Materiały źródłowe

• #1 Bacterial Vaginosis (BV): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/3963-bacterial-vaginosis

  Bacterial vaginosis (BV) is easily treatable with antibiotics from a healthcare provider. […] Your healthcare provider will prescribe antibiotics, typically metronidazole or clindamycin. These medications come in a gel or cream you insert into your vagina. Some antibiotics are pills you can take orally (by swallowing them). […] Its important to finish the antibiotic and take it as your provider prescribes. Stopping early because your symptoms go away increases your risk of getting BV again. […] There are no over-the-counter products to treat bacterial vaginosis (BV). Avoid using douches or products meant for yeast infections, which could make BV worse. See a healthcare provider for treatment. […] Most of the time, one round of antibiotics taken for up to seven days eliminates the infection. About 10% to 15% of people need another round of treatment.

• #2 About Bacterial Vaginosis (BV) | Bacterial Vaginosis (BV) | CDC

  https://www.cdc.gov/bacterial-vaginosis/about/index.html

  Bacterial vaginosis (BV) is a common, treatable, vaginal condition. […] Treating BV during pregnancy is very important. If you are pregnant and have BV, your baby is more likely to be born early (premature) or at a low birth weight. […] A healthcare provider can treat BV with antibiotics. If you have symptoms, you should be checked and treated by a healthcare provider. It is important to take all the medicine your provider prescribes, even if your symptoms go away. Treatment also may reduce the risk for getting other STDs. BV can return even after treatment. […] At times, BV will go away without treatment. However, treatment can help avoid the increased chance of some serious health risks associated with BV, including: Getting or transmitting HIV, Delivering your baby too early if you have BV while pregnant and, Getting other STDs like chlamydia and gonorrhea. These bacteria can cause pelvic inflammatory disease (PID), which can make it difficult for you to have children.

• #3 Frontiers | Bacterial vaginosis: a review of approaches to treatment and prevention

  https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2023.1100029/full

  The focus of this review is to discuss the evidence for potential non-antibiotic therapeutic and preventive options for BV, including those currently under investigation and those more informally used. […] Antibiotics are the first line treatment for BV. The recommended therapeutic regimens include oral or intravaginal metronidazole and intravaginal clindamycin. These treatments have similar efficacy and are effective for short-term resolution of the infection. Recurrent bacterial vaginosis is a common drawback to current treatment options. Within 6–12 months of finishing antibiotic therapy, 50%–80% of women will experience a bacterial vaginosis recurrence. Proposed reasons for this treatment failure include reinfection via sexual partners, antimicrobial resistance, biofilm, and failure to reestablish a health-optimal vaginal microbiota.

• #4 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  Treatment for BV is recommended for women with symptoms. Established benefits of therapy among nonpregnant women are to relieve vaginal symptoms and signs of infection. Other potential benefits of treatment include reduction in the risk for acquiring C. trachomatis, N. gonorrhoeae, T. vaginalis, M. genitalium, HIV, HPV, and HSV-2. No data are available that directly compare the efficacy of oral and topical medications for treating BV. […] Recommended Regimens for Bacterial Vaginosis […] Metronidazole 500 mg orally 2 times/day for 7 days […] OR […] Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once a day for 5 days […] OR […] Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days. […] Alternative Regimens […] Clindamycin 300 mg orally 2 times/day for 7 days

• #5 Bacterial Vaginosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459216/

  Bacterial vaginosis can be treated with either clindamycin or metronidazole. Both of these medications are effective if taken by mouth or applied vaginally. Both are safe to use in pregnant patients. Initial treatment for bacterial vaginosis demonstrates notable efficacy, as cure rates within 1 month typically range from 80% to 90%. […] Recurrence of bacterial vaginosis may occur in as many as 80% of women within 9 months following initial treatment. About 10% to 15% of females do not improve after the first course of antibiotics and may require additional treatment. […] A 2016 Cochrane review found high-quality evidence that treating the sexual partners of females with bacterial vaginosis did not affect symptoms, clinical outcomes, or the recurrence of bacterial vaginosis. […] In 2017, secnidazole was approved by the U.S. Food and Drug Administration (FDA) for single-dose oral treatment for bacterial vaginosis.

• #6 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  Treatment for BV is recommended for women with symptoms. Established benefits of therapy among nonpregnant women are to relieve vaginal symptoms and signs of infection. Other potential benefits of treatment include reduction in the risk for acquiring C. trachomatis, N. gonorrhoeae, T. vaginalis, M. genitalium, HIV, HPV, and HSV-2. No data are available that directly compare the efficacy of oral and topical medications for treating BV. […] Recommended Regimens for Bacterial Vaginosis […] Metronidazole 500 mg orally 2 times/day for 7 days […] OR […] Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once a day for 5 days […] OR […] Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days. […] Alternative Regimens […] Clindamycin 300 mg orally 2 times/day for 7 days

• #7 Vaginitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0401/p807.html

  Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. […] Oral and topical clindamycin and metronidazole are equally effective at eradicating bacterial vaginosis. […] Current treatment recommendations from the Centers for Disease Control and Prevention (CDC) are listed in Table 4. Nonpregnant women with symptomatic disease require antibacterial therapy to relieve vaginal symptoms. Other benefits of treatment include decreasing the risk of HIV and other sexually transmitted infections and reducing infectious complications following abortion or hysterectomy. […] A Cochrane review of 24 randomized controlled trials (RCTs) showed that clindamycin and metronidazole (Flagyl) are equally effective, achieving clinical cure in 91 and 92 percent of cases, respectively, after two to three weeks of treatment.

• #8 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  Treatment for BV is recommended for women with symptoms. Established benefits of therapy among nonpregnant women are to relieve vaginal symptoms and signs of infection. Other potential benefits of treatment include reduction in the risk for acquiring C. trachomatis, N. gonorrhoeae, T. vaginalis, M. genitalium, HIV, HPV, and HSV-2. No data are available that directly compare the efficacy of oral and topical medications for treating BV. […] Recommended Regimens for Bacterial Vaginosis […] Metronidazole 500 mg orally 2 times/day for 7 days […] OR […] Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once a day for 5 days […] OR […] Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days. […] Alternative Regimens […] Clindamycin 300 mg orally 2 times/day for 7 days

• #9 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  OR […] Clindamycin ovules 100 mg* intravaginally once at bedtime for 3 days […] OR […] Secnidazole 2 g oral granules in a single dose […] OR […] Tinidazole 2 g orally once daily for 2 days […] OR […] Tinidazole 1 g orally once daily for 5 days. […] Additional BV treatment regimens include metronidazole 1.3% vaginal gel in a single dose and clindamycin phosphate (Clindesse) 2% vaginal cream in a single dose. BV biofilm disrupting agents (i.e., TOL-463) are being investigated to determine their role in enhancing the likelihood of BV cure relative to approved therapies. Studies have evaluated the clinical and microbiologic efficacy of intravaginal Lactobacillus and other probiotic formulations to treat BV and restore normal vaginal microbiota; overall, no studies support these products as an adjunctive or replacement therapy for women with BV.

