Bacterial vaginosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Antimicrobial therapy is recommended for all symptomatic women and high risk asymptomatic pregnant women with bacterial vaginosis. [[Metronidazole]] is the drug of choice in pregnant patients. | Antimicrobial therapy is recommended for all symptomatic women and high risk asymptomatic pregnant women with bacterial vaginosis. [[Metronidazole]] is the drug of choice in pregnant patients.<ref name=CDC_MMWR-2015>Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016</ref>< | ||
==Medical Therapy== | ==Medical Therapy== | ||
Treatment is recommended for women with symptoms. Other potential benefits to treatment include reduction in the risk for acquiring C. trachomatis, N. gonorrhoeae, T. vaginalis, HIV, and herpes simplex type 2 | Treatment is recommended for women with symptoms. Other potential benefits to treatment include reduction in the risk for acquiring C. trachomatis, N. gonorrhoeae, T. vaginalis, HIV, and herpes simplex type 2.<ref name=CDC_MMWR-2015>Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016</ref> | ||
===Management of Sex Partners=== | ===Management of Sex Partners=== | ||
Data from 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. | Data from 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.<ref name=CDC_MMWR-2015>Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016</ref> | ||
===Pregnancy=== | ===Pregnancy=== | ||
Treatment is recommended for all symptomatic pregnant women. Treatment of asymptomatic BV among pregnant women who are at high risk for preterm delivery (previous preterm birth) is | Treatment is recommended for all symptomatic pregnant women. Treatment of asymptomatic BV among pregnant women who are at high risk for preterm delivery (previous preterm birth) is recommended.<ref name=CDC_MMWR-2015>Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016</ref> | ||
===Follow-Up=== | |||
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.<ref name=CDC_MMWR-2015>Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016</ref> | |||
===Antimicrobial Regimen=== | ===Antimicrobial Regimen=== | ||
Revision as of 17:10, 20 October 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Antimicrobial therapy is recommended for all symptomatic women and high risk asymptomatic pregnant women with bacterial vaginosis. Metronidazole is the drug of choice in pregnant patients.[1]<
Medical Therapy
Treatment is recommended for women with symptoms. Other potential benefits to treatment include reduction in the risk for acquiring C. trachomatis, N. gonorrhoeae, T. vaginalis, HIV, and herpes simplex type 2.[1]
Management of Sex Partners
Data from 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.[1]
Pregnancy
Treatment is recommended for all symptomatic pregnant women. Treatment of asymptomatic BV among pregnant women who are at high risk for preterm delivery (previous preterm birth) is recommended.[1]
Follow-Up
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.[1]
Antimicrobial Regimen
- 1. Bacterial Vaginosis Treatment[2]
- Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
- Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
- Preferred regimen (3): Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
- Alternative regimen (1): Tinidazole 2 g PO qd for 2 days
- Alternative regimen (2): Tinidazole 1 g PO qd for 5 days
- Alternative regimen (3): Clindamycin 300 mg PO bid for 7 days
- Alternative regimen (4): Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days
- Note: Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and vaginal contraceptive diaphragms). Use of such products within 72 hours following treatment with clindamycin ovules is not recommended.
- 2. Management of Sex Partners
- Routine treatment of sex partners is not recommended.
- 3. Special Considerations
- 3.1 Allergy, Intolerance, or Adverse Reactions
- Intravaginal Clindamycin cream is preferred in case of allergy or intolerance to Metronidazole or Tinidazole. Intravaginal Metronidazole gel can be considered for women who are not allergic to Metronidazole but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.
- 3.2 Pregnancy
- Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
- Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
- Note: Tinidazole should be avoided during pregnancy
- 3.3 HIV Infection
- Women with HIV who have BV should receive the same treatment regimen as those who do not have HIV infection.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016
- ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.