How is bacterial vaginosis (BV) managed?

Updated: Oct 25, 2018
  • Author: Philippe H Girerd, MD; Chief Editor: Michel E Rivlin, MD  more...
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General principles of treatment of BV include the following:

  • Antibiotics are the mainstay of therapy

  • Data on the efficacy of dietary supplementation with Lactobacillus (acidophilus) are conflicting

  • Asymptomatic women with G vaginalis colonization do not need treatment

  • BV occurring in pregnant women should be treated

  • Treatment before cesarean delivery, total abdominal hysterectomy, or insertion of an IUD is also recommended

  • Uncomplicated cases typically resolve after standard antibiotic treatment

  • BV that does not resolve after one course of treatment may be cured by giving a second course of the same agent or by switching to another agent (eg, from metronidazole to clindamycin or from clindamycin to metronidazole)

  • Some women with recurrent BV may benefit from evaluation or treatment of G vaginalis colonization in their sexual partner (controversial)

  • Patients should be advised to stop douching or using bubble bath or any other over-the-counter vaginal hygiene products

  • Patients should wash only with hypoallergenic bar soaps or no soap at all and should avoid liquid soaps and body washes

  • Surgery is not indicated

  • Testing for other infections (eg, N gonorrhoeae, C trachomatis, or herpes simplex virus [HSV]-1) may be appropriate

  • Therapy with metronidazole or clindamycin may alter the vaginal flora and predispose the patient to development of vaginal candidiasis

See Treatment and Medication for more detail.

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