Zidoval Vaginal Gel for BV: How It Works and How to Use It
The five-night metronidazole course, step-by-step application, and the considerations that matter while you are using it.
Part of the Bacterial Vaginosis condition guide.
Key fact: Zidoval is the shortest first-line BV course at five nights, and it delivers metronidazole directly to the vagina — so the nausea and metallic taste associated with the tablets are much less of a problem.
Get Zidoval Vaginal Gel Online
Access Doctor provides Zidoval vaginal gel following a GPhC-regulated online consultation with our pharmacist independent prescribers.
Order Zidoval Gel →What Zidoval is
Zidoval is a vaginal gel containing metronidazole 0.75% (7.5mg per gram). It is licensed for the treatment of bacterial vaginosis and is supplied with single-use applicators. A standard course is five nights — the shortest of the three first-line options.
It contains the same antibiotic as metronidazole tablets, delivered locally rather than systemically. It is prescription-only in the UK.
| Detail | |
|---|---|
| Active ingredient | Metronidazole 0.75% (7.5mg/g) |
| Form | Vaginal gel with single-use applicators |
| Course | One applicator at bedtime for 5 consecutive nights |
| Alcohol restriction | Yes — during and for 48 hours after |
| Affects latex | No |
| Suppressive use | Twice weekly for 3–6 months in recurrent BV |
| Availability | Prescription only |
How it works on BV
In BV, the anaerobic bacteria that normally live in small numbers in the vagina overgrow and displace the protective lactobacilli that keep vaginal pH below 4.5. Metronidazole is highly active against exactly those anaerobes. It enters the bacterial cell and disrupts its DNA, killing the organism.
Applying it as a gel puts a high concentration of the drug where the problem is while keeping systemic exposure low. Cure rates for a first episode are comparable to oral tablets — typically quoted in the region of 70 to 80% — with considerably fewer whole-body side effects.
5 nights
Shortest standard first-line course for BV
2–3 days
Before most women notice clear improvement
48 hours
After the last dose before alcohol is safe again
How to use it, step by step
Use one applicator at bedtime for five consecutive nights. Night-time application matters — lying down keeps the gel in contact with the vaginal wall for longer, and most leakage then happens in the morning.
1
Fill the applicator
Wash your hands. Remove the tube cap and screw an applicator firmly onto the threaded end. Squeeze the tube gently until the applicator fills and the plunger is pushed out fully. Unscrew the applicator and recap the tube.
2
Get into position
Lie on your back with your knees bent and drawn towards your chest. Standing with one foot raised on a chair or the edge of the bath also works — use whichever is more comfortable.
3
Insert and release the gel
Hold the barrel and gently insert the applicator into the vagina as far as it goes comfortably. Press the plunger slowly all the way in to release the gel, then withdraw the applicator.
4
Dispose and repeat nightly
Throw the applicator away — they are single-use and must not be washed and reused. Wash your hands. Repeat every night until all five doses are complete, even if symptoms have already gone.
Important considerations while using Zidoval
These are the practical points that come up most often during a course.
| Consideration | What to do |
|---|---|
| Alcohol | Avoid completely during the course and for 48 hours after the last application |
| Tampons | Do not use — they absorb the gel. Use a panty liner for leakage instead |
| Periods | The course can continue during a period, but flow may reduce how well the gel works. Where possible, time the course to avoid one |
| Condoms and diaphragms | Not affected by Zidoval — unlike Dalacin cream, latex is safe |
| Sex during the course | Best avoided, as it can displace the gel; there is no absolute prohibition |
| Allergies | Do not use if you are allergic to metronidazole or other nitroimidazoles |
| Warfarin | Metronidazole can enhance its effect — tell your prescriber before ordering |
| Lithium | Metronidazole can raise lithium levels — tell your prescriber before ordering |
| Missed dose | Apply as soon as you remember and continue the course; do not double up |
| Douching | Do not douche during or after the course — it worsens the underlying imbalance |
Complete the full five nights. Symptoms usually settle by day three, well before the bacterial overgrowth is fully suppressed. Stopping early leaves a larger surviving population and is one of the more common reasons an episode returns within weeks.
The alcohol warning
The alcohol restriction surprises people using a vaginal gel, on the reasonable assumption that a local treatment should not have systemic rules. A small amount of metronidazole is absorbed through the vaginal wall, which is enough for the interaction to apply.
Do not drink alcohol during the five-night course or for 48 hours after the final application. The reaction — flushing, throbbing headache, severe nausea, vomiting and palpitations — is unpleasant and can be alarming. This includes alcohol in cough medicines, mouthwashes and some tonics.
