From the Guidelines
The recommended treatment for bacterial vaginosis is typically a course of antibiotics, with first-line treatment usually involving oral metronidazole 500 mg twice daily for 7 days, or metronidazole gel 0.75% applied intravaginally once daily for 5 days, or clindamycin cream 2% applied intravaginally at bedtime for 7 days. The goal of therapy for bacterial vaginosis (BV) is to relieve vaginal symptoms and signs of infection, and all women who have symptomatic disease require treatment, regardless of pregnancy status 1. Some key points to consider when treating BV include:
- The benefits of therapy for BV in pregnant women are to relieve vaginal symptoms and signs of infection, reduce the risk for infectious complications associated with BV during pregnancy, and reduce the risk for other infections 1.
- During treatment, patients should avoid alcohol consumption with metronidazole or tinidazole due to potential disulfiram-like reactions.
- Sexual abstinence or condom use is recommended during treatment.
- While bacterial vaginosis often results from an imbalance in vaginal flora where beneficial lactobacilli are replaced by anaerobic bacteria like Gardnerella vaginalis, it's essential to complete the full course of antibiotics even if symptoms resolve earlier.
- Recurrence is common, affecting up to 50% of women within 12 months, and may require repeated or extended treatment courses.
- Probiotics may help prevent recurrence by restoring normal vaginal flora, though evidence for their effectiveness varies. Alternative regimens include oral clindamycin 300 mg twice daily for 7 days or tinidazole 2 g orally once daily for 2-3 days 1. It is also important to note that 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 recurrence and seek medical attention if they occur 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 recommended treatment for bacterial vaginosis is metronidazole vaginal gel. The treatment regimen consists of daily application for 5 days 2.
- Clinical cure rates for evaluable patients determined at 4 weeks after completion of therapy were 53% for the QD regimen and 57% for the BID regimen 2.
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, the treatment options are:
- Metronidazole (250 mg orally three times a day for 7 days) for both high-risk and low-risk women 3
- For recurrent bacterial vaginosis, treatment options include:
Efficacy of Treatment Options
Studies have shown that clindamycin vaginal cream and oral metronidazole have comparable cure rates for bacterial vaginosis 4, 5.
- A study comparing once-daily and twice-daily dosing of 0.75% metronidazole gel found that both regimens had similar efficacy and safety profiles 6
- Another study found that clindamycin cream was a safe, well-tolerated, and effective alternative to oral metronidazole for the treatment of bacterial vaginosis 5
Considerations for Treatment
It is essential to note that data do not support routine treatment of male sex partners 3.
- The underlying mechanisms of recurrent etiology of bacterial vaginosis are not fully understood, and further research is needed to develop effective treatment strategies 7