• #10 Bacterial Vaginosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459216/

  In 2021, the FDA approved a single-dose clindamycin vaginal gel for the treatment of bacterial vaginosis in females aged 12 and older. […] The treatment regimens used to treat bacterial vaginosis are as follows: Metronidazole: 500 mg orally twice daily for 7 days; Metronidazole 0.75% gel: 5 g intravaginally once daily for 5 days; Clindamycin 2% cream: 5 g intravaginally nightly for 7 days; Clindamycin 2% gel: 5 g intravaginally once only. […] The alternative regimens for treating bacterial vaginosis are as follows: Clindamycin ovules: 100 mg ovule intravaginally every night for 3 days; Clindamycin tablets: 300 mg orally twice daily for 7 days; Tinidazole: 1 g orally every day for 5 days OR 2 g orally every day for 2 days; Secnidazole granules: 2 g of oral granules all at once. […] According to the Centers for Disease Control and Prevention (CDC), multiple recurrences of bacterial vaginosis can be managed using any 1 of several treatment regimens.

• #11 Bacterial Vaginosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459216/

  Bacterial vaginosis can be treated with either clindamycin or metronidazole. Both of these medications are effective if taken by mouth or applied vaginally. Both are safe to use in pregnant patients. Initial treatment for bacterial vaginosis demonstrates notable efficacy, as cure rates within 1 month typically range from 80% to 90%. […] Recurrence of bacterial vaginosis may occur in as many as 80% of women within 9 months following initial treatment. About 10% to 15% of females do not improve after the first course of antibiotics and may require additional treatment. […] A 2016 Cochrane review found high-quality evidence that treating the sexual partners of females with bacterial vaginosis did not affect symptoms, clinical outcomes, or the recurrence of bacterial vaginosis. […] In 2017, secnidazole was approved by the U.S. Food and Drug Administration (FDA) for single-dose oral treatment for bacterial vaginosis.

• #12 Bacterial vaginosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285

  Secnidazole (Solosec). This is an antibiotic you eat one time with food. It comes as a packet of granules that you sprinkle onto a soft food, such as applesauce, pudding or yogurt. You eat the mixture within 30 minutes. But take care not to crunch or chew the granules. […] Usually, treatment isn’t needed for a sex partner whose sex is male. But BV can spread to partners whose sex is female. So testing and treatment may be needed if a female partner has symptoms. […] Take your medicine or use the cream or gel for as long as prescribed, even if your symptoms go away. If you stop treatment early, BV may come back. This is called recurrent bacterial vaginosis. […] It’s common for bacterial vaginosis to come back within 3 to 12 months even with proper treatment. Researchers are exploring options for recurrent BV. If your symptoms return soon after treatment, talk with your care team. It might be possible for you to take extended-use metronidazole therapy. […] There may be some benefit to probiotics, but more information is needed. In a random trial, probiotics were no better than a treatment that didn’t contain medicine, called a placebo, in stopping recurrent BV. So probiotics are not recommended as a treatment option for bacterial vaginosis.

• #13 Bacterial Vaginosis Medication: Antibiotics

  https://emedicine.medscape.com/article/254342-medication

  Antibiotics are the mainstay of therapy for bacterial vaginosis. Medications include metronidazole (Flagyl), clindamycin (Cleocin) oral or vaginal suppositories, and metronidazole vaginal gel (MetroGel-Vaginal). Metronidazole and clindamycin are the preferred medications used to treat Gardnerella infections. […] In September 2017, the FDA approved the first single-dose oral treatment secnidazole (Solosec, Symbiomix Therapeutics) for women with bacterial vaginosis. Approval was based on two randomized, placebo-controlled studies that evaluated the efficacy of secnidazole in treatment of bacterial vaginosis. Efficacy was assessed by clinical outcomes evaluated 21-30 days following a single dose of secnidazole. A clinical responder was defined as having „normal” vaginal discharge, negative „whiff” test, and clue cells 20%; additional endpoints included Nugent score cure and therapeutic outcome.

• #14 Bacterial Vaginosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459216/

  In 2021, the FDA approved a single-dose clindamycin vaginal gel for the treatment of bacterial vaginosis in females aged 12 and older. […] The treatment regimens used to treat bacterial vaginosis are as follows: Metronidazole: 500 mg orally twice daily for 7 days; Metronidazole 0.75% gel: 5 g intravaginally once daily for 5 days; Clindamycin 2% cream: 5 g intravaginally nightly for 7 days; Clindamycin 2% gel: 5 g intravaginally once only. […] The alternative regimens for treating bacterial vaginosis are as follows: Clindamycin ovules: 100 mg ovule intravaginally every night for 3 days; Clindamycin tablets: 300 mg orally twice daily for 7 days; Tinidazole: 1 g orally every day for 5 days OR 2 g orally every day for 2 days; Secnidazole granules: 2 g of oral granules all at once. […] According to the Centers for Disease Control and Prevention (CDC), multiple recurrences of bacterial vaginosis can be managed using any 1 of several treatment regimens.

• #15 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  Data from earlier clinical trials indicate that a woman’s response to therapy and the likelihood of relapse or recurrence are not affected by treatment of her sex partner. Therefore, routine treatment of sex partners is not recommended. However, a pilot study reported that male partner treatment (i.e., metronidazole 400 mg orally 2 times/day in conjunction with 2% clindamycin cream applied topically to the penile skin 2 times/day for 7 days) of women with recurrent BV had an immediate and sustained effect on the composition of the vaginal microbiota, with an overall decrease in bacterial diversity at day 28. […] BV treatment is recommended for all symptomatic pregnant women because symptomatic BV has been associated with adverse pregnancy outcomes, including premature rupture of membranes, preterm birth, intra-amniotic infection, and postpartum endometritis. Studies have been undertaken to determine the efficacy of BV treatment among this population, including two trials demonstrating that oral metronidazole was efficacious during pregnancy by using the 250 mg 3 times/day regimen; however, oral metronidazole administered as a 500 mg 2 times/day regimen can also be used.

• #16 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  Data from earlier clinical trials indicate that a woman’s response to therapy and the likelihood of relapse or recurrence are not affected by treatment of her sex partner. Therefore, routine treatment of sex partners is not recommended. However, a pilot study reported that male partner treatment (i.e., metronidazole 400 mg orally 2 times/day in conjunction with 2% clindamycin cream applied topically to the penile skin 2 times/day for 7 days) of women with recurrent BV had an immediate and sustained effect on the composition of the vaginal microbiota, with an overall decrease in bacterial diversity at day 28. […] BV treatment is recommended for all symptomatic pregnant women because symptomatic BV has been associated with adverse pregnancy outcomes, including premature rupture of membranes, preterm birth, intra-amniotic infection, and postpartum endometritis. Studies have been undertaken to determine the efficacy of BV treatment among this population, including two trials demonstrating that oral metronidazole was efficacious during pregnancy by using the 250 mg 3 times/day regimen; however, oral metronidazole administered as a 500 mg 2 times/day regimen can also be used.

