I don't want BV *or* a Bitter Vag!

August 7, 2011 10:59 PM

Bacterial Vaginosis Treatment: How long until the godawfully bitter taste from the antibiotics goes away? (NSFW)

After a somewhat confusing series of no-it-isn't/yes-it-is BV diagnoses, I was prescribed and just finished a course of antibiotics (clindamycin), in the form of a suppository cream. But this medicine has an incredibly bitter taste. How long from the last dosage does it take for the taste to subside? In other words, how long from the last dose do I have to wait before oral sex isn't incredibly unpleasant/impossible for my partner? Is there anything I can do to speed the process along?

posted by anonymous to health & fitness (3 answers total)

Do not use douches or any other type of cleanser internally - your body will naturally go back to where it was quite soon.

I wouldn't expect it to be a problem for more than 24 hours or 48 max after the last dose. If you are receiving oral sex frequently enough that this is an issue, then god bless you and your partner, you are a lucky woman.
posted by treehorn+bunny at 12:17 AM on August 8, 2011 [2 favorites]

Firstly, I'm not a doctor, and I really think you should ask your doctor this. There are some pretty major risks here - clindamycin has potentially unpleasant, dangerous, and (rarely) lethal side effects. (Pfizer product .pdf. See "Warnings").

Topical formulations of clindamycin have significantly higher concentrations of active ingredient than oral formulations, because only 5% (or so) of what's in your vagina is being absorbed into your system. But if you had oral sex with your partner while the clindamycin was present in your vagina, s/he has potentially been ingesting quite a bit of the cream, and thus taking the drug orally at a much higher dose. That could present a danger to your partner.

Given that the scary scenario is colitis, if your partner has or develops diarrhoea, get him or her to a doctor fast.

As for how long after you stop using it :

Because you're using it topically, you first have to wait until the last dose has all been absorbed or discharged/excreted (sorry, I'm failing to find the right word there). The leaflet above notes it's in a mineral oil base that can damage condoms up to 72 hours after the last dose. That might also be seen as a reasonable indicator of how long it's going to be until the drug itself has been absorbed from your vagina, and consequently isn't present for taste and safety purposes.

But, if you wanted to avoid any chance of bitter flavors, you'd also want to wait until the drug has been metabolised out of your system. A bit of googling suggests it has a half life of 2-3 hours (although there appears to be at least one study suggesting up to 15 hours) and is excreted through the liver. If you've got a normal liver, half of it will be gone from your system every 2-3 hours (but say 15 to be safe). I'd wait six or seven times that to get your systemic levels down to 1% (or so) of an effective dose. At 3 hours that works out to a day. At fifteen hours it's a bit over 4 days.

(To be sure, 1% of an effective dose in your system is NOT going to be 1% of an effective dose available through your genitals as he goes down on you, but on the chance that a) I've messed up the calculations here, b) you're not going to ask your doctor about this, and c) a doctor doesn't pop in to answer this one, I'm trying to be cautious.)

So to be cautious and safe, 72hours + 4 days. A week.
posted by Ahab at 1:33 AM on August 8, 2011

Hi Ahab, I'm a doctor (although not the OP's doctor), I'm not worried about it. I took it from the question that the taste was so bitter that the clindamycin suppository had just been tasted, not actually ingested. It seems doubtful to me that the OP's partner, as nice as he/she is, would have braved the horribly bitter taste to continue with oral sex for long enough to get any real exposure from it. Although considering the half life to excretion is an interesting point, most topical medications don't cause any noticeable taste difference in your various bodily fluids, just like most medications you take by mouth don't do this. Topical medications are particularly unlikely to reach significant systemic levels - the whole point of using a topical medication vs. an oral medication is that it is much less likely to give a person systemic side effects, so just like you wouldn't expect rinsing your mouth with lidocaine to cause cardiac side effects, you shouldn't expect topical clindamycin to give you C diff colitis, even though it is being used on mucous membranes (it is possible, case reports have been published, just unlikely, see this abstract's reference to the occurrence of colitis after topical clinda as "not clinically relevant" - and the OP is at more risk than the partner). I think you put great effort into your answer though and appreciate the sentiments.
posted by treehorn+bunny at 11:57 AM on August 8, 2011 [1 favorite]