From the Guidelines
Bacterial vaginosis (BV) is caused by an imbalance in vaginal bacteria and should be treated with metronidazole 500mg orally twice daily for 7 days, or metronidazole gel 0.75% intravaginally once daily for 5 days, or clindamycin cream 2% intravaginally at bedtime for 7 days, as these regimens are equally efficacious and recommended by the Centers for Disease Control and Prevention 1.
Causes of BV
The causes of BV include:
- Douching
- Multiple sexual partners
- New partners
- IUD use
- Lack of vaginal lactobacilli BV is associated with having multiple sex partners, douching, and lack of vaginal lactobacilli; however, it is unclear whether BV results from acquisition of a sexually transmitted pathogen 1.
Symptoms of BV
Symptoms of BV include:
- Fishy-smelling discharge
- Itching
- Burning However, up to 50% of women with BV may not report symptoms of BV 1.
Treatment of BV
Treatment of BV typically involves antibiotics, and the recommended regimens are:
- Metronidazole 500mg orally twice daily for 7 days
- Metronidazole gel 0.75% intravaginally once daily for 5 days
- Clindamycin cream 2% intravaginally at bedtime for 7 days During treatment, patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter, and to complete the full course even if symptoms improve 1.
Prevention of Recurrence
To prevent recurrence, patients should:
- Avoid douching
- Use condoms
- Wear cotton underwear
- Consider probiotics BV requires treatment as it increases risk of STIs and can cause complications during pregnancy 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 clinical diagnosis of bacterial vaginosis was based on Amsel's criteria and defined by the presence of an abnormal homogeneous vaginal discharge that (a) has a pH of greater than 4. 5, (b) emits a "fishy" amine odor when mixed with a 10% KOH solution, and (c) contains ≥20% clue cells on microscopic examination. Therapeutic cure was a composite endpoint, consisting of both a clinical cure and 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 causes of Bacterial Vaginosis (BV) are not explicitly stated in the provided text, but the treatment for BV is tinidazole oral tablets, given as either 2 g once daily for 2 days or 1 g once daily for 5 days.
- The therapeutic cure rates for tinidazole were 36.8% for the 2-day regimen and 27.4% for the 5-day regimen, compared to 5.1% for the placebo.
- The clinical cure rates for tinidazole were 51.3% for the 2-day regimen and 35.6% for the 5-day regimen, compared to 11.5% for the placebo.
- The Nugent score cure rates for tinidazole were 38.2% for the 2-day regimen and 27.4% for the 5-day regimen, compared to 5.1% for the placebo 2.
From the Research
Causes of Bacterial Vaginosis (BV)
There are no research papers provided to directly answer the causes of BV.
Treatment for Bacterial Vaginosis (BV)
- The standard treatment for BV includes the administration of metronidazole, clindamycin, or tinidazole orally or intravaginally 3.
- For nonpregnant women, 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) are recommended as the preferred treatment for BV 4, 5.
- For pregnant women, metronidazole (250 mg orally three times a day for 7 days) is recommended to prevent adverse outcomes of pregnancy and relieve symptoms 4, 5.
- Alternative strategies to standard therapies may include antimicrobial substances, probiotics, prebiotics, and acidifying agents to reestablish the physiologic vaginal environment and improve local immunity response 3.
- Clindamycin may be a safe and effective alternative to metronidazole for treating women with BV, with a similar failure rate and mild adverse reactions 6.
- Tinidazole has been shown to be equivalent to oral metronidazole, intravaginal clindamycin cream, and intravaginal metronidazole tablets in efficacy, with a more favorable side effect profile and better gastrointestinal tolerability 7.