• #17 New guidelines for bacterial vaginosis diagnosis and treatment

  https://www.contemporaryobgyn.net/view/cdc-updates-guidelines-for-diagnosis-and-treatment-of-bacterial-vaginosis

  Updated guidelines recommend various oral and intravaginal treatment methods for women with symptomatic BV. Therapy benefits among nonpregnant women include relief of vaginal symptoms and reduce signs of infection. Potential benefits also include a reduction in the risk for C. trachomatis, N. gonorrhoeae, T. vaginalis, M. genitalium, HIV, HPV, and HSV-2. […] Recommended treatment includes 250 mg oral metronidazole 3 times a day, or 500 mg twice a day. […] BV treatment is recommended for all symptomatic pregnant women, so as to reduce the possibility of adverse pregnancy outcomes such as premature rupture of membranes, preterm birth, intra-amniotic infection, and postpartum endometriosis. […] Studies show that, for pregnant women at low risk for preterm delivery, asymptomatic BV treatment does not reduce adverse pregnancy outcomes. However, asymptomatic BV treatment of pregnant women at high risk for preterm delivery, according to seven studies, produced mixed results: one revealed harm, two reported no benefit, and four demonstrated benefit.

• #18 New guidelines for bacterial vaginosis diagnosis and treatment

  https://www.contemporaryobgyn.net/view/cdc-updates-guidelines-for-diagnosis-and-treatment-of-bacterial-vaginosis

  Metronidazole therapy poses a low risk during pregnancy, according to data from multiple cross-sectional, case-control, and cohort studies of pregnant women. Although it crosses the placenta, no evidence of teratogenicity or mutagenic effects among infants has been found. […] Although data are limited regarding the use of tinidazole in human pregnancies, animal data show moderate risk. Therefore, tinidazole should be avoided during pregnancy. Secnidazole, Clindesse 2% vaginal cream, metronidazole 1.3% vaginal gel, and 750 mg vaginal metronidazole tablets should also be avoided due to lack of data. […] Metronidazole is secreted in breast milk; however, breastfed infants receive it in lower doses than those used to treat infant infections. Although several studies identified no evidence of metronidazole-associated adverse effects in breastfed infants, certain clinicians recommend deferring breastfeeding for 12-24 hours after maternal treatment with a single 2 g dose of metronidazole. Lower doses, however, produce a lower concentration in breast milk and are considered compatible with breastfeeding.

• #19 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  Although older studies indicated a possible link between using vaginal clindamycin during pregnancy and adverse outcomes for the newborn, newer data demonstrate that this treatment approach is safe for pregnant women. Data from human studies are limited regarding the use of tinidazole in pregnancy; however, animal data demonstrate that such therapy poses moderate risk. Thus, tinidazole should be avoided during pregnancy. […] Metronidazole is secreted in breast milk. With maternal oral therapy, breastfed infants receive metronidazole in doses that are less than those used to treat infections among infants, although the active metabolite adds to the total infant exposure. Plasma levels of the drug and metabolite are measurable but remain less than maternal plasma levels. Although multiple reported case series identified no evidence of metronidazole-associated adverse effects for breastfed infants, certain clinicians recommend deferring breastfeeding for 12-24 hours after maternal treatment with a single 2-g dose of metronidazole. […] BV appears to recur with higher frequency among women who have HIV infection. Women with HIV infection and BV should receive the same treatment regimen as those who do not have HIV.

• #20 Frontiers | Bacterial vaginosis: a review of approaches to treatment and prevention

  https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2023.1100029/full

  The focus of this review is to discuss the evidence for potential non-antibiotic therapeutic and preventive options for BV, including those currently under investigation and those more informally used. […] Antibiotics are the first line treatment for BV. The recommended therapeutic regimens include oral or intravaginal metronidazole and intravaginal clindamycin. These treatments have similar efficacy and are effective for short-term resolution of the infection. Recurrent bacterial vaginosis is a common drawback to current treatment options. Within 6–12 months of finishing antibiotic therapy, 50%–80% of women will experience a bacterial vaginosis recurrence. Proposed reasons for this treatment failure include reinfection via sexual partners, antimicrobial resistance, biofilm, and failure to reestablish a health-optimal vaginal microbiota.

• #21 The right bug in the right place: opportunities for bacterial vaginosis treatment | npj Biofilms and Microbiomes

  https://www.nature.com/articles/s41522-022-00295-y

  Antibiotics are widely used for BV treatment and have an effective initial cure rate varying between 80% and 90% 1month after treatment. The recommended antibiotics for BV and recurrent BV are metronidazole and clindamycin in the clinic, which can be administered orally or intravaginally. These recommended regimens have similar efficacy for BV treatment, with minor differences in recurrence rates. Other tested antibiotics include tinidazole and secnidazole, which have similar activity in vitro against a range of microorganisms associated with BV. […] […] Recurrent BV is a common problem associated with the treatment of BV and presents as repeated cases of BV after the initial cessation of symptoms. Available research suggests that recurrent BV may be caused by a relapse of infection due to an inability to reestablish a Lactobacillus-dominated vaginal microbiome or the ineffective suppression of BV-related bacteria. Recurrence of BV can also indicate persistent BV, where a positive BV diagnosis remains unchanged after treatment. A high rate of BV recurrence after 1year has been observed, ranging from 50% to 100% depending on the antibiotic used and geographic locations, underscoring the need for additional treatments. […]

• #22 Patient education: Bacterial vaginosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bacterial-vaginosis-beyond-the-basics

  Clindamycin is available as an oral pill or vaginal cream or gel. The vaginal cream is inserted into the vagina at bedtime for seven days. Other vaginal treatment options include a one-day vaginal clindamycin cream or gel and three-day vaginal suppository. Clindamycin cream should not be used with latex condoms due to the risk of condom breakage. […] People who are having surgery that involves the vagina should be treated if BV is present, even if they do not have symptoms. […] Pregnant people with symptoms of BV infection are treated; oral therapy with metronidazole or clindamycin is preferred over vaginal treatments. […] People with a confirmed relapse of BV are retreated with an antibiotic. The antibiotic can be the same as the initial treatment or one that hasn’t yet been used (for example, the person might try a vaginal medication instead of an oral pill).

• #23 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  All women with BV should be tested for HIV and other STIs. Follow-up visits are unnecessary if symptoms resolve. Because persistent or recurrent BV is common, women should be advised to return for evaluation if symptoms recur. Using a different recommended treatment regimen can be considered for women who have a recurrence; however, retreatment with the same recommended regimen is an acceptable approach for treating persistent or recurrent BV after the first occurrence. For women with multiple recurrences after completion of a recommended regimen, either 0.75% metronidazole gel or 750 mg metronidazole vaginal suppository twice weekly for 3 months has been reported to reduce recurrences, although this benefit does not persist when suppressive therapy is discontinued. Limited data indicate that for women with multiple recurrences, an oral nitroimidazole (metronidazole or tinidazole 500 mg 2 times/day for 7 days), followed by intravaginal boric acid 600 mg daily for 21 days and suppressive 0.75% metronidazole gel twice weekly for 46 months, might be an option for women with recurrent BV.

