Treatment of Recurrent Bacterial Vaginosis

Introduction to Recurrent BV Management

• The Centers for Disease Control and Prevention recommends avoiding alcohol during metronidazole treatment and for 24 hours after to prevent disulfiram-like reactions 1
• The American College of Obstetricians and Gynecologists notes that clindamycin cream is oil-based and may weaken latex condoms and diaphragms 1

Treatment Approach

• The Centers for Disease Control and Prevention states that routine treatment of sex partners is NOT recommended, as clinical trials show no influence on treatment response or recurrence rates 2, 1
• The American College of Obstetricians and Gynecologists advises that single-dose metronidazole regimens have lower efficacy (84% vs 95% for 7-day regimens) and should be avoided in recurrent cases 2

Special Considerations

• The American College of Obstetricians and Gynecologists recommends metronidazole 250 mg orally three times daily for 7 days in the second trimester for pregnant women 1
• The American College of Obstetricians and Gynecologists prefers clindamycin vaginal cream in the first trimester due to metronidazole concerns 1
• Treatment of bacterial vaginosis in high-risk pregnant women may reduce preterm delivery risk, according to the American College of Obstetricians and Gynecologists 1