Treatment of Indeterminate Bacterial Vaginosis Results

Diagnostic Criteria for BV

The Centers for Disease Control and Prevention recommends that BV diagnosis requires meeting at least 3 of 4 Amsel criteria: homogeneous white discharge, clue cells on microscopy, vaginal pH >4.5, and positive whiff test 3, 4, 5
Alternatively, Gram stain can be used to determine the relative concentration of bacterial morphotypes characteristic of BV, as suggested by the Centers for Disease Control and Prevention 3, 4
Laboratory testing fails to identify a cause of vaginitis in a substantial minority of women, according to the Centers for Disease Control and Prevention 3, 5

The Centers for Disease Control and Prevention recommends that only women with symptomatic disease require treatment, as the principal goal of therapy is to relieve vaginal symptoms and signs 3, 6
Treatment is not recommended for asymptomatic women with indeterminate results unless they fall into specific high-risk categories, as stated by the American College of Obstetricians and Gynecologists 1, 2

The Centers for Disease Control and Prevention suggests treating women with indeterminate BV results before surgical abortion procedures, as treatment of BV with metronidazole has been shown to substantially reduce post-abortion PID 3, 6
The American College of Obstetricians and Gynecologists recommends considering treatment before hysterectomy or other invasive gynecological procedures due to increased risk for postoperative infectious complications 2
High-risk pregnant women with history of preterm delivery may benefit from treatment, as it may reduce risk of prematurity, according to the American College of Obstetricians and Gynecologists 6, 2

The American College of Obstetricians and Gynecologists recommends metronidazole 500 mg orally twice daily for 7 days (95% cure rate) 2
Metronidazole gel 0.75%, one full applicator (5g) intravaginally once daily for 5 days is also recommended by the American College of Obstetricians and Gynecologists 2
Clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days is an alternative treatment option, as suggested by the American College of Obstetricians and Gynecologists 2

Metronidazole 2g orally in a single dose (84% cure rate) is a useful alternative when compliance is a concern, according to the American College of Obstetricians and Gynecologists 2
Clindamycin 300 mg orally twice daily for 7 days is another alternative regimen, as recommended by the Centers for Disease Control and Prevention 6, 2

Patients using metronidazole should avoid alcohol during treatment and for 24 hours afterward due to potential disulfiram-like reaction, as warned by the Centers for Disease Control and Prevention 6, 2
Clindamycin cream is oil-based and might weaken latex condoms and diaphragms, according to the Centers for Disease Control and Prevention 6, 2
Treatment of male sex partners has not been shown to alter the clinical course or reduce recurrence rates of BV, as stated by the Centers for Disease Control and Prevention 3, 2

Treating asymptomatic women with indeterminate results unnecessarily exposes them to medication side effects without clear benefit, as cautioned by the Centers for Disease Control and Prevention 3, 6
Failing to treat before invasive gynecological procedures may increase risk of post-procedure infections, according to the American College of Obstetricians and Gynecologists 2