• #24 Patient education: Bacterial vaginosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bacterial-vaginosis-beyond-the-basics

  After finishing the antibiotic, people with recurrent BV are offered „maintenance therapy.” The best way to do this is not known as there are not a lot of studies on giving longer treatment. Options for maintenance therapy include: Inserting metronidazole gel in the vagina twice a week for four to six months will frequently reduce the risk of BV recurrence. […] Other treatments are also being studied. Clindamycin (oral or vaginal) is not usually recommended as a long-term treatment. The currently available probiotics do not prevent recurrence of BV.

• #25 Recurrent Bacterial Vaginosis

  https://www.exxcellence.org/list-of-pearls/recurrent-bacterial-vaginosis/?

  Bacterial vaginosis occurs when the vaginal microbiota dominant species shifts from Lactobacillus to Gardnerella vaginalis and anaerobic bacteria. Oral or vaginal metronidazole or vaginal clindamycin cures acute bacterial vaginosis in 80% to 90% of cases; however, recurrence can occur up to 60% of the time by 12 months. No standardized treatment for recurrent bacterial vaginosis exists. Vaginal metronidazole 0.75% gel given once daily for 10 days and then twice weekly for 16 weeks demonstrates a 70% protection rate compared with placebo, but the recurrence by 6 months post treatment is high. Oral metronidazole, 500 mg daily, for 7 days followed by vaginal boric acid capsules, 600 mg twice daily, for 21 days is another treatment option with recurrence rates of 30% by 6 months post treatment. While preliminary data suggest a benefit of vaginal L crispatus probiotic, other oral/vaginal probiotics are not beneficial. A single-dose of metronidazole 1.3% gel may be superior as compared to other regimens of longer duration. Treating male sexual partners is also ineffective. Symptomatic pregnant patients with bacterial vaginosis should be treated with oral metronidazole, 500 mg twice daily or 250 mg 3 times daily, for 7 days.

• #26 Recurrent Bacterial Vaginosis

  https://www.exxcellence.org/list-of-pearls/recurrent-bacterial-vaginosis/?

  Recurrence may occur due to either reinfection or incomplete restoration of normal vaginal flora with prior therapy. Relapse may occur due to antibiotic resistance or the development of a biofilm. Biofilms are produced by G vaginalis and consist of an assemblage of microbes within a surface-associated extracellular matrix that acts to inhibit antibiotic penetration.

• #27 Bacterial vaginosis: drivers of recurrence and challenges and opportunities in partner treatment | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02077-3

  Bacterial vaginosis (BV) is the most common vaginal dysbiosis to affect women globally, yet an unacceptably high proportion of women experience BV recurrence within 6 months of recommended antibiotic therapy. […] Recommended first-line antimicrobial treatments, metronidazole or clindamycin, provide broad anaerobic coverage and are administered orally or intravaginally. […] Clinicians and researchers agree that there is an urgent need to develop more effective treatments to improve BV cure, and ultimately reduce adverse health outcomes. […] If reinfection is a key driver of recurrence, current antimicrobial regimens directed to women alone are unlikely to achieve a high level of sustained cure, and the approach of partner treatment to reduce reinfection is justified. […] Ultimately, the pathogenesis of BV recurrence is likely to be multifaceted and not attributable to a single mechanism in all women.

• #28 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  Data from earlier clinical trials indicate that a woman’s response to therapy and the likelihood of relapse or recurrence are not affected by treatment of her sex partner. Therefore, routine treatment of sex partners is not recommended. However, a pilot study reported that male partner treatment (i.e., metronidazole 400 mg orally 2 times/day in conjunction with 2% clindamycin cream applied topically to the penile skin 2 times/day for 7 days) of women with recurrent BV had an immediate and sustained effect on the composition of the vaginal microbiota, with an overall decrease in bacterial diversity at day 28. […] BV treatment is recommended for all symptomatic pregnant women because symptomatic BV has been associated with adverse pregnancy outcomes, including premature rupture of membranes, preterm birth, intra-amniotic infection, and postpartum endometritis. Studies have been undertaken to determine the efficacy of BV treatment among this population, including two trials demonstrating that oral metronidazole was efficacious during pregnancy by using the 250 mg 3 times/day regimen; however, oral metronidazole administered as a 500 mg 2 times/day regimen can also be used.

• #29 Trial finds male-partner antibiotic treatment cuts bacterial vaginosis recurrence | CIDRAP

  https://www.cidrap.umn.edu/sexually-transmitted-infections/trial-finds-male-partner-antibiotic-treatment-cuts-bacterial

  The results of a randomized controlled trial conducted in Australia indicate that the addition of antibiotic treatment for male partners of women who have bacterial vaginosis (BV) significantly reduces recurrence of the infection, researchers reported yesterday in the New England Journal of Medicine. […] The trial, in fact, was stopped early because BV recurrence was cut in half among women who were taking first-line antibiotics and whose partners also received topical and oral antibiotic treatment, compared with the control group, in which only the women received first-line antibiotic treatment. […] Trial investigators say the findings suggest that reinfection from male sexual partners contributes to BV recurrence and supports the idea that it should be considered an STI. […] „This successful intervention is relatively cheap and short and has the potential for the first time to not only improve BV cure for women, but opens up exciting new opportunities for BV prevention, and prevention of the serious complications associated with BV,” co-lead investigator Catriona Bradshaw, PhD, of Monash University and the Melbourne Sexual Health Centre, said in a university press release.

• #30 Trial finds male-partner antibiotic treatment cuts bacterial vaginosis recurrence | CIDRAP

  https://www.cidrap.umn.edu/sexually-transmitted-infections/trial-finds-male-partner-antibiotic-treatment-cuts-bacterial

  In the partner-treatment group, the women received first-line recommended antibiotics for a week, and their male partners received an oral and topical antibiotic (400 milligram metronidazole tablets and 2% clindamycin cream, both twice daily for 7 days). […] This successful intervention is relatively cheap and short and has the potential for the first time to not only improve BV cure for women, but opens up exciting new opportunities for BV prevention, and prevention of the serious complications associated with BV. […] Recurrence of BV occurred in 24 of 69 women (35%) in the partner-treatment group compared with 43 of 68 women (63%) in the control group. […] „Despite these limitations, this trial provides data critical to educating clinicians and patients about the role of sexual transmission of bacterial vaginosis associated bacteria and the benefit of male-partner treatment,” Christina Muzny, MD, MSPH, and Jack Sobel, MD, wrote. „It is time to start the conversation.”

