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

Treatment for Bacterial Vaginosis (BV)

First-line treatment for bacterial vaginosis is oral metronidazole 500 mg twice daily for 7 days, which has a 95% cure rate. 1

First-Line Treatment Options

The CDC recommends the following treatment regimens for bacterial vaginosis:

• Oral options:

  • Metronidazole 500 mg orally twice daily for 7 days (preferred oral regimen) 1
  • Metronidazole 2 g orally in a single dose (alternative, but with lower cure rate of 84%) 1

• Vaginal options:

  • Metronidazole gel 0.75% intravaginally once daily for 5 days (95% cure rate) 1
  • Clindamycin cream 2% intravaginally at bedtime for 7 days 1

Special Considerations for Pregnant Women

For pregnant women with BV, treatment recommendations differ by trimester:

• First trimester: Clindamycin cream 2% intravaginally 1
• Second and third trimesters: Oral metronidazole, metronidazole gel, or clindamycin cream 1
• Treatment of asymptomatic BV should be considered in high-risk pregnant women to reduce the risk of preterm birth 1

Alternative Treatment: Tinidazole

Tinidazole is FDA-approved for BV treatment with two dosing options:

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

Clinical trials demonstrated superior efficacy of tinidazole over placebo, with therapeutic cure rates of 27.4% and 36.8% for the respective regimens 2.

Diagnosis Confirmation

Before initiating treatment, confirm BV diagnosis using Amsel's criteria (at least 3 of 4):

1. Homogeneous, white discharge adhering to vaginal walls
2. Presence of clue cells on microscopy
3. Vaginal fluid pH > 4.5
4. Fishy odor with 10% KOH (positive whiff test) 1

Management of Recurrent BV

For recurrent BV (common in 50-80% of women within a year of treatment 3):

1. Extended course of metronidazole 500 mg twice daily for 10-14 days 4
2. If ineffective, metronidazole vaginal gel 0.75% for 10 days, followed by twice weekly for 3-6 months 4

Important Precautions

• Patients using metronidazole should avoid alcohol during treatment and for 24 hours after 1
• Clindamycin cream can weaken latex condoms and diaphragms 1
• Follow-up visits are generally not needed unless symptoms persist or recur within 2 months 1
• Pregnant women should have a follow-up evaluation one month after completing treatment 1

Preventive Measures

Several measures may help prevent BV recurrence:

• Consistent condom use 1, 3
• Smoking cessation 1, 3
• Hormonal contraception 3
• For postmenopausal women: vaginal estrogen with or without lactobacillus-containing probiotics 1

Treatment of Partners

Treatment of male sex partners is not routinely recommended for BV 1, 5, but may be considered in cases of recurrent infection.

Complications if Left Untreated

Untreated BV increases the risk of:

• Preterm premature rupture of membranes
• Preterm labor and birth
• Postpartum endometritis
• Increased susceptibility to STIs, including HIV
• Pelvic inflammatory disease 1

The evidence strongly supports prompt treatment of BV with metronidazole as the first-line therapy due to its high cure rate and established safety profile.