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 supported by the Centers for Disease Control and Prevention guidelines 1. The choice of treatment depends on the severity of symptoms, patient preferences, and the presence of any underlying medical conditions.
- Metronidazole 500 mg orally twice a day for 7 days is a commonly recommended regimen.
- Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days, is an alternative option.
- Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days, is also effective, although it may be less efficacious than metronidazole regimens. During treatment, patients should avoid alcohol consumption with metronidazole due to potential disulfiram-like reactions, and sexual intercourse is typically discouraged or condoms should be used as the condition can be transmitted to partners 1. Treatment is important even for mild cases as bacterial vaginosis increases susceptibility to other infections and can lead to complications in pregnant women, such as premature rupture of the membranes, preterm labor, and post-partum endometritis 1. Recurrence is common, affecting about 30% of women within 3 months after treatment, and may require extended or maintenance therapy. It is essential to note that the U.S. Preventive Services Task Force recommends against screening for bacterial vaginosis in asymptomatic pregnant women at low risk for preterm delivery, but the evidence is insufficient to assess the balance of benefits and harms of screening for bacterial vaginosis in asymptomatic pregnant women at high risk for preterm delivery 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 given as either:
- 2 g once daily for 2 days
- 1 g once daily for 5 days 2 2. Key points:
- The treatment is based on a randomized, double-blind, placebo-controlled clinical trial.
- The efficacy of tinidazole was measured by therapeutic cure, clinical cure, and microbiologic cure.
- The cure rates for tinidazole were superior to placebo.
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:
- Other treatment options that have been studied include:
Special Considerations
- Treatment of male sex partners is not recommended 3
- Recurrent bacterial vaginosis may be due to persistence of residual infection, resistance, or reinfection from partners 5
- Biofilm disruption, probiotics, and prebiotics have shown promise in treating recurrent bacterial vaginosis, but further study is needed 5