• #31 Bacterial vaginosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285

  Secnidazole (Solosec). This is an antibiotic you eat one time with food. It comes as a packet of granules that you sprinkle onto a soft food, such as applesauce, pudding or yogurt. You eat the mixture within 30 minutes. But take care not to crunch or chew the granules. […] Usually, treatment isn’t needed for a sex partner whose sex is male. But BV can spread to partners whose sex is female. So testing and treatment may be needed if a female partner has symptoms. […] Take your medicine or use the cream or gel for as long as prescribed, even if your symptoms go away. If you stop treatment early, BV may come back. This is called recurrent bacterial vaginosis. […] It’s common for bacterial vaginosis to come back within 3 to 12 months even with proper treatment. Researchers are exploring options for recurrent BV. If your symptoms return soon after treatment, talk with your care team. It might be possible for you to take extended-use metronidazole therapy. […] There may be some benefit to probiotics, but more information is needed. In a random trial, probiotics were no better than a treatment that didn’t contain medicine, called a placebo, in stopping recurrent BV. So probiotics are not recommended as a treatment option for bacterial vaginosis.

• #32 Bacterial vaginosis – aftercare Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/selfcare-instructions/bacterial-vaginosis-aftercare

  If you have BV, your provider may prescribe: […] Antibiotic pills that you swallow […] Antibiotic creams or suppositories that you insert into your vagina […] Be sure you use the medicine exactly as prescribed and follow the instructions on the label. […] You cannot spread BV to a male partner. But if you have a female partner, it is possible it can spread to her. She may need to be treated for BV, as well.

• #33 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  OR […] Clindamycin ovules 100 mg* intravaginally once at bedtime for 3 days […] OR […] Secnidazole 2 g oral granules in a single dose […] OR […] Tinidazole 2 g orally once daily for 2 days […] OR […] Tinidazole 1 g orally once daily for 5 days. […] Additional BV treatment regimens include metronidazole 1.3% vaginal gel in a single dose and clindamycin phosphate (Clindesse) 2% vaginal cream in a single dose. BV biofilm disrupting agents (i.e., TOL-463) are being investigated to determine their role in enhancing the likelihood of BV cure relative to approved therapies. Studies have evaluated the clinical and microbiologic efficacy of intravaginal Lactobacillus and other probiotic formulations to treat BV and restore normal vaginal microbiota; overall, no studies support these products as an adjunctive or replacement therapy for women with BV.

• #34 Frontiers | Bacterial vaginosis: a review of approaches to treatment and prevention

  https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2023.1100029/full

  Probiotics are live microorganisms that can be ingested through diet or supplements, or can be administered vaginally. Probiotics containing Lactobacillus are often used and marketed for the management of BV and may be beneficial in preventing recurrent BV through recolonization of the vaginal microbiota. […] Vaginal microbiome transplantation (VMT) is a novel therapeutic option currently under investigation for prevention of recurrent BV. In VMT, women receive vaginal fluid collected from healthy donors. […] The administration of lactic acid, and other pH modulators, therefore, may hold potential in the management of BV. […] One hypothesized reason for high rates of recurrence of BV is the presence of a polymicrobial biofilm. Biofilms are composed of microbial cells and an extracellular matrix that can provide bacterial protection, and are generally associated with decreased efficacy of antimicrobial agents.

• #35 Microbiome Therapy Protects Against Recurrent Bacterial Vaginosis | UC San Francisco

  https://www.ucsf.edu/news/2020/05/417386/microbiome-therapy-protects-against-recurrent-bacterial-vaginosis

  A product containing healthy vaginal bacteria has proved effective against recurrent bacterial vaginosis (BV), an extremely common vaginal infection that is associated with preterm birth, HIV infection and problems with in vitro fertilization. […] The randomized, placebo-controlled, double-blind trial showed a significant reduction in the recurrence of BV and found no safety risks from the bacteria used in the LACTIN-V formulation of the species Lactobacillus crispatus CTV-05, a common bacterium found in healthy vaginal microbiomes. […] While BV is commonly treated with an antibiotic called metronidazole, up to three-quarters of women get the infection again within three months. The study found that LACTIN-V reduced these recurrences significantly. Just 30 percent of women who were given LACTIN-V after initial antibiotic treatment had a recurrence within 12 weeks, compared to 45 percent of the women who received the antibiotic and a placebo.

• #36 Frontiers | Bacterial vaginosis: a review of approaches to treatment and prevention

  https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2023.1100029/full

  Probiotics are live microorganisms that can be ingested through diet or supplements, or can be administered vaginally. Probiotics containing Lactobacillus are often used and marketed for the management of BV and may be beneficial in preventing recurrent BV through recolonization of the vaginal microbiota. […] Vaginal microbiome transplantation (VMT) is a novel therapeutic option currently under investigation for prevention of recurrent BV. In VMT, women receive vaginal fluid collected from healthy donors. […] The administration of lactic acid, and other pH modulators, therefore, may hold potential in the management of BV. […] One hypothesized reason for high rates of recurrence of BV is the presence of a polymicrobial biofilm. Biofilms are composed of microbial cells and an extracellular matrix that can provide bacterial protection, and are generally associated with decreased efficacy of antimicrobial agents.

• #37 Frontiers | Bacterial vaginosis: a review of approaches to treatment and prevention

  https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2023.1100029/full

  Probiotics are live microorganisms that can be ingested through diet or supplements, or can be administered vaginally. Probiotics containing Lactobacillus are often used and marketed for the management of BV and may be beneficial in preventing recurrent BV through recolonization of the vaginal microbiota. […] Vaginal microbiome transplantation (VMT) is a novel therapeutic option currently under investigation for prevention of recurrent BV. In VMT, women receive vaginal fluid collected from healthy donors. […] The administration of lactic acid, and other pH modulators, therefore, may hold potential in the management of BV. […] One hypothesized reason for high rates of recurrence of BV is the presence of a polymicrobial biofilm. Biofilms are composed of microbial cells and an extracellular matrix that can provide bacterial protection, and are generally associated with decreased efficacy of antimicrobial agents.

• #38 Frontiers | Bacterial vaginosis: a review of approaches to treatment and prevention

  https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2023.1100029/full

  Probiotics are live microorganisms that can be ingested through diet or supplements, or can be administered vaginally. Probiotics containing Lactobacillus are often used and marketed for the management of BV and may be beneficial in preventing recurrent BV through recolonization of the vaginal microbiota. […] Vaginal microbiome transplantation (VMT) is a novel therapeutic option currently under investigation for prevention of recurrent BV. In VMT, women receive vaginal fluid collected from healthy donors. […] The administration of lactic acid, and other pH modulators, therefore, may hold potential in the management of BV. […] One hypothesized reason for high rates of recurrence of BV is the presence of a polymicrobial biofilm. Biofilms are composed of microbial cells and an extracellular matrix that can provide bacterial protection, and are generally associated with decreased efficacy of antimicrobial agents.

