---|---|
| Metronidazole 500 mg tablets (generic Flagyl) | Often a 7-day course | Paid separately at pharmacy |
| Metronidazole 0.75% vaginal gel (generic) | Often a multi-dose tube | Paid separately at pharmacy |
| Metronidazole 1.3% vaginal gel (Nuvessa) | Single-dose applicator | Paid separately at pharmacy |
| Flagyl (brand, oral) | Brand oral option | Usually more expensive than generic |
Generic oral metronidazole is widely used and works well for many BV cases. Brand Flagyl and proprietary single-dose gels may cost more than generic options. Compare prices at GoodRx or through your pharmacy plan. Your $45 Bidwell visit covers clinician review; the pharmacy fill is separate.
You must be physically located in one of these states at the time of your visit.
Yes. BV in non-pregnant adult women is routinely treated via telehealth. Bidwell reviews intakes during business hours for a $45 online visit.
Oral: 500 mg twice daily for 7 days. Vaginal gel: 0.75%, one applicatorful daily for 5 days. Either is CDC first-line for BV.
Disulfiram-like reaction: flushing, severe nausea, vomiting, racing heart. Avoid alcohol during treatment and for 72 hours after the last dose.
Most women notice reduced discharge and odor within 48–72 hours. Full resolution by end of course. If not better in 72 hours, contact us.
Recent alcohol, disulfiram in past 2 weeks, known allergy, severe liver disease, active seizure disorder. Pregnancy should be managed by OB.
Similar cure rates. Gel has fewer systemic side effects (no metallic taste). Oral is more convenient. Provider helps you choose.
2021 CDC guidelines allow metronidazole in all trimesters for BV and trichomoniasis, but pregnant patients should be managed by their OB, not via telehealth.
Metronidazole cost varies by formulation, pharmacy, insurance, and discount-card pricing. The cash-pay Bidwell visit is separate from the pharmacy fill.
For BV: no, CDC does not recommend treating asymptomatic male partners. For trichomoniasis: yes, all current sexual partners need treatment.
No — metronidazole is for bacterial and protozoal infections, not fungal. For yeast, see our fluconazole page.