What is the treatment for the transitional phase between normal vaginal flora and bacterial vaginosis (BV)?

From the Guidelines

The transitional phase between normal vaginal flora and bacterial vaginosis (BV) typically does not require antibiotic treatment unless the patient is symptomatic, in which case metronidazole 500mg orally twice daily for 7 days is recommended. This approach is based on the guidelines provided by the Centers for Disease Control and Prevention, as outlined in the study from 2002 1. The recommended treatment regimens 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's essential to note that patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, as mentioned in the study 1. Additionally, clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms. For asymptomatic patients, lifestyle modifications such as avoiding douching, using condoms during intercourse, and wearing breathable cotton underwear may help restore normal flora. Probiotic supplements containing Lactobacillus species may also be beneficial, although the evidence for their effectiveness is mixed. The primary goal of treatment is to restore the normal Lactobacillus-dominant vaginal environment and prevent progression to full bacterial vaginosis. Regular monitoring may be recommended for asymptomatic patients with intermediate flora to ensure it doesn't progress to full BV.

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. A clinical diagnosis of bacterial vaginosis was based on Amsel's criteria and defined by the presence of an abnormal homogeneous vaginal discharge that (a) has a pH of greater than 4. 5, (b) emits a "fishy" amine odor when mixed with a 10% KOH solution, and (c) contains ≥20% clue cells on microscopic examination.

The FDA drug label does not answer the question about treating the transitional phase between normal and bacterial vaginosis (BV) as the label only discusses the treatment of bacterial vaginosis, not the transitional phase. 2

From the Research

Treatment for Transitional Phase between Normal Vaginal Flora and Bacterial Vaginosis (BV)

The transitional phase between normal vaginal flora and bacterial vaginosis (BV) is a condition where the vaginal microbiota is imbalanced, but not yet meeting the full criteria for BV.

• The treatment for this phase is not explicitly defined in the provided studies, as they primarily focus on the treatment of established BV.
• However, the studies suggest that the treatment for BV can be effective in restoring the balance of vaginal flora 3, 4, 5, 6, 7.
• The most commonly recommended treatments for BV include:
  • Metronidazole (500 mg orally twice daily for 7 days) 3, 4, 5, 7
  • Clindamycin vaginal cream (2%, once daily for 7 days) 4, 7
  • Metronidazole vaginal gel (0.75%, twice daily for 5 days) 4, 7
  • Tinidazole (1 g daily for 5 days) 6
  • Secnidazole (2 g, once) 3
• It is essential to note that the treatment for the transitional phase may vary depending on the individual's specific condition and medical history.
• Further research is needed to determine the most effective treatment for the transitional phase between normal vaginal flora and BV.