From the Guidelines
The recommended treatment for bacterial vaginosis is typically a course of antibiotics, with metronidazole being the first-line treatment, either as a 500 mg oral dose taken twice daily for 7 days, or as a 0.75% vaginal gel applied once daily for 5 days, as stated in the 2002 guidelines for treatment of sexually transmitted diseases 1. The treatment options for bacterial vaginosis include:
- Metronidazole 500 mg orally twice a day for 7 days
- Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days
- Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days It is essential to note that patients should avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, as stated in the 2002 guidelines 1. Additionally, clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms. The condition occurs when normal vaginal lactobacilli are replaced by an overgrowth of anaerobic bacteria, disrupting the vaginal pH balance, and recurrence is common, affecting about 50% of women within a year, and may require repeated or extended treatment courses, as mentioned in the 1998 guidelines 1. For women who are pregnant or cannot tolerate metronidazole, clindamycin 300 mg oral capsules twice daily for 7 days may be prescribed, as recommended by the Centers for Disease Control and Prevention in 1998 1. During treatment, patients should abstain from sexual intercourse or use condoms to prevent transmission, as stated in the 1993 guidelines 1. Follow-up visits are unnecessary if symptoms resolve, but a follow-up evaluation at 1 month after completion of treatment should be considered to evaluate whether therapy was successful, especially in high-risk pregnant women, as recommended in the 1998 guidelines 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. 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 recommended 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 2 2. Key points:
- The treatment is based on a randomized, double-blind, placebo-controlled clinical trial in 235 non-pregnant women.
- The efficacy of tinidazole was evaluated using Amsel's criteria and Nugent score.
- Tinidazole demonstrated superior efficacy over placebo in achieving therapeutic cure, clinical cure, and microbiologic cure.
From the Research
Treatment Options for Bacterial Vaginosis
The recommended treatment for bacterial vaginosis varies depending on the patient's pregnancy status and other factors.
- For nonpregnant women, treatment options include:
- For pregnant women, treatment options include:
- For recurrent bacterial vaginosis, treatment options include:
Comparison of Treatment Regimens
Studies have compared the efficacy of different treatment regimens for bacterial vaginosis.
- A study found that 0.75% metronidazole vaginal gel twice daily for five days was similar in efficacy to standard oral metronidazole treatment, but with fewer gastrointestinal complaints 5
- Another study found that vaginal application of 500 mg metronidazole daily for 7 days was equally effective as oral administration in the treatment of bacterial vaginosis 6
Additional Considerations
Data do not support routine treatment of male sex partners of women with bacterial vaginosis 3, 4. Treatment of bacterial vaginosis during pregnancy should focus on eliminating symptoms, and data on adverse pregnancy outcomes for women with bacterial vaginosis remain insufficient to recommend treatment of asymptomatic patients 4.