What are the treatment options for chronic Bacterial Vaginosis (BV) diagnosis?

From the Guidelines

Chronic bacterial vaginosis (BV) should be treated with metronidazole 500mg orally twice a day for 7 days or metronidazole gel 0.75% intravaginally once a day for 5 days as the first-line treatment options. These treatments have been shown to be equally efficacious in treating BV, with the goal of relieving vaginal symptoms and signs 1. The treatment options for chronic BV include:

• Metronidazole 500mg orally twice a day for 7 days
• Metronidazole gel 0.75% intravaginally once a day for 5 days
• Clindamycin cream 2% intravaginally at bedtime for 7 days It is essential to note that patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, and that clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms 1. Alternative regimens, such as metronidazole 2g orally in a single dose or clindamycin 300mg orally twice a day for 7 days, have lower efficacy for BV and are not recommended as first-line treatments. Follow-up visits are unnecessary if symptoms resolve, but recurrence of BV is not unusual, and women should be aware of this possibility 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 treatment options for chronic Bacterial Vaginosis (BV) diagnosis are:

• Tinidazole 2 g once daily for 2 days
• Tinidazole 1 g once daily for 5 days 2 2 2

From the Research

Treatment Options for Chronic Bacterial Vaginosis (BV)

The current treatment options for chronic BV include:

• Antibiotics, such as metronidazole and clindamycin, which provide a short-term cure for bacterial vaginosis, but may not provide a consistent long-term cure for many women 3
• Combination pharmacotherapy long-term suppressive regimens, which have shown promising results in preventing recurrence and achieving long-term cure 4
• Probiotics, vaginal microbiome transplantation, pH modulation, and biofilm disruption, which are being explored as potential treatment and prevention strategies 3
• Behavioral modifications, such as smoking cessation, condom use, and hormonal contraception, which may help prevent recurrence 3

FDA-Approved Treatment Regimens

The only FDA-approved treatment regimens for BV are antibiotics, such as:

• Metronidazole (500 mg orally twice daily for 7 days) 5, 6, 7
• Clindamycin (2% vaginal cream, once daily for 7 days) 5, 6, 7
• Metronidazole vaginal gel (0.75%, twice daily for 5 days) 6, 7

Alternative Treatment Regimens

Alternative treatment regimens that have shown effectiveness include:

• Single-dose metronidazole (2 g orally) 7
• Oral clindamycin (300 mg twice daily for 7 days) 7
• Longer courses of therapy for women with documented multiple recurrences 5

Special Considerations

Special considerations for treatment of BV include:

• Pregnant women, who may require systemic therapy to prevent adverse outcomes of pregnancy 6
• Women with a prior preterm birth, who may require more aggressive treatment to prevent recurrence 6
• Women with symptomatic disease, who may require treatment to relieve symptoms 6