If avoiding alcohol for a week is genuinely impractical, say so at consultation. Dalacin 2% cream contains clindamycin and carries no alcohol restriction, which makes it the usual alternative. The alcohol rule is covered in full in our guide to how to take metronidazole.
Side effects
Zidoval is generally well tolerated. Because absorption is minimal, the systemic effects that make metronidazole tablets unpopular are much less common.
Common and usually mild
Local irritation or itching, a change in vaginal discharge, and mild pelvic discomfort. These usually settle as the course progresses.
Less common
Thrush developing during or after the course, headache, a mild metallic taste, and nausea.
Stop and seek advice
Rash, swelling of the face or throat, or difficulty breathing, which may indicate an allergic reaction. Also numbness or tingling in the hands or feet.
Not features of BV
Pelvic pain, fever, pain during sex or bleeding between periods need in-person assessment regardless of treatment.
The complete side effect and interaction picture for metronidazole in all its forms is in metronidazole side effects and warnings.
Twice-weekly use for recurrent BV
Zidoval has a second role beyond treating a single episode. For women with genuinely recurrent BV — three or more confirmed episodes in twelve months — vaginal metronidazole gel is the established suppressive option, used twice weekly for three to six months after an active episode has been cleared.
In practice that means one applicator on two fixed days each week rather than a nightly course. It reduces the frequency of episodes while it is being used, though the benefit largely does not persist once it is stopped, which is why it works best alongside systematic trigger management. Our guide to recurrent BV covers the whole approach, including the 2025 evidence on partner treatment.
Order Zidoval Gel for BV Relief
Complete a short online consultation and, if suitable, our GPhC-registered pharmacist independent prescribers can supply Zidoval with discreet delivery.
Order Zidoval Gel →Frequently Asked Questions
How do you use Zidoval vaginal gel?
Screw an applicator onto the tube and squeeze until it is filled, lie on your back with your knees bent, insert the applicator into the vagina as far as is comfortable and press the plunger fully. Use one applicator at bedtime for five consecutive nights and discard each applicator after use.
Can you drink alcohol while using Zidoval gel?
No. Although only a small amount of metronidazole is absorbed from the gel, alcohol should be avoided during the five-night course and for 48 hours after the last application. Drinking can cause flushing, nausea, vomiting and palpitations.
Can you use tampons with Zidoval gel?
No. Tampons absorb the gel and reduce how much stays in contact with the vaginal wall, so they should not be used during the course. A panty liner is the appropriate option for managing leakage.
Does Zidoval gel affect condoms?
No. Unlike Dalacin 2% cream, Zidoval does not weaken latex, so condoms and diaphragms can be used normally. Sex is still often best avoided during the course because it can reduce how much gel stays in place.
How long does Zidoval take to work?
Most women notice a clear improvement within two to three days, with odour usually settling first. Complete all five applications even if symptoms have gone, because stopping early makes early recurrence more likely.
Can Zidoval be used twice weekly for recurrent BV?
Yes. For genuinely recurrent BV, vaginal metronidazole gel is used twice weekly for three to six months as suppressive therapy after an active episode has been treated. This reduces the frequency of episodes while it is being used and should be prescriber-supervised.
What are the side effects of Zidoval gel?
The most common are local irritation, a change in discharge and thrush developing during or after the course. Because little is absorbed, the nausea and metallic taste associated with metronidazole tablets are much less common with the gel.
Completing the treatment
Zidoval vaginal gel is available from Access Doctor following an online consultation with a pharmacist independent prescriber. Tell us about any previous courses, your alcohol plans and whether episodes have been recurring — that determines whether a standard five-night course or a suppressive approach is appropriate.
Bacterial vaginosis · Rx
Zidoval Vaginal Gel
Metronidazole 0.75% gel applied nightly for five nights.
View product →Bacterial vaginosis · Rx
Metronidazole 400mg Tablets
First-line oral antibiotic for BV, taken twice daily for five to seven days.
View product →Bacterial vaginosis · Rx
Dalacin 2% Cream
Clindamycin vaginal cream, a seven-night course with no alcohol restriction.
View product →Self-test · Pharmacy
Canestest Self-Test
Checks vaginal pH at home to help distinguish BV from thrush before you treat.
View product →References
- Electronic Medicines Compendium. Zidoval 7.5mg/g Vaginal Gel — Summary of Product Characteristics. medicines.org.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summaries: Bacterial vaginosis. 2025. cks.nice.org.uk
- British National Formulary. Metronidazole. bnf.nice.org.uk
- Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines: Bacterial Vaginosis. cdc.gov
- NHS. Bacterial vaginosis. nhs.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.