• #39 The right bug in the right place: opportunities for bacterial vaginosis treatment | npj Biofilms and Microbiomes

  https://www.nature.com/articles/s41522-022-00295-y

  Finally, when mixed strains are used, each Lactobacillus strain needs to pass the standard of federal agency, which is a larger challenge than a single strain. Like VMT, the use of probiotics also lacks uniform and effective policy supervision. The lack of a standardized manufacturing process focused on the effectiveness and safety of probiotics, including the proper species, dose, administration method, presence of contaminating microorganisms, and auxiliary ingredients of probiotics, adds to uncertainty around the results for probiotics. […] […] VMT uses a similar approach as fecal microbiome transplant (FMT) which has greatly developed in the past decade in the field of gastroenterology, most prominently to treat recurring Clostridioides difficile infections. VMT is the process of obtaining vaginal fluid from a donor and administer it into the vagina of a recipient, after thorough testing and minimal processing with the goal of maintaining the viability of the bacteria. The mixture of fluid not only includes the microbes from the donor but also potentially cells, bacteriophages, proteins such as cytokines, and metabolites such as lipids and antimicrobial peptides. Recently, a study recruited five patients suffering from recurrent BV and introduced treatment with VMT after an antibiotic regimen. Four of five patients had long-term remission after VMT, making it a promising alternative treatment for recurrent BV. […]

• #40 Bacterial vaginosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285

  To treat bacterial vaginosis, your doctor may prescribe one of the following medicines: […] Metronidazole (Flagyl, Metrogel-Vaginal, others). This medicine comes as a pill or topical gel. You swallow the pill, but the gel is inserted into your vagina. Avoid alcohol while using this medicine and for a full day afterward. It might cause nausea or stomach pain. Check the instructions on the product. […] Clindamycin (Cleocin, Clindesse, others). This medicine comes as a cream that you insert into the vagina. Or you can use the pill or suppository form. The cream and suppositories may weaken latex condoms. Avoid sex during treatment and for at least three days after you stop using the medicine. Or use another method of birth control. […] Tinidazole (Tindamax). You take this medicine by mouth. It can cause stomach upset. So avoid alcohol during treatment and for at least three days after completing treatment.

• #41 Bacterial Vaginosis (BV): Symptoms, Causes, Diagnosis, Treatment, Prevention, Complications

  https://www.webmd.com/women/what-is-bacterial-vaginosis

  Bacterial Vaginosis Treatment […] There are a variety of medications your doctor may prescribe to treat BV. Even if you dont have symptoms, its important to know how to get rid of BV. […] To treat BV, your doctor can prescribe antibiotics, which could be in the form of a tablet or granules you take by mouth, or an ovule suppository, cream, or gel you put into your vagina. […] These medications include: Clindamycin, a cream you use in your vagina. It sells under the brand names Cleocin and Clindesse. Don’t rely on condoms for birth control with this medication, as it can weaken latex condoms not only while youre taking it, but for at least 3 days after you stop. […] Metronidazole, available as a pill you swallow or a gel you insert in your vagina. This medication sells under the brand names Flagyl and Metrogel-Vaginal. […] Secnidazole, available as a single pill you take once. Its sold under the brand name Solosec. […] Tinidazole, available as a pill you swallow. Its sold under the brand name Tindamax. […] You’ll need to take most treatments for 5-7 days. Complete your entire course of medication, even if the symptoms go away. If you stop early, the infection could come back. […] If your partner also has a vagina, they may want to see their doctor to find out if they need treatment. Partners with a penis do not need to be treated.

• #42 Bacterial Vaginosis

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/genital/bacterial-vaginosis/

  Bacterial vaginosis patient information leaflet. […] Metronidazole is the treatment of choice in pregnancy. Intravaginal clindamycin cream should be avoided in first trimester. […] Women may benefit from using lactic acid vaginal gels to facilitate restoration of the normal vaginal flora. Preparations are available over the counter in pharmacies. […] Advise patients to avoid alcohol during metronidazole therapy and for at least 48 hours after stopping. […] Avoid clindamycin cream in 1st trimester of pregnancy. Clindamycin cream can weaken latex condoms/diaphragms, which should not be used during treatment and for 72 hours afterwards. […] Caution: Risk of C. difficile infection.

• #43 Bacterial vaginosis: drivers of recurrence and challenges and opportunities in partner treatment | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02077-3

  Bacterial vaginosis (BV) is the most common vaginal dysbiosis to affect women globally, yet an unacceptably high proportion of women experience BV recurrence within 6 months of recommended antibiotic therapy. […] Recommended first-line antimicrobial treatments, metronidazole or clindamycin, provide broad anaerobic coverage and are administered orally or intravaginally. […] Clinicians and researchers agree that there is an urgent need to develop more effective treatments to improve BV cure, and ultimately reduce adverse health outcomes. […] If reinfection is a key driver of recurrence, current antimicrobial regimens directed to women alone are unlikely to achieve a high level of sustained cure, and the approach of partner treatment to reduce reinfection is justified. […] Ultimately, the pathogenesis of BV recurrence is likely to be multifaceted and not attributable to a single mechanism in all women.

• #44 Antibacterial treatment of bacterial vaginosis: current and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3181210/

  The cure rates of women given antibiotics were higher (58%100%) than the cure rates of women given placebo (5%29%) when evaluated 4 weeks after treatment. […] The efficacy of vaginal and oral regimens was similar when evaluated 2 weeks and 5 weeks after treatment. […] In 1992, a meta-analysis was conducted on ten studies comparing different oral metronidazole regimens. […] A more recent review also concluded that the 7-day regimen of metronidazole is superior to the single-dose regimen leading the authors to recommend it as the first-line regimen in the treatment of BV. […] Metronidazole therapy is associated with side effects including gastrointestinal effects (metallic taste in the mouth, nausea, vomiting) and candida infection. […] Clindamycin is a second antimicrobial agent for the treatment of BV.

• #45 Bacterial Vaginosis Treatment & Management: Approach Considerations, Medical Care, Further Outpatient Care

  https://emedicine.medscape.com/article/254342-treatment

  Uncomplicated cases of bacterial vaginosis (BV) typically resolve after the standard antibiotic treatment. […] BV that does not resolve after one course of treatment may be cured by a second course with the same agent. […] Another option is to switch to another agent (ie, metronidazole to clindamycin, or clindamycin to metronidazole) as other concomitant organisms may respond better to an alternate medication. […] Therapy with metronidazole or clindamycin may alter the vaginal flora and predispose the patient to development of vaginal candidiasis. […] Discourage douching, bubble baths, and over-the-counter vulvovaginal hygiene products. […] Studies are conflicting regarding the efficacy of a diet supplemented with Lactobacillus (acidophilus). […] Probiotic prophylaxis resulted in lower recurrence rates for bacterial vaginosis and Gardnerella vaginalis for 2 months. […] Correction or modification of the following factors may help reduce the incidence or recurrence of BV: Recent antibiotic use, Decreased estrogen production of the host, Wearing an IUD, Douching, Bubble baths, Feminine hygiene products, Liquid soaps and body washes.

