From the Guidelines
Gardnerella vaginalis infection, commonly known as bacterial vaginosis (BV), is typically treated with antibiotics, with metronidazole being the first-line treatment, taken orally as 500 mg twice daily for 7 days, or as a vaginal gel (0.75%) applied once daily for 5 days, as recommended by the CDC guidelines 1. The treatment options for BV include:
- 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 may cause disulfiram-like reactions 1. The benefits of therapy for BV in pregnant women are to relieve vaginal symptoms and signs of infection, reduce the risk for infectious complications associated with BV during pregnancy, and reduce the risk for other infections 1. Alternative regimens, such as metronidazole 2 g orally in a single dose or clindamycin 300 mg orally twice a day for 7 days, may be considered, but they have lower efficacy for BV 1. Good hygiene practices, avoiding douching, and using condoms can help prevent recurrence, and if symptoms persist after treatment, a follow-up with a healthcare provider is recommended as resistant infections may require alternative approaches 1.
From the Research
Treatment Options for Gardnerella
- The treatment of Gardnerella vaginalis associated bacterial vaginosis can be done using pivampicillin or metronidazole, with pivampicillin showing higher clinical efficacy in some studies 2.
- Oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream have been compared for the treatment of bacterial vaginosis, with no statistically significant differences in cure rates found between the three treatments 3.
- For urinary tract infection (UTI) by Gardnerella vaginalis, oral metronidazole and oral ampicillin have been compared, with ampicillin found to be effective, safe, and well-tolerated, while metronidazole was effective but had more adverse events 4.
- Vaginal clindamycin and oral metronidazole have been compared for the treatment of bacterial vaginosis, with clindamycin found to be as effective as and better tolerated than metronidazole 5.
Factors Associated with Treatment Failure
- The presence of Prevotella and Gardnerella has been associated with treatment failure following first-line antibiotics for bacterial vaginosis, with a higher abundance of Prevotella pretreatment and Gardnerella immediately posttreatment increasing the odds of recurrence 6.
- The presence of an untreated regular sexual partner has also been found to increase the likelihood of recurrence 6.
Available Treatments
- Pivampicillin: 700 mg twice daily for 6 days 2
- Metronidazole: 400 mg three times daily for 7 days 2, 500 mg twice daily for 1 week 3, or 500 mg twice daily for 7 days 5
- Clindamycin vaginal cream: 2% clindamycin vaginal cream 5 g once daily for 7 days 3
- Clindamycin vaginal ovules: 100-mg ovules of clindamycin intravaginally for 3 consecutive days 5
- Ampicillin: 2 g for 10 days 4