Bacterial vaginosis is a clinical syndrome resulting from replacement of the normal hydrogen peroxide (H2O2)-producing Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria, such as G. vaginalis and Mycoplasma hominis. The cause of the microbial alteration is not fully understood.
Whereas trichomoniasis is a sexually transmitted infection, bacterial vaginosis is an endogenous reproductive tract infection. Treatment of sexual partners has not been demonstrated to be of benefit. It is recommended that predisposing factors such as the use of antiseptic/antibiotic vaginal preparations or vaginal douching be reduced or eliminated.
Additional studies are needed to confirm the relationship between an altered vaginal microflora and the acquisition of HIV
The current recommendation is to only treat symptomatic women.
Recommended regimen
• metronidazole, 400 or 500mg orally, twice daily for 7 days
Note
Patients taking metronidazole should be cautioned not to consume alcohol while they are taking the drug and up to 24 hours after taking the last dose.
Alternative regimens
• metronidazole, 2g orally, as a single dose
OR
• clindamycin vaginal cream 2%, 5g at bedtime intravaginally for 7 days
OR
• metronidazole gel 0.75%, 5g twice daily intravaginally for 5 days
OR
• clindamycin, 300mg orally twice daily for 7 days.
Follow-up
Patients should be advised to return if symptoms persist as re-treatment may be needed.
BACTERIAL VAGINOSIS AND SURGICAL PROCEDURES
Women with bacterial vaginosis, scheduled to undergo reproductive tract surgery or a therapeutic abortion, should receive treatment with metronidazole.
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