Treatment of bacterial vaginosis

OBJECTIVE: The purpose of this article is to review the treatment options for bacterial vaginosis, including the newer topical antibiotics, metronidazole gel and clindamycin cream. The article also examines the controversies over whether bacterial vaginosis is a sexually transmitted disease and whether asymptomatic women should be treated. DATA SOURCE: A MEDLINE search was conducted to identify pertinent literature, including review articles. STUDY SELECTION: Emphasis was placed on those clinical trials using metronidazole gel or clindamycin cream. Studies addressing the complications of bacterial vaginosis in pregnancy, the risk of treatment in pregnancy, and the method of transmission of the disease also were reviewed. DATA EXTRACTION: Clinical studies evaluating clindamycin cream and metronidazole gel were scarce; therefore, data from all available trials were reviewed. The objectives, methodology, and results from other studies were reviewed; those addressing complications of the disease and risks and benefits of treatment were included. DATA SYNTHESIS: There is evidence both for and against bacterial vaginosis being a sexually transmitted disease. Potential complications of the disease may warrant treatment of certain asymptomatic women, especially during pregnancy. Treatment options include oral or vaginal metronidazole or clindamycin, all of which provide high cure rates. Vaginal antibiotics result in minimal risk to the fetus in pregnant patients. CONCLUSIONS: Complications of bacterial vaginosis may be associated with significant morbidity, especially among pregnant women. Treatment of asymptomatic women with the disease is controversial, but may be justified in certain high-risk populations. The topical agents, clindamycin vaginal cream 2% and metronidazole vaginal gel 0.75% provide a safe, effective, but expensive alternative to oral antibiotic regimens for the treatment of bacterial vaginosis.