From the Guidelines
Bacterial vaginosis (BV) should be treated with metronidazole 500mg orally twice a day for 7 days or metronidazole gel 0.75% applied intravaginally once a day for 5 days to relieve symptoms and prevent complications. The symptoms of BV include abnormal vaginal discharge with a fishy odor, vaginal itching, and burning during urination. The discharge is typically thin, grayish-white, and more noticeable after sexual intercourse. BV occurs when the normal balance of vaginal bacteria is disrupted, with an overgrowth of anaerobic bacteria and a reduction in beneficial lactobacilli. While BV can resolve spontaneously, treatment is important to relieve symptoms and prevent complications like increased risk of STIs or pregnancy complications, as noted in 1. Some key points to consider during treatment include:
- Avoiding alcohol with metronidazole as it can cause nausea and vomiting, as mentioned in 1
- Refraining from sexual intercourse or using condoms, as noted in 1
- Completing the full course of antibiotics even if symptoms resolve earlier Alternative treatments include clindamycin 2% vaginal cream applied once daily for 7 days or clindamycin 300mg oral capsules twice daily for 7 days, as discussed in 1. However, the metronidazole regimens are considered more efficacious, as stated in 1. Follow-up visits are unnecessary if symptoms resolve, but because recurrence of BV is not unusual, women should be aware of the signs and symptoms of BV and seek medical attention if they recur, as mentioned in 1.
From the FDA Drug Label
A randomized, double-blind, placebo-controlled clinical trial in 235 non-pregnant women was conducted to evaluate the efficacy of tinidazole for the treatment of bacterial vaginosis. A clinical diagnosis of bacterial vaginosis was based on Amsel's criteria and defined by the presence of an abnormal homogeneous vaginal discharge that (a) has a pH of greater than 4. 5, (b) emits a "fishy" amine odor when mixed with a 10% KOH solution, and (c) contains ≥20% clue cells on microscopic examination. Therapeutic cure was a composite endpoint, consisting of both a clinical cure and microbiologic cure In patients with all four Amsel's criteria and with a baseline Nugent score ≥4, tinidazole oral tablets given as either 2 g once daily for 2 days or 1 g once daily for 5 days demonstrated superior efficacy over placebo tablets as measured by therapeutic cure, clinical cure, and a microbiologic cure.
The symptoms of bacterial vaginosis include:
- Abnormal homogeneous vaginal discharge
- Vaginal discharge with a pH of greater than 4.5
- Vaginal discharge that emits a "fishy" amine odor when mixed with a 10% KOH solution
- Vaginal discharge that contains ≥20% clue cells on microscopic examination
The treatment for bacterial vaginosis is tinidazole oral tablets given as either:
- 2 g once daily for 2 days
- 1 g once daily for 5 days 2
From the Research
Bacterial Vaginosis Symptoms
- Bacterial vaginosis is a common condition among patients seen by gynecologists, characterized by symptoms such as vaginal discharge 3
- The symptoms of bacterial vaginosis can be relieved through treatment, with the main objective of treatment being to eliminate symptoms and prevent adverse outcomes of pregnancy in high-risk women 4
Treatment Options
- Several treatment options are available for bacterial vaginosis, including:
- These treatment options have been shown to be effective in treating bacterial vaginosis, with comparable cure rates and side effects 3, 4, 5, 6, 7
Treatment Recommendations
- For nonpregnant women, oral metronidazole, clindamycin vaginal cream, or metronidazole vaginal gel are recommended as the preferred treatment for bacterial vaginosis 4
- For pregnant high-risk women, systemic therapy with oral metronidazole is recommended to prevent adverse outcomes of pregnancy and relieve symptoms 4
- For pregnant low-risk women with symptomatic disease, oral metronidazole is recommended to relieve symptoms 4
- Data do not support routine treatment of male sex partners of infected females 4, 5