From the Guidelines
Bacterial vaginosis (BV) should be treated when symptomatic or in specific clinical scenarios, but not always. Treatment is recommended for women with symptoms such as abnormal discharge, odor, or discomfort, and for asymptomatic pregnant women at high risk for preterm birth. The standard treatment is oral metronidazole 500mg twice daily for 7 days, or alternatives like metronidazole gel 0.75% (one applicator intravaginally once daily for 5 days) or clindamycin cream 2% (one applicator intravaginally at bedtime for 7 days) 1. For recurrent BV, extended metronidazole therapy or suppressive treatment may be used. Treatment is important because BV increases susceptibility to STIs and can cause complications during pregnancy 1. However, asymptomatic non-pregnant women generally don't require treatment as BV can sometimes resolve spontaneously and treatment doesn't always prevent recurrence 1. During treatment, patients should avoid alcohol with metronidazole and refrain from sexual intercourse or use condoms to prevent reinfection. 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.
- The optimal treatment regimen for pregnant women with bacterial vaginosis is unclear, and more research is needed to evaluate the benefit of screening and treating asymptomatic bacterial vaginosis in women at highest risk for preterm delivery 1.
- Treatment of symptomatic cases should be based on the clinical situation, and the Centers for Disease Control and Prevention Web site should be referred to for current treatment recommendations.
From the FDA Drug Label
Tinidazole is indicated for the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, or anaerobic vaginosis) in adult women [see Use in Specific Populations ( 8.1) and Clinical Studies ( 14.5)].
No, you do not always treat bacterial vaginosis. The decision to treat should be based on the presence of symptoms and the results of diagnostic tests, as well as the potential risks and benefits of treatment. According to the drug label, tinidazole is indicated for the treatment of bacterial vaginosis in adult women, but it should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria 2.
From the Research
Treatment of Bacterial Vaginosis
- Bacterial vaginosis (BV) is a common but treatable condition, with effective available treatments including oral and intravaginal metronidazole and clindamycin, and oral tinidazole 3.
- The recommended treatment for recurrent BV consists of an extended course of metronidazole treatment, and alternative treatments such as metronidazole vaginal gel and secnidazole may also be effective 3, 4.
- Studies have compared the efficacy of different treatments, including oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream, and found similar cure rates for these treatments 4, 5.
Limitations of Current Treatments
- Current therapeutic approaches to the treatment of BV have limitations, including the frequent recurrence of symptoms and the inability to prevent serious sequelae such as preterm delivery 6.
- The incomplete understanding of the pathophysiology of BV has hindered the development of optimal treatment and prevention approaches 6.
- New drugs are not forthcoming, and reliance on the optimal use of available agents has become essential, with a need for approaches that combine antimicrobials with biofilm-disrupting agents and partner treatments 6, 7.
Future Directions
- Further studies are needed to explore new therapeutic actions to cure, prevent, or delay recurrences of BV, including the use of probiotics as adjuvant therapy 7.
- Alternative treatments, such as tinidazole, rifaximin, nitrofuran, dequalinium chloride, vitamin C, and lactic acid, are being studied, and may provide more options for switching therapy, combining therapies, and long-term prophylactic use to prevent recurrences 7.