• #46 Bacterial vaginosis treatment guidelines – Melbourne Sexual Health Centre (MSHC)

  https://www.mshc.org.au/health-professionals/treatment-guidelines/bacterial-vaginosis-treatment-guidelines

  Bacterial vaginosis is a bacterial infection caused by a change in the normal balance of vaginal bacteria. […] Treatment is indicated in: Symptomatic women […] Women undergoing an invasive upper genital tract procedure such as termination of pregnancy or insertion of IUD, where feasible, to reduce the risk of PID/endometritis. The benefit of this practice has not been established. […] Asymptomatic women requesting treatment […] Male partner treatment has now been shown to improve BV cure. […] Recommended treatment for uncomplicated BV in women who are not pregnant includes Metronidazole 400mg PO, twice daily for 7 days or Clindamycin 2% intravaginal cream 5g, nightly for 7 nights or Metronidazole gel 0.75%, one applicator (5g) intravaginally, nightly for 5 nights. […] Treatment is recommended in symptomatic pregnant women to alleviate symptoms.

• #47 Diagnosis and Treatmetns for Vaginosis | Walnut Hill OBGYN

  https://walnuthillobgyn.com/blog/bacterial-vaginosis/

  The results of one randomized controlled trial indicated that treatment of BV with metronidazole substantially reduced post-abortion PID. On the basis of these data, consideration should be given to treatment of women who have symptomatic or asymptomatic BV before surgical abortion procedures are performed. […] For treatment of pregnant women, see Bacterial Vaginosis, Special Considerations, Pregnancy. […] Metronidazole 500 mg orally twice a day for 7 days, or […] Clindamycin cream 2%, one full applicator (5 g) intra-vaginally at bedtime for 7 days, or […] Metronidazole gel 0.75%, one full applicator (5 g) intra-vaginally twice a day for 5 days. […] Metronidazole 2 g orally in a single dose, or […] Clindamycin 300 mg orally twice a day for 7 days. […] Oral metronidazole (500 mg twice a day) is efficacious for the treatment of BV, resulting in relief of symptoms and improvement in clinical course and flora disturbances.

• #48 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  Although older studies indicated a possible link between using vaginal clindamycin during pregnancy and adverse outcomes for the newborn, newer data demonstrate that this treatment approach is safe for pregnant women. Data from human studies are limited regarding the use of tinidazole in pregnancy; however, animal data demonstrate that such therapy poses moderate risk. Thus, tinidazole should be avoided during pregnancy. […] Metronidazole is secreted in breast milk. With maternal oral therapy, breastfed infants receive metronidazole in doses that are less than those used to treat infections among infants, although the active metabolite adds to the total infant exposure. Plasma levels of the drug and metabolite are measurable but remain less than maternal plasma levels. Although multiple reported case series identified no evidence of metronidazole-associated adverse effects for breastfed infants, certain clinicians recommend deferring breastfeeding for 12-24 hours after maternal treatment with a single 2-g dose of metronidazole. […] BV appears to recur with higher frequency among women who have HIV infection. Women with HIV infection and BV should receive the same treatment regimen as those who do not have HIV.

• #49 New guidelines for bacterial vaginosis diagnosis and treatment

  https://www.contemporaryobgyn.net/view/cdc-updates-guidelines-for-diagnosis-and-treatment-of-bacterial-vaginosis

  Metronidazole therapy poses a low risk during pregnancy, according to data from multiple cross-sectional, case-control, and cohort studies of pregnant women. Although it crosses the placenta, no evidence of teratogenicity or mutagenic effects among infants has been found. […] Although data are limited regarding the use of tinidazole in human pregnancies, animal data show moderate risk. Therefore, tinidazole should be avoided during pregnancy. Secnidazole, Clindesse 2% vaginal cream, metronidazole 1.3% vaginal gel, and 750 mg vaginal metronidazole tablets should also be avoided due to lack of data. […] Metronidazole is secreted in breast milk; however, breastfed infants receive it in lower doses than those used to treat infant infections. Although several studies identified no evidence of metronidazole-associated adverse effects in breastfed infants, certain clinicians recommend deferring breastfeeding for 12-24 hours after maternal treatment with a single 2 g dose of metronidazole. Lower doses, however, produce a lower concentration in breast milk and are considered compatible with breastfeeding.

• #50 Bacterial Vaginosis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/bv.htm

  Although older studies indicated a possible link between using vaginal clindamycin during pregnancy and adverse outcomes for the newborn, newer data demonstrate that this treatment approach is safe for pregnant women. Data from human studies are limited regarding the use of tinidazole in pregnancy; however, animal data demonstrate that such therapy poses moderate risk. Thus, tinidazole should be avoided during pregnancy. […] Metronidazole is secreted in breast milk. With maternal oral therapy, breastfed infants receive metronidazole in doses that are less than those used to treat infections among infants, although the active metabolite adds to the total infant exposure. Plasma levels of the drug and metabolite are measurable but remain less than maternal plasma levels. Although multiple reported case series identified no evidence of metronidazole-associated adverse effects for breastfed infants, certain clinicians recommend deferring breastfeeding for 12-24 hours after maternal treatment with a single 2-g dose of metronidazole. […] BV appears to recur with higher frequency among women who have HIV infection. Women with HIV infection and BV should receive the same treatment regimen as those who do not have HIV.

• #51 Bacterial Vaginosis Treatment & Management: Approach Considerations, Medical Care, Further Outpatient Care

  https://emedicine.medscape.com/article/254342-treatment

  Uncomplicated cases of bacterial vaginosis (BV) typically resolve after the standard antibiotic treatment. […] BV that does not resolve after one course of treatment may be cured by a second course with the same agent. […] Another option is to switch to another agent (ie, metronidazole to clindamycin, or clindamycin to metronidazole) as other concomitant organisms may respond better to an alternate medication. […] Therapy with metronidazole or clindamycin may alter the vaginal flora and predispose the patient to development of vaginal candidiasis. […] Discourage douching, bubble baths, and over-the-counter vulvovaginal hygiene products. […] Studies are conflicting regarding the efficacy of a diet supplemented with Lactobacillus (acidophilus). […] Probiotic prophylaxis resulted in lower recurrence rates for bacterial vaginosis and Gardnerella vaginalis for 2 months. […] Correction or modification of the following factors may help reduce the incidence or recurrence of BV: Recent antibiotic use, Decreased estrogen production of the host, Wearing an IUD, Douching, Bubble baths, Feminine hygiene products, Liquid soaps and body washes.

• #52 Prescription for Bacterial Vaginosis Treatment | Webdoctor.ieVector

  https://www.webdoctor.ie/bacterial-vaginosis-treatment/

  BV does recur. Using treatments such as Relactogel from the pharmacy after completing your course of prescription medication helps maintain the acid balance in the vagina, reducing the likelihood of bacterial vaginosis recurring. […] Often BV will settle without treatment, or with over-the-counter treatments such as Relactogel. For more information on this, you can speak with your local pharmacist. However, sometimes prescription medication is necessary. […] Common side effects of the oral antibiotic prescribed include nausea, decreased appetite and a metallic taste in your mouth. It is essential that you avoid alcohol completely when you are taking this medication and for 72 hours after you finish the treatment. There is a significant interaction between this medication and alcohol and you will experience a severe reaction (vomiting, palpitations and severe headache).

