Bacterial Vaginosis Treatment Guidelines

First-Line Treatment Options

The Centers for Disease Control and Prevention recommends oral metronidazole 500 mg twice daily for 7 days as the standard treatment with excellent clinical efficacy 2, 3
Alternative topical options with similar efficacy include metronidazole gel 0.75%, one full applicator (5g) intravaginally twice daily for 5 days, as suggested by the Centers for Disease Control and Prevention 2, 4
The Centers for Disease Control and Prevention also recommends clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days 2, 4

The Centers for Disease Control and Prevention suggests metronidazole 2g orally in a single dose, which has a lower efficacy of 84% but is useful when compliance is a concern 2, 3
Clindamycin 300 mg orally twice daily for 7 days is another alternative treatment option recommended by the Centers for Disease Control and Prevention 2, 3
Flagyl ER (metronidazole) 750 mg once daily for 7 days is an FDA-approved treatment, although it has limited comparative data 2

Patients must avoid consuming alcohol during metronidazole treatment and for 24 hours afterward to prevent disulfiram-like reactions, as advised by the Centers for Disease Control and Prevention 2, 3
The Centers for Disease Control and Prevention warns that clindamycin cream is oil-based and may weaken latex condoms and diaphragms 2, 3
Patients allergic to oral metronidazole should not use metronidazole vaginally, according to the Centers for Disease Control and Prevention 2, 3
For metronidazole allergy, clindamycin cream is the preferred alternative, as recommended by the Centers for Disease Control and Prevention 2, 3

For pregnant women, especially in the second trimester, the Centers for Disease Control and Prevention recommends metronidazole 250 mg orally three times daily for 7 days 2, 1
Alternative regimens for pregnant women include metronidazole 2g orally in a single dose, as suggested by the Centers for Disease Control and Prevention 2
The Centers for Disease Control and Prevention also recommends clindamycin 300 mg orally twice daily for 7 days for pregnant women 2
Treatment of bacterial vaginosis in high-risk pregnant women may reduce the risk of preterm delivery, according to the American College of Obstetricians and Gynecologists 1
During the first trimester, clindamycin vaginal cream is preferred due to concerns about metronidazole, as recommended by the Centers for Disease Control and Prevention 5, 6

Follow-up visits are unnecessary if symptoms resolve, as stated by the Centers for Disease Control and Prevention 2, 3

Routine treatment of male sex partners is not recommended, as it has not been shown to influence a woman's response to therapy or reduce recurrence rates, according to the Centers for Disease Control and Prevention 2, 3
Treatment of sex partners has not influenced the woman's response to therapy in clinical trials, as reported by the Centers for Disease Control and Prevention 2, 3

Bacterial vaginosis is associated with adverse pregnancy outcomes, including preterm delivery, as noted by the American College of Obstetricians and Gynecologists 2, 1
Before surgical abortion or hysterectomy, screening and treating women with bacterial vaginosis is recommended due to increased risk for postoperative infectious complications, as advised by the American College of Obstetricians and Gynecologists 1