Treatment of Gardnerella Vaginalis Infection

First-Line Treatment Options

• The Centers for Disease Control and Prevention recommends oral metronidazole 500 mg twice daily for 7 days as the preferred treatment with the highest efficacy 2, 1
• Metronidazole gel 0.75%, one full applicator (5g) intravaginally twice daily for 5 days is equally effective with fewer systemic side effects 2, 1
• Clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days is another effective first-line option 2, 1

Alternative Treatment Options

• Oral metronidazole 2g as a single dose (84% cure rate) is less effective than the 7-day regimen but may be useful when compliance is a concern 2, 3, 1
• Oral clindamycin 300 mg twice daily for 7 days can be used when metronidazole cannot be used 2, 1

Treatment Considerations

Side Effects and Precautions

• Patients using metronidazole should avoid alcohol during treatment and for 24 hours afterward due to potential disulfiram-like reaction 2, 3, 1
• Clindamycin cream is oil-based and may weaken latex condoms and diaphragms 2, 1
• Metronidazole may cause gastrointestinal upset; intravaginal preparations have fewer systemic side effects 1

Allergy or Intolerance to Metronidazole

• Clindamycin cream or oral clindamycin is preferred for patients with allergy or intolerance to metronidazole 4, 1
• Patients allergic to oral metronidazole should not be administered metronidazole vaginally 1

Special Populations

Pregnancy

• During first trimester: Clindamycin vaginal cream is preferred due to contraindication of metronidazole 2, 1
• During second and third trimesters: Oral metronidazole can be used 2, 1
• Treatment of BV in high-risk pregnant women (history of preterm delivery) may reduce risk of prematurity 2

HIV Infection

• Patients with HIV and Gardnerella vaginalis infection should receive the same treatment as persons without HIV 5, 1

Follow-Up and Management

• Follow-up visits are unnecessary if symptoms resolve 4, 1
• If treatment failure occurs with either regimen, the patient should be re-treated with metronidazole 500 mg twice daily for 7 days 6
• For persistent treatment failures, consider metronidazole 2g once daily for 3-5 days 6

Management of Sex Partners

• 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 2, 3, 1

Special Clinical Situations

• Before surgical abortion or other invasive gynecological procedures, treatment of BV (symptomatic or asymptomatic) is recommended to reduce risk of post-procedure infections 2, 3, 1
• Treatment of BV with metronidazole has been shown to substantially reduce post-abortion PID 3, 1