Bacterial Vaginosis Treatment Guidelines

Recommended First-Line Regimens

The Centers for Disease Control and Prevention (CDC) recommends metronidazole 500 mg orally twice daily for 7 days as a first-line treatment for bacterial vaginosis, which demonstrates superior efficacy compared to alternative regimens 1, 2, 3
The CDC guidelines establish metronidazole gel 0.75%, one full applicator (5g) intravaginally once daily for 5 days as an equally acceptable first-line option for non-pregnant women 2
The CDC also recommends clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days as a first-line option for non-pregnant women 2

Patients must avoid alcohol during metronidazole treatment and for 24 hours after completion to prevent disulfiram-like reactions 1, 2, 3
Clindamycin cream and ovules are oil-based and weaken latex condoms and diaphragms 1, 2

Metronidazole 2g orally as a single dose has a cure rate of 84% compared to 95% for the 7-day regimen, and is useful only when compliance is a major concern 5, 6
Clindamycin 300 mg orally twice daily for 7 days is an alternative regimen for bacterial vaginosis 5

For pregnant women with high risk of preterm delivery, the CDC recommends metronidazole 250 mg orally three times daily for 7 days as the preferred treatment 2
For pregnant women with low risk of preterm delivery, metronidazole 250 mg orally three times daily for 7 days is recommended for symptomatic disease only 2

Routine treatment of sex partners is not recommended, as clinical trials demonstrate no effect on cure rates, relapse, or recurrence 1, 2, 3, 7
Follow-up visits are unnecessary if symptoms resolve 1, 2, 7

Bacterial vaginosis increases the risk of postabortion PID, adverse pregnancy outcomes, and post-hysterectomy infectious complications 1, 2, 3, 8, 9
Treatment with metronidazole reduces postabortion PID by 10-75% 3, 9
Screening and treating women with bacterial vaginosis before surgical abortion or hysterectomy is recommended, in addition to routine prophylaxis 3, 9