How is bacterial vaginosis treated?

Updated: Dec 04, 2018
  • Author: Hetal B Gor, MD, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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Answer

Recommended regimens for bacterial vaginosis include the following:

  • Metronidazole 500 mg orally twice a day for 7 days

  • Metronidazole gel 0.75%, 1 full applicator (5 g) intravaginally, once a day for 5 days

  • Clindamycin cream 2%, 1 full applicator (5 g) intravaginally at bedtime for 7 days

Alternative regimens include the following:

  • Clindamycin 300 mg orally twice a day for 7 days

  • Clindamycin ovules 100 mg intravaginally once at bed time for 3 days

Patients should be advised to avoid alcohol consumption during and 24 hours after treatment with metronidazole. Clindamycin cream is oil-based and might weaken latex condoms and diaphragms for 5 days after use. Clindamycin should not be used in the second half of pregnancy.

Routine follow-up visits are unnecessary. Routine treatment of sex partners is not recommended. The recurrence rate is 20-40% after 1 month. Twice weekly metronidazole gel for 6 months may reduce recurrences.

Regimens for pregnant women with bacterial vaginosis include the following:

  • Metronidazole 500 mg orally twice a day for 7 days

  • Metronidazole 250 mg orally 3 times a day for 7 day

  • Clindamycin 300 mg orally twice a day for 7 day

Pregnant women should have a follow-up visit 1 month after completion of treatment.

Treatment regimens in patients with HIV are the same as in patients without HIV, but bacterial vaginosis appears to be more persistent in women who are HIV positive.

Therapy is not recommended for male partners, but female partners of women with BV should be examined and treated.


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