From the Guidelines
Treatment of Bacterial Vaginosis in Pregnancy
Treatment of bacterial vaginosis (BV) in pregnancy is recommended to reduce the risk of preterm labor and other complications. The recommended treatment is metronidazole 500 mg orally, twice a day for 7 days [ 1 ], or clindamycin 300 mg orally, twice a day for 7 days. Alternatively, metronidazole gel 0.75% can be used intravaginally, one applicator (5 grams) once a day for 5 days [ 1 ].
- Key Considerations:
- Treatment should be provided to all pregnant women with symptomatic bacterial vaginosis.
- Consideration should be given to treating asymptomatic women at high risk of preterm labor [ 1 ].
- Important Notes:
- Treatment Options:
- Oral metronidazole
- Oral clindamycin
- Vaginal metronidazole gel
- Clindamycin cream [ 1 ]
From the FDA Drug Label
Metronidazole vaginal gel is indicated in the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, or anaerobic vaginosis)
- The treatment for bacterial vaginosis (BV) in pregnancy is metronidazole vaginal gel 2.
- The diagnosis of BV is typically defined by the presence of a homogeneous vaginal discharge with a pH of greater than 4.5, a “fishy” amine odor when mixed with a 10% KOH solution, and clue cells on microscopic examination.
- It is essential to rule out other pathogens commonly associated with vulvovaginitis before initiating treatment with metronidazole vaginal gel.
From the Research
Treatment Options for Bacterial Vaginosis in Pregnancy
- The treatment of bacterial vaginosis (BV) in pregnancy is a topic of ongoing debate, with some studies suggesting that treatment may reduce the risk of preterm birth and other adverse outcomes 3, 4, 5, 6, 7.
- Antibiotic therapy, such as metronidazole and clindamycin, is commonly used to treat BV in pregnancy, with studies showing that it can effectively eradicate the infection 4, 5, 6, 7.
- However, the evidence on whether treatment of BV in pregnancy reduces the risk of preterm birth is mixed, with some studies showing a reduction in risk and others showing no significant effect 3, 4, 6, 7.
- A systematic review of 21 trials found that antibiotic treatment of BV in pregnancy did not significantly reduce the risk of preterm birth before 37 weeks, but may reduce the risk of late miscarriage 4.
- Another study found that oral metronidazole was effective in treating BV in pregnancy and may reduce the risk of preterm birth, but the evidence was not conclusive 5.
- A meta-analysis of 10 studies found that antibiotic treatment of BV in pregnancy did not significantly decrease preterm delivery at <37 weeks of gestation, but may be effective in high-risk patients with a previous preterm delivery 7.
Comparison of Treatment Regimens
- A study comparing metronidazole and clindamycin found that both treatments were effective in eradicating BV, but oral metronidazole may have some advantages over vaginal metronidazole and clindamycin 5.
- Another study found that oral antibiotics may have some advantages over vaginal antibiotics in terms of reducing the risk of preterm birth and improving birthweight 4.
- The optimal duration of treatment is not clear, but one study suggested that treatment durations of > or =7 days may be more effective in reducing preterm delivery 7.
Recommendations
- The evidence suggests that treatment of BV in pregnancy may be beneficial in reducing the risk of preterm birth and other adverse outcomes, particularly in high-risk patients with a previous preterm delivery 3, 4, 5, 6, 7.
- However, the decision to treat BV in pregnancy should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 3, 4, 5, 6, 7.