Treatment of Symptomatic Bacterial Vaginosis

Introduction to Treatment

• The Centers for Disease Control and Prevention recommends treating symptomatic bacterial vaginosis with metronidazole 500 mg orally twice daily for 7 days to relieve vaginal symptoms and signs 1

First-Line Treatment Regimen

• The Centers for Disease Control and Prevention recommends metronidazole 500 mg orally twice daily for 7 days as the preferred regimen with a 95% cure rate 1

Alternative Treatment Options

• Alternative treatment options include metronidazole 2 g orally as a single dose with an 84% cure rate, clindamycin 2% vaginal cream, one full applicator intravaginally at bedtime for 7 days, metronidazole 0.75% gel, one full applicator intravaginally twice daily for 5 days, and clindamycin 300 mg orally twice daily for 7 days 1

Critical Patient Instructions

• Patients must avoid all alcohol during metronidazole treatment and for 24 hours after completion to prevent disulfiram-like reactions, as recommended by the Centers for Disease Control and Prevention and Praxis Medical Insights 1, 2
• If using clindamycin cream, warn the patient that it is oil-based and can weaken latex condoms and diaphragms for up to 5 days after treatment, according to Praxis Medical Insights 2, 3

Management of Sexual Partners

• Routine treatment of male sex partners is not recommended by the Centers for Disease Control and Prevention, Praxis Medical Insights, unless in cases of recurrent bacterial vaginosis 1, 2, 3
• In cases of recurrent bacterial vaginosis, consider treating male partners with metronidazole 400 mg orally twice daily for 7 days plus 2% clindamycin cream applied topically to penile skin twice daily for 7 days, as suggested by Praxis Medical Insights 2, 4

Follow-Up Recommendations

• No follow-up visit is necessary if symptoms resolve after treatment, according to the Centers for Disease Control and Prevention and Praxis Medical Insights 1, 2

Common Pitfalls to Avoid

• Do not treat asymptomatic bacterial vaginosis found on routine screening unless the patient is undergoing surgical abortion or other invasive uterine procedures, as recommended by the Centers for Disease Control and Prevention 1
• Do not rely on Gardnerella vaginalis culture for diagnosis—it is not specific and can be isolated from half of normal women, according to the Centers for Disease Control and Prevention 1