What is the diagnosis and treatment for Gardnerella (Bacterial) vaginosis?

From the Guidelines

Gardnerella vaginosis, also known as bacterial vaginosis (BV), should be treated with metronidazole or clindamycin to relieve symptoms and prevent complications, as recommended by the CDC guidelines 1. The treatment of BV typically involves antibiotics, with metronidazole being the first-line option, which can be taken as oral tablets (500 mg twice daily for 7 days) or as a vaginal gel (0.75%, applied once daily for 5 days) 1. Clindamycin is an alternative, available as a vaginal cream (2%, applied at bedtime for 7 days) or oral capsules (300 mg twice daily for 7 days) 1. Some key points to consider when treating BV include:

• The benefits of therapy for BV in nonpregnant women are to relieve vaginal symptoms and signs of infection, and reduce the risk for infectious complications after abortion or hysterectomy 1.
• Follow-up visits are unnecessary if symptoms resolve, but recurrence is not unusual and patients should return for additional treatment if symptoms recur 1.
• Treatment of the male sex partner has not been beneficial in preventing the recurrence of BV 1.
• Risk factors for BV include douching, new or multiple sexual partners, and lack of condom use.
• While BV can resolve spontaneously, treatment is important to prevent complications like increased risk of STIs, pelvic inflammatory disease, and pregnancy complications. It is essential to complete the full course of antibiotics even if symptoms resolve quickly and to avoid alcohol with metronidazole due to potential severe reactions 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. A microbiologic diagnosis of bacterial vaginosis was based on Gram stain of the vaginal smear demonstrating (a) markedly reduced or absent Lactobacillus morphology, (b) predominance of Gardnerella morphotype, and (c) absent or few white blood cells, with quantification of these bacterial morphotypes to determine the Nugent score, where a score ≥4 was required for study inclusion and a score of 0 to 3 considered a microbiologic cure. 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 of bacterial vaginosis (also known as Gardnerella vaginosis) with tinidazole has been studied.

• The therapeutic cure rates for tinidazole were 97.5% for the 2g x 2 days regimen and 92.1% for the 1g x 5 days regimen.
• The clinical cure rates were 93.2% for the 2g x 2 days regimen and 87.7% for the 1g x 5 days regimen.
• The Nugent score cure rates were 92.1% for the 2g x 2 days regimen and 87.7% for the 1g x 5 days regimen 2.

From the Research

Gardnerella Vaginosis Treatment Options

• The treatment of bacterial vaginosis, which is often associated with Gardnerella vaginalis, can be achieved through various methods, including metronidazole, clindamycin, and tinidazole 3, 4, 5, 6, 7.
• Metronidazole is a commonly recommended treatment, with a dosage of 500 mg orally twice daily for 7 days for nonpregnant women 3, 7.
• For pregnant women, metronidazole is also recommended, but with a dosage of 250 mg orally three times a day for 7 days 3.
• Clindamycin vaginal cream and metronidazole vaginal gel are alternative treatment options, with a 2% clindamycin vaginal cream applied once daily for 7 days and a 0.75% metronidazole vaginal gel applied twice daily for 5 days 3, 7.
• Tinidazole has been shown to be an effective treatment for bacterial vaginosis, with a more favorable side effect profile compared to metronidazole 4.
• A single 2 g dose of metronidazole, nimorazole, or tinidazole can also be effective in treating vaginitis associated with Gardnerella vaginalis 6.

Efficacy of Treatment Options

• Metronidazole has been shown to be effective in eradicating Gardnerella vaginalis, Bacteroides spp., and Mobiluncus spp. from vaginal specimens 5.
• Tinidazole has been found to have a more favorable side effect profile compared to metronidazole, with better gastrointestinal tolerability and less metallic taste 4.
• The efficacy of metronidazole, clindamycin, and tinidazole in treating bacterial vaginosis has been consistently demonstrated in various studies 3, 4, 5, 6, 7.

Treatment Considerations

• The treatment of bacterial vaginosis during pregnancy should focus on the elimination of symptoms, as data on adverse pregnancy outcomes for women with bacterial vaginosis remain insufficient to recommend treatment of asymptomatic patients 3, 7.
• Routine treatment of male sex partners is not recommended, as data do not support its effectiveness in preventing the spread of bacterial vaginosis 3, 7.