• #53 Bacterial vaginosis: Symptoms and treatment – Brighton Sexual Health

  https://brightonsexualhealth.com/advice/bacterial-vaginosis/

  It is treated with antibiotics. These can be either in the form of tablets you swallow or a vaginal gel. […] If you have a same-sex partner, they might also need treating. […] BV treatment in pregnancy can differ, please let your health care provider know if you are, or could be pregnant. […] Side effects of the treatment depend on the antibiotic used. The most common antibiotic used is metronidazole. We advise to avoid alcohol throughout the treatment and at least for 48 hours after. Antibiotics can interact with other medications you might be taking. Please liaise with a health care provider before taking antibiotics. […] Vaginal antibiotic creams could trigger or worsen vaginal thrush. […] It is common for bacterial vaginosis to come back. If it does, you will be given a further antibiotic course. If you have more than 4 episodes of BV in 12 months, it is considered chronic BV. This is managed with a longer course of antibiotics. […] There are no recommended natural remedies for BV. You can however limit risk factors linked to BV such as: […] If you have an IUD, you can discuss alternative birth control methods.

• #54 Home remedies for bacterial vaginosis: Probiotics, garlic, and more

  https://www.medicalnewstoday.com/articles/317562

  Probiotics and other supplements may help treat bacterial vaginosis (BV) without antibiotics. Using barrier protection and practicing proper hygiene can also reduce the risk of developing BV. […] Antibiotics can treat most cases of BV. However, some people may prefer to try home remedies first. […] Probiotics help the body grow beneficial bacteria that can fight the bacteria associated with BV. A 2019 review concluded that probiotic therapy might have both short- and long-term benefits in treating BV. […] Several compounds in garlic have natural antibacterial properties. A 2014 study found that garlic supplement tablets had a similar therapeutic effect in treating BV as metronidazole, an oral antibiotic. […] Vaginal suppositories containing boric acid may help treat BV. A 2021 study found that using intravaginal boric acid in addition to antibiotic medications can be of benefit in treating BV.

• #55 Bacterial vaginosis – Wikipedia

  https://en.wikipedia.org/wiki/Bacterial_vaginosis

  A 2009 Cochrane review found tentative but insufficient evidence for probiotics as a treatment for BV. A 2014 review reached the same conclusion. A 2013 review found some evidence supporting the use of probiotics during pregnancy. The preferred probiotics for BV are those containing high doses of lactobacilli (around 109 CFUs) given in the vagina. Intravaginal administration is preferred to taking them by mouth. Prolonged repetitive courses of treatment appear to be more promising than short courses. […] The lack of effectiveness of commercially available Lactobacillus probiotics may be because most do not actually contain vaginal lactobacilli strains. LACTIN-V is a live biopharmaceutical medication containing the vaginally important Lactobacillus crispatus which is under development for the treatment of bacterial vaginosis and recurrent urinary tract infections. It has shown initial effectiveness in considerably reducing recurrence of bacterial vaginosis following antibiotic treatment. LACTIN-V is not yet Food and Drug Administration (FDA)-approved or commercially available. […] Estrogen-containing contraceptives have been found to decrease recurrence of BV.

• #56 Bacterial vaginosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285

  To treat bacterial vaginosis, your doctor may prescribe one of the following medicines: […] Metronidazole (Flagyl, Metrogel-Vaginal, others). This medicine comes as a pill or topical gel. You swallow the pill, but the gel is inserted into your vagina. Avoid alcohol while using this medicine and for a full day afterward. It might cause nausea or stomach pain. Check the instructions on the product. […] Clindamycin (Cleocin, Clindesse, others). This medicine comes as a cream that you insert into the vagina. Or you can use the pill or suppository form. The cream and suppositories may weaken latex condoms. Avoid sex during treatment and for at least three days after you stop using the medicine. Or use another method of birth control. […] Tinidazole (Tindamax). You take this medicine by mouth. It can cause stomach upset. So avoid alcohol during treatment and for at least three days after completing treatment.

• #57 Bacterial vaginosis (BV): Symptoms, causes, and more

  https://www.medicalnewstoday.com/articles/184622

  Below, we explore some treatment options for BV. […] Antibiotics are effective in up to 90% of BV cases, but the condition often comes back within a few weeks. […] Metronidazole is the most common antibiotic treatment for BV. […] Clindamycin is an alternative antibiotic. It may work if metronidazole is not effective or if the infection recurs. […] Tinidazole is another antibiotic that can treat BV if metronidazole does not work or if the condition recurs. […] Current treatments are associated with recurrence rates of more than 50% within 6 months of the treatment. […] For recurrent BV, doctors may recommend an extended course of metronidazole. If this is ineffective, they may prescribe a metronidazole vaginal gel. A person either uses this every day for 10 days or two times a week for 36 months. […] While there is no general consensus about the best approach, treating recurrent BV usually involves a longer course of treatment.

• #58 Frontiers | Bacterial vaginosis: a review of approaches to treatment and prevention

  https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2023.1100029/full

  There is insufficient evidence to recommend commercially available probiotics at this time. […] Despite high prevalence of BV worldwide and the inability of antibiotics to provide a long-term cure, few effective alternative treatment options exist. There are various studies underway attempting to identify novel approaches, with possible solutions ranging from diet and lifestyle changes to biofilm disruption, pH modulation and vaginal microbiome transplantation.

• #59 The right bug in the right place: opportunities for bacterial vaginosis treatment | npj Biofilms and Microbiomes

  https://www.nature.com/articles/s41522-022-00295-y

  The advantages of treatment with antibiotics are their availability and convenience for clinical use. Patients can easily administer antibiotics at home with instruction. Also, since BV is characterized by the overgrowth of anaerobic bacteria, reduced vaginal bacterial load following antibiotic treatment may provide the chance for Lactobacillus species to compete for nutrients and biological niches again. Overall, a large proportion of women with BV have been cured after one-time treatment in a short period of time. […] […] However, the main issue with using antibiotic treatment for BV is the high rate of recurrence within months of treatment. Relapse may occur when vaginosis-related bacteria re-colonize and take over the vaginal microbiome. Furthermore, vaginosis-related bacteria that recur after antibiotic treatment, such as Gardnerella vaginalis and Atopobium vaginae, may have higher resistance and become less sensitive to another round of antibiotic treatment. Also, orally administered metronidazole and clindamycin disturb the healthy gut microbiome, whereas even local usage of antibiotics is a risk factor for vulvovaginal candidiasis. […]

• #60 Bacterial Vaginosis (BV): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/3963-bacterial-vaginosis

  Bacterial vaginosis (BV) is easily treatable with antibiotics from a healthcare provider. […] Your healthcare provider will prescribe antibiotics, typically metronidazole or clindamycin. These medications come in a gel or cream you insert into your vagina. Some antibiotics are pills you can take orally (by swallowing them). […] Its important to finish the antibiotic and take it as your provider prescribes. Stopping early because your symptoms go away increases your risk of getting BV again. […] There are no over-the-counter products to treat bacterial vaginosis (BV). Avoid using douches or products meant for yeast infections, which could make BV worse. See a healthcare provider for treatment. […] Most of the time, one round of antibiotics taken for up to seven days eliminates the infection. About 10% to 15% of people need another round of treatment.

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