From the Guidelines
The standard treatment for bacterial vaginosis (BV) is antibiotics, with metronidazole being the first-line option, which can be taken orally as 500mg twice daily for 7 days, or as a vaginal gel (0.75%) applied once daily for 5 days, as recommended by the Centers for Disease Control and Prevention 1.
Treatment Options
The following treatment options are available for BV:
- 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 severe reactions 1.
Special Considerations
For pregnant women, the treatment of BV is crucial to prevent premature rupture of the membranes, preterm labor, and post-partum endometritis, and oral metronidazole or clindamycin are the recommended options for treatment 1.
Follow-Up
Follow-up visits are unnecessary if symptoms resolve, but women should be aware that recurrence of BV is not unusual, and a follow-up with a healthcare provider is recommended if symptoms persist after treatment 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. 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 therapeutic cure rates reported in this clinical study conducted with tinidazole were based on resolution of 4 out of 4 Amsel's criteria and a Nugent score of <4.
- Treatment options: Tinidazole oral tablets can be given as either 2 g once daily for 2 days or 1 g once daily for 5 days.
- Efficacy: Tinidazole has demonstrated superior efficacy over placebo in treating bacterial vaginosis, with therapeutic cure rates of 97.5% and 93.2% for the 2-day and 5-day regimens, respectively 2.
- Key considerations: The treatment should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria, and other pathogens commonly associated with vulvovaginitis should be ruled out 2.
From the Research
Treatment Options for Bacterial Vaginosis
- The recommended 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) for nonpregnant women 3, 4.
- For pregnant women, the treatment objective is to prevent adverse outcomes of pregnancy and relieve symptoms. Metronidazole (250 mg orally three times a day for 7 days) is recommended for both high-risk and low-risk pregnant women 3.
- Alternative treatment regimens include single-dose metronidazole (2 g orally), oral clindamycin (300 mg twice daily for 7 days), and 0.75% metronidazole vaginal gel (twice daily for 5 days) 4, 5.
Recurrent Bacterial Vaginosis
- Recurrent bacterial vaginosis can be treated with an extended course of metronidazole (500 mg twice daily for 10-14 days) or metronidazole vaginal gel 0.75% for 10 days, followed by two times per week for 3-6 months 6.
- Other options for recurrent bacterial vaginosis include clindamycin and tinidazole, especially in cases of metronidazole resistance 6.
- New treatment strategies, such as secnidazole, biofilm disruption, probiotics, prebiotics, and botanical treatments, are being studied but require further research before clinical use 6, 7.
Comparison of Treatment Options
- A study comparing oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream found no significant differences in cure rates among the three treatments 5.
- However, the study noted that Gardnerella vaginalis may remain after a clinical cure, which could explain cases of recurrent disease 5.
- Patients treated with intravaginal products reported being more satisfied with the treatment, but experienced similar rates of posttreatment vulvovaginal candidiasis as those treated with oral metronidazole 5.