Treatment for Non-pregnant Women:
Treatment is generally reserved for symptomatic
women. Treatment is not recommended for sexual partners or asymptomatic
women unless these women are to undergo
a surgical abortion. BV has been associated with endometritis, PID or vaginal
cuff cellulitis in women undergoing ambulatory invasive procedures (endometrial
biopsies, hysteroscopy, IUD insertions) and vaginal/abdominal surgery. Although
data are insufficient to recommend treatment of asymptomatic patients prior
to procedures other than surgical abortions, many providers elect to treat
asymptomatic BV before any procedure involving the upper genital tract.
500 mg orally twice a day for 7 days (cure
rate of over 90-95%)
|Intravaginal clindamycin cream
2% daily for 7 days
0.75% once or twice a day for
5 days (78-87% cure rate)
|| 100 g intravaginally once at bedtime for
| Oral Clindamycin
300 mg twice a day for 7 days is also effective
Single dose oral 2 gm stat (cure rates of
Intravaginal lactobacilli formulations are
ineffective in preventing relapses because these organisms are
not adapted to the vaginal
environment, do not adhere to the epithelium, and do not contain
hydrogen peroxide producing organisms.
not recommended for sexual partners.
Treatment of Pregnant Women:
All symptomatic women should
be treated for BV.
250 mg orally three times a day for 7 days
300 mg orally twice a day for 7 days
2 g orally single dose
The use of topical agents is not recommended. Some specialists
believe that systemic delivery allows for treatment for possible
subclinical infection of the upper genital tract. In addition,
clindamycin cream has been shown to increase preterm birth and
is therefore not recommended.
There is no evidence of teratogenicity from
metronidazole even when used in the first trimester. Some experts
suggest that treating
early in pregnancy may be important in preventing adverse outcomes.
regimen for pregnant women who are asymptomatic but at high risk
for preterm labor.
has been associated with adverse pregnancy outcomes including
preterm labor. Three out of four studies done to evaluate the effect
on treating BV in women at high risk for preterm labor (history
of previous premature delivery) demonstrated a decreased rate of
subsequent preterm labor in those women treated. While the optimal
treatment regimen has not been established, the one trial that
did not show a benefit treated women at 19 weeks and later. Therefore,
it is recommended that women at high risk for preterm labor be
screened and treated for BV at the first prenatal visit occurring
ideally in the first trimester or early second trimester. Recommended
regimens are identical to those listed for symptomatic pregnant
women. A follow-up appointment one month after treatment should
be considered for those women treated under these circumstances.