Empiric Therapy
The treatment regimens for bacterial vaginosis are provided below, including primary, alternative, and adjunctive treatments, as well as specific treatments for pregnant patients, patients allergic to metronidazole, and patients with recurrent infection. [1, 2, 3, 4, 5, 6]
Primary treatment
Metronidazole 500 mg PO BID for 7d or metronidazole gel 0.75% (use one full applicator [5g] intravaginally daily for 5d) or clindamycin cream 2% (use one full applicator [5g] intravaginally at bedtime for 7d
Secnidazole 1 packet (2 gram) of granules PO qDay, without regard to timing of meals
Alternative treatment
Tinidazole 2 g PO once daily for 2d or tinidazole 1 g PO once daily for 5d or clindamycin 300 mg PO BID for 7d or clindamycin ovules 100 mg intravaginally once at bedtime for 3d or metronidazole extended-release 750 mg PO once daily for 7d. Intravaginal dequalinium chloride 10 mg once daily for 6d also appears to be effective but is not FDA approved for use in the United States. [6]
Pregnant patients
Metronidazole 500 mg PO BID for 7d or metronidazole 250 mg PO TID for 7d or clindamycin 300 mg PO BID for 7d
Patients allergic to metronidazole
Intravaginal clindamycin cream is preferred in the presence of patient allergies or intolerance
Recurrent infection
Metronidazole gel 0.75% (after completion of recommended regimen, use one full applicator [5g] intravaginally twice weekly for 4-6mo or using a different treatment regimen is an option in patients with recurrent infections; re-treatment with the same topical regimen is also an acceptable approach in early stages of infection
Treatment of partners has not been shown to decrease recurrence rates
Adjunctive therapy
Probiotic (Lactobacillus rhamnosus, L acidophilus, and Streptococcus thermophilus) vaginal capsule daily for 7d, repeat 7d later (not FDA approved) [5]
Organism-specific therapy
Specific etiology is not typically established for the diagnosis of bacterial vaginosis
