From the Guidelines
Bacterial vaginosis should be treated with metronidazole 500 mg orally twice a day for 7 days, or as a vaginal gel (0.75%) applied once daily for 5 days, as these regimens have been shown to be equally efficacious in treating the infection. The treatment of bacterial vaginosis is crucial to relieve symptoms, improve clinical course, and reduce the risk of complications such as preterm labor and postpartum endometritis, especially in pregnant women 1.
Treatment Options
- Metronidazole 500 mg orally twice a day for 7 days
- Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days
- Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
It is essential to note that patients should avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, as it can cause severe nausea and vomiting 1. Additionally, clindamycin cream and ovules are oil-based and may weaken latex condoms and diaphragms, so patients should refer to condom product labeling for additional information.
Special Considerations
- Pregnant women with symptomatic bacterial vaginosis should be treated to relieve symptoms and reduce the risk of complications
- High-risk pregnant women (those who have previously delivered a premature infant) may benefit from treatment to reduce the risk of preterm delivery 1
- Sexual partners generally do not need treatment, but using condoms during treatment is advisable to prevent transmission
Prevention of Recurrence
- Avoid douching
- Use unscented soaps
- Wear cotton underwear
- Wipe from front to back after using the toilet
By following these treatment guidelines and taking steps to prevent recurrence, patients with bacterial vaginosis can effectively manage their symptoms and reduce the risk of complications, ultimately improving their quality of life.
From the Research
Treatment Options for Bacterial Vaginosis
- For nonpregnant women, the preferred treatment for bacterial vaginosis includes metronidazole (500 mg orally twice daily for 7 days), clindamycin vaginal cream (2%, once daily for 7 days), or metronidazole vaginal gel (0.75%, twice daily for 5 days) 2, 3.
- For pregnant high-risk women (women with a prior preterm birth), the recommended treatment is metronidazole (250 mg orally three times a day for 7 days) to prevent adverse outcomes of pregnancy and relieve symptoms 2.
- For pregnant low-risk women (women without a prior preterm birth) with symptomatic disease, the main objective of the treatment is to relieve symptoms, and metronidazole (250 mg orally three times a day for 7 days) is recommended 2.
- Current FDA-approved treatments for bacterial vaginosis are antibiotics such as metronidazole and clindamycin, which provide a short-term cure but may not provide a consistent long-term cure for many women 4.
Alternative Strategies and Prevention
- Alternative strategies to standard treatments include probiotics, vaginal microbiome transplantation, pH modulation, and biofilm disruption 4, 5.
- Behavioral modifications that may help prevent bacterial vaginosis include smoking cessation, condom use, and hormonal contraception 4.
- Additional strategies considered by many people include dietary modification, non-medical vaginally applied products, choice of lubricant, and treatments from medical practices outside of allopathic medicine 4.
Male-Partner Treatment
- Treating the male partner with oral and topical antimicrobial treatment (metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days) in addition to treating the woman with first-line recommended antimicrobial agents may increase the likelihood of cure and reduce the recurrence of bacterial vaginosis 6.