Bacterial vaginosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Antimicrobial therapy is recommended for all symptomatic women and high risk asymptomatic pregnant women with bacterial vaginosis. Metronidazole is the drug of choice in pregnant patients.[1]

Medical Therapy

Treatment is recommended for women with symptoms. Other potential benefits to treatment include reduction in the risk for acquiring C. trachomatis, N. gonorrhea, T. vaginalis, HIV, and herpes simplex type 2.[1]

Management of Sex Partner

Data from clinical trials indicate that a woman’s response to therapy and the likelihood of relapse or recurrence are not affected by treatment of her sex partner. Therefore, routine treatment of sex partners is not recommended.[1]

Pregnancy

Treatment is recommended for all symptomatic pregnant women. Treatment of asymptomatic BV among pregnant women who are at high risk for preterm delivery (previous preterm birth) is recommended.[1]

Follow-Up

Follow-up visits are unnecessary if symptoms resolve. Because persistent and recurrent BV are common, women should be advised to return for evaluation if symptoms recur.[1]

Antimicrobial Regimen

  • 1. Bacterial Vaginosis Treatment[2]
  • Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
  • Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
  • Preferred regimen (3): Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
  • Alternative regimen (1): Tinidazole 2 g PO qd for 2 days
  • Alternative regimen (2): Tinidazole 1 g PO qd for 5 days
  • Alternative regimen (3): Clindamycin 300 mg PO bid for 7 days
  • Alternative regimen (4): Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days
  • Note: Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and vaginal contraceptive diaphragms). Use of such products within 72 hours following treatment with clindamycin ovules is not recommended.
  • 2. Management of Sex Partners
  • Routine treatment of sex partners is not recommended.
  • 3. Special Considerations
  • 3.1 Allergy, Intolerance, or Adverse Reactions
  • Intravaginal Clindamycin cream is preferred in case of allergy or intolerance to Metronidazole or Tinidazole. Intravaginal Metronidazole gel can be considered for women who are not allergic to Metronidazole but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.
  • 3.2 Pregnancy
  • Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
  • Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
  • Note: Tinidazole should be avoided during pregnancy
  • 3.3 HIV Infection
  • Women with HIV who have BV should receive the same treatment regimen as those who do not have HIV infection.

References

  1. 1.0 1.1 1.2 1.3 1.4 Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016
  2. Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

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