From the Guidelines
Trace clue cells in pregnancy do not require treatment unless accompanied by symptoms of bacterial vaginosis (BV), as the presence of trace clue cells alone may represent normal variations in vaginal microbiota during pregnancy rather than a pathological infection requiring intervention. The decision to treat should be based on the presence of symptoms such as abnormal discharge, odor, or irritation, as these are indicative of an infection that could potentially lead to adverse pregnancy outcomes like preterm birth, premature rupture of membranes, and postpartum endometritis 1.
Considerations for Treatment
- The standard treatment for symptomatic BV in pregnancy is oral metronidazole 500 mg twice daily for 7 days or metronidazole 250 mg three times daily for 7 days, as recommended by guidelines 1.
- Alternative regimens include oral clindamycin 300 mg twice daily for 7 days or clindamycin vaginal cream 2% applied at bedtime for 7 days.
- Metronidazole is considered safe in all trimesters of pregnancy, making it a viable option for treating BV during pregnancy.
- After treatment, follow-up testing is not necessary if symptoms resolve, indicating successful treatment of the infection.
Screening and Risk Assessment
- The U.S. Preventive Services Task Force (USPSTF) concludes that for asymptomatic pregnant women at low risk for preterm delivery, there is moderate certainty that screening for bacterial vaginosis has no net benefit 1.
- For asymptomatic pregnant women at high risk for preterm delivery, the evidence is conflicting, and the balance of benefits and harms cannot be determined, suggesting a need for individualized clinical judgment.
- Risk factors for preterm delivery include African-American race or ethnicity, body mass index less than 20 kg/m2, previous preterm delivery, vaginal bleeding, a short cervix (<2.5 cm), pelvic infection, and bacterial vaginosis, which should be considered when deciding on screening and treatment strategies.
From the Research
Trace Clue Cells in Pregnancy
- Trace clue cells are an indicator of bacterial vaginosis (BV), a condition characterized by a dysbiosis of the vaginal microbiota 2
- The presence of clue cells is used to diagnose BV, but the treatment of BV in pregnancy is controversial 3
Treatment of Bacterial Vaginosis in Pregnancy
- There is no consensus on whether to screen for or treat BV in the general pregnant population to prevent adverse outcomes such as preterm birth 4
- The American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, and the US Preventive Services Task Force recommend against routinely screening asymptomatic pregnant women for BV 3
- Treatment of symptomatic BV is recommended to relieve symptoms, but there is insufficient evidence to demonstrate that treatment of asymptomatic BV improves outcomes 3
Effectiveness of Treatment
- Metronidazole and clindamycin are commonly used to treat BV, but the effectiveness of these treatments in preventing preterm birth is unclear 2, 5
- A systematic review found that treatment with metronidazole or clindamycin did not significantly reduce the risk of spontaneous preterm delivery 2
- Tinidazole has been shown to be effective in treating BV, with a more favorable side effect profile than metronidazole 6