What is the recommended treatment for Bacterial Vaginosis (BV)?

From the Guidelines

The recommended treatment for Bacterial Vaginosis (BV) is 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. These regimens are equally efficacious and are the preferred treatments for BV, as they have been shown to be effective in relieving vaginal symptoms and reducing the risk of infectious complications associated with BV during pregnancy 1.

Key Considerations

• Patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, due to potential disulfiram-like reactions.
• Clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms, so patients should be aware of this potential interaction.
• Alternative regimens, such as oral clindamycin 300 mg twice daily for 7 days, may be considered, but have lower efficacy for BV.
• For pregnant women, oral therapy is preferred over topical treatments, and a follow-up evaluation should be done one month after completion of treatment to verify that therapy was effective 1.

Treatment Goals

• The primary goal of therapy is to relieve vaginal symptoms and reduce the risk of infectious complications associated with BV.
• Treatment may also help to reduce the risk of adverse pregnancy outcomes, such as premature rupture of membranes, preterm labor, and post-partum endometritis, especially in women with a history of preterm birth 1.

Additional Considerations

• Recurrent BV may require extended or maintenance therapy, and some clinicians recommend probiotics as an adjunctive treatment to help restore normal vaginal flora, though evidence for this is still emerging.
• Sexual partners generally do not require treatment, but using condoms during treatment may help prevent recurrence.

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 (BV) 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

Treatment Options for Bacterial Vaginosis (BV)

The recommended treatment for BV varies depending on the patient's pregnancy status and the severity of symptoms.

• For nonpregnant women, treatment options include:
  • Metronidazole (500 mg orally twice daily for 7 days) 3
  • Clindamycin vaginal cream (2%, once daily for 7 days) 3, 4
  • Metronidazole vaginal gel (0.75%, twice daily for 5 days) 3
• 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 BV, an extended course of metronidazole treatment (500 mg twice daily for 10-14 days) is recommended 5
• Alternative treatments for recurrent BV include metronidazole vaginal gel 0.75% for 10 days, followed by two times per week for 3-6 months 5
• Other treatment options, such as secnidazole and tinidazole, have also shown efficacy in treating BV 6, 7

Considerations for Treatment

• The choice of treatment should be based on the patient's medical history, pregnancy status, and the severity of symptoms
• Treatment of male sex partners is not recommended 3
• The use of probiotics, prebiotics, and botanical treatments has shown some promise, but further studies are needed to confirm their efficacy 5