gynecology and obstetrics
Bacterial Vaginosis (BV)
Treatment of Bacterial Vaginosis
Metronidazoleorclindamycin The following treatments for bacterial vaginosis are equally effective (seeCDC: Sexually Transmitted Infections Treatment Guidelines, 2021): Oralmetronidazole500 mg twice a day for 7 days Metronidazole0.75% gel 5 g (one applicator full) intravaginally once a day for 5 days 2%clindamycinvaginal cream once a day for 7 days For topical treatments,metronidazoleis preferred;clindamycinis an alternative option. Oralmetronidazoleis the treatment of choice for patients who are not pregnant. For pregnant patients, topical regimens are preferred because systemic effects are possible with oral medications. Women treated withclindamycincream should not use latex products (ie, condoms or diaphragms) for contraception because the cream weakens latex. 2 g orally once is another option for treating bacterial vaginosis ( Treatment references , Treatment of sex partners is not recommended. For vaginitis during the 1st trimester of pregnancy,metronidazolevaginal gel should be used, although treatment during pregnancy has not been shown to lower the risk of pregnancy complications. To prevent endometritis, clinicians may give oralmetronidazoleprophylactically before elective abortion to all patients or only to those who test positive for bacterial vaginosis. gel 2 times a week for 16 weeks may be considered in patients with recurrent bacterial vaginosis ( Treatment references ). 1.Schwebke JR, Morgan FG Jr, Koltun W, Nyirjesy P: A phase-3, double-blind, placebo-controlled study of the effectiveness and safety of single oral doses ofsecnidazole2 g for the treatment of women with bacterial vaginosis.Am J Obstet Gynecol217 (6):678.e1–678.e9, 2017. doi: 10.1016/j.ajog.2017.08.017 2.Hillier SL, Nyirjesy P, Waldbaum AS, et al:Secnidazoletreatment of bacterial vaginosis: A randomized controlled trial.Obstet Gynecol130 (2):379-386, 2017. doi: 10.1097/AOG.0000000000002135 3.Sobel JD, Ferris D, Schwebke J, et al: Suppressive antibacterial therapy with 0.75%metronidazolevaginal gel to prevent recurrent bacterial vaginosis.Am J Obstet Gynecol194(5):1283-1289, 2006. doi:10.1016/j.ajog.2005.11.041 