Abstaining from Intercourse During Bacterial Vaginosis Treatment
Patients should abstain from sexual intercourse until they complete their full course of BV treatment to minimize the risk of reinfection and ensure treatment effectiveness. 1
Rationale for Abstinence During Treatment
The Centers for Disease Control and Prevention (CDC) guidelines provide clear recommendations regarding sexual activity during bacterial vaginosis treatment:
- Patients treated for BV should abstain from sexual intercourse until therapy is completed (7 days for a 7-day regimen or until completion of a shorter regimen) 1
- Sexual abstinence during treatment helps:
- Maximize treatment effectiveness
- Prevent potential reinfection
- Allow vaginal flora to normalize
Treatment Regimens for BV
Standard treatment options for BV include:
- Metronidazole 500 mg orally twice daily for 7 days (95% cure rate) 1, 2
- Metronidazole 2 g orally in a single dose (84% cure rate) 1
- Metronidazole gel 0.75%, one full applicator intravaginally once daily for 5 days 2
- Clindamycin cream 2%, one full applicator intravaginally at bedtime for 7 days 2
Partner Treatment Considerations
- Unlike some STIs, routine treatment of male sex partners is not recommended for BV 1, 2
- Clinical trials indicate that partner treatment does not affect a woman's response to therapy or likelihood of recurrence 2
- However, if the patient has multiple sexual partners or a new partner, this may increase risk of recurrence 3
Important Precautions
- Patients using metronidazole should avoid alcohol during treatment and for 24 hours afterward to prevent disulfiram-like reactions 1, 2
- Oil-based vaginal products like clindamycin cream might weaken latex condoms and diaphragms 2
- After completing treatment, consistent condom use may help reduce BV recurrence 3
Follow-Up Recommendations
- Follow-up visits are not necessary if symptoms resolve 1
- However, recurrence is common, with 50-80% of women experiencing recurrence within a year of treatment 4, 5
- If symptoms persist or recur, reevaluation and retreatment with a different regimen may be necessary 2
Special Considerations for Pregnant Women
- BV during pregnancy is associated with preterm birth, premature rupture of membranes, and other adverse outcomes 2
- Pregnant women should be treated according to CDC guidelines, with medication choices depending on trimester 2
- Clindamycin cream 2% is preferred in the first trimester, while metronidazole can be used after the first trimester 2
By following these evidence-based recommendations, including abstaining from intercourse during treatment, patients can maximize their chances of successful BV treatment and minimize the risk of recurrence.