Treatment of Mycoplasma, Ureaplasma, Bacterial Vaginosis, and Yeast Infections
For bacterial vaginosis, metronidazole 500 mg orally twice daily for 7 days is the most effective first-line treatment with a 95% cure rate, while fluconazole 150 mg as a single oral dose is the recommended treatment for vaginal yeast infections. 1, 2
Bacterial Vaginosis (BV) Treatment
First-Line Treatment Options
- Metronidazole 500 mg orally twice daily for 7 days (95% cure rate)
- Metronidazole gel 0.75%, one full applicator (5g) intravaginally once daily for 5 days
- Clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days 1
Important Precautions
- Patients should abstain from sexual intercourse until completing the full course of treatment
- Avoid alcohol during metronidazole treatment and for 24 hours afterward to prevent disulfiram-like reactions
- Metronidazole can cause gastrointestinal disturbances, metallic taste, and potential for peripheral neuropathy with prolonged use 1
Pregnancy Considerations
- Clindamycin cream 2% is the preferred treatment during first trimester
- Metronidazole is contraindicated in first trimester but may be used safely afterward
- Amoxicillin-clavulanic acid is an alternative safe option during pregnancy 1
Recurrent BV Management
- Extended course of metronidazole (500 mg twice daily for 10-14 days)
- If ineffective, metronidazole vaginal gel 0.75% for 10 days, followed by twice weekly for 3-6 months 3
- BV recurrence is common (50-80% within one year of treatment) 1
- Use a different treatment regimen than the initial one for recurrent BV 1
Vaginal Yeast Infection Treatment
First-Line Treatment
- Fluconazole 150 mg oral tablet as a single dose (55% therapeutic cure rate) 2
- Equivalent to 7-day regimens of intravaginal clotrimazole or miconazole 2
Treatment Considerations
- Fluconazole has more gastrointestinal side effects (16%) compared to intravaginal agents (4%) 2
- Common side effects include headache (13%), abdominal pain (6%), and nausea (7%) 2
- Fluconazole should be administered with caution to patients with:
- Renal dysfunction
- QT prolongation risk factors
- Patients taking medications metabolized by CYP2C9, CYP2C19, and CYP3A4 2
Mycoplasma and Ureaplasma Infections
While the provided evidence doesn't specifically address Mycoplasma and Ureaplasma treatment, these organisms are often associated with bacterial vaginosis. Based on general medical knowledge:
- Doxycycline 100 mg orally twice daily for 7 days is typically effective for Mycoplasma and Ureaplasma
- Azithromycin 1 gram as a single dose is an alternative treatment
- For pregnant women, azithromycin is preferred as doxycycline is contraindicated
Clinical Pearls and Pitfalls
- Diagnosis confirmation is crucial: BV diagnosis requires three of the following: homogeneous discharge, clue cells, vaginal fluid pH >4.5, and positive whiff test 1
- Partner treatment: Unlike some STIs, routine treatment of male sex partners is not recommended for BV 1
- Follow-up: Not necessary if symptoms resolve, except for pregnant women who should be evaluated 1 month after treatment 1
- Drug interactions: Fluconazole has significant drug interactions due to its inhibition of CYP enzymes; review patient's medication list before prescribing 2
- Treatment failure: Consider biofilm formation as a potential cause of treatment failure in recurrent BV 3
Special Populations
Pregnant Women
- Treatment of BV during pregnancy is recommended due to risks of preterm birth, low birth weight, and other complications 1
- High-risk pregnant women (history of preterm birth) should be screened and treated for BV, preferably in early second trimester 1
Recurrent Infections
- For recurrent yeast infections, consider longer courses of fluconazole
- For recurrent BV, extended treatment courses are recommended as noted above 3