Bacterial Vaginosis; Treatment

NWHRC Health Center - Bacterial Vaginosis, March 16, 2005

As with other vaginal infections, the primary goal for treating bacterial vaginosis (BV) is to relieve signs and symptoms of infection. All women with symptoms should be treated. In addition, treatment is indicated in order to reduce post-abortion or post-surgical complications. BV is treated with antibiotics. The most common therapy is metronidazole, also known as Flagyl. It is available in oral (pill) form or in a gel (MetroGel-Vaginal) that is applied into the vagina. A once-daily oral dose of Flagyl recently became available. Clindamycin, another antibiotic available in oral and intravaginal form (Cleocin), may also be used. Over-the-counter treatments available for some vaginal infections (Candidiasis, or "yeast" infections) are NOT effective for BV.

Special cautions about treatment of BV: Patients should avoid consuming any alcohol while taking metronidazole (either oral or intravaginal) as it may result in nausea and vomiting. Women using intravaginal clindamycin cream or ovules should be advised that the oil-based medication may weaken latex condoms or diaphragms.

Follow-up visits are not necessary if symptoms go away. Treatment is effective in about 75 percent of cases. However, BV frequently recurs, and can chronic in some women. For recurrent BV, a more powerful antibiotic, such as clindamycin, may be prescribed.

Women also may be advised not to have sex during treatment and to have partners wear condoms. Studies indicate that the likelihood of a woman developing another infection at a later date after treatment is not affected by treating her male partners with antibiotics. Therefore, it is not recommended that a woman have her male partner tested or treated. Female partners may need treatment, however.

Treatment is more complicated for pregnant women. BV testing is recommended for those who have no symptoms of BV but who have previously delivered a premature infant. If they have BV, they are treated in the earliest part of the second trimester.

Regardless of other risk factors for pre-term delivery, all symptomatic pregnant women should be tested and treated. However, treatment of pregnant women with no symptoms of BV is controversial. For pregnant women with no symptoms who are at high risk for preterm delivery (i.e., past premature delivery), studies show a reduction in preterm delivery after treatment of BV. For pregnant women with no symptoms who are at low risk for preterm delivery (no history of premature delivery), the studies are not as clear, although treatment of BV has resulted in a reduction of some complications. In any case, pregnant women should be screened and treated during the first prenatal visit. Women at high risk for preterm delivery should be followed and evaluated one month after treatment. Pregnant women should be treated with oral rather than topical (intravaginal) medications.

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Editorial Staff of the National Women's Health Resource Center 2002/02/01 2005/03/16 Bacterial vaginosis (BV) is the most common of three vaginal infections that fall under the category known as vaginitis. Bacterial vaginosis,Flagyl,Infertility,Lactobacillus,Pelvic inflammatory disease,pH,PID,Vaginitis