What is the recommended treatment for bacterial vaginosis?

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.

Treatment Options

• 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

Important 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.
• The treatment aims to relieve vaginal symptoms and signs of infection, reduce the risk for infectious complications associated with bacterial vaginosis during pregnancy, and reduce the risk for other infections, as noted in the guidelines for treating STDs 1.

Follow-Up and Recurrence

• Follow-up visits are unnecessary if symptoms resolve, but because recurrence of bacterial vaginosis is not unusual, women should be aware of the signs of recurrence and seek medical attention if symptoms persist or recur.
• Recurrence is common, affecting about 30% of women within 3 months, and may require repeated or extended treatment courses, highlighting the importance of patient education and follow-up care 1.

From the FDA Drug Label

Tinidazole is indicated for the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, or anaerobic vaginosis) in adult women [see Use in Specific Populations ( 8.1) and Clinical Studies ( 14.5)]. 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:

• Tinidazole is indicated for the treatment of bacterial vaginosis in adult women.
• The treatment regimen consists of either 2 g once daily for 2 days or 1 g once daily for 5 days.
• The efficacy of tinidazole was demonstrated in a randomized, double-blind, placebo-controlled clinical trial.

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:
  • Metronidazole (500 mg orally twice daily for 7 days) 3
  • Clindamycin vaginal cream (2%, once daily for 7 days) 3
  • Metronidazole vaginal gel (0.75%, twice daily for 5 days) 3, 4
• 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:
  • An extended course of metronidazole treatment (500 mg twice daily for 10-14 days) 5
  • Metronidazole vaginal gel 0.75% for 10 days, followed by two times per week for 3-6 months 5
• Other treatment options that have been studied include:
  • Tinidazole, which has been shown to be equivalent to metronidazole in efficacy and has a more favorable side effect profile 6
  • Clindamycin, which can be used orally or as a vaginal cream 3, 7

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