Bacterial vaginosis

Bacterial vaginosis – Tips from Other Journals

Bacterial Vaginosis

Thomason and colleagues review current knowledge on bacterial vaginosis. Previously called Haemophilus, Corynebacterium and Gardnerella vaginitis, after the presumed pathogenic agent, bacterial vaginosis is now believed to be caused by an overgrowth of several aerobic and anaerobic bacteria. A malodorous vaginal discharge is the symptom most commonly reported. However, more than half of women with the condition are asymptomatic.

The most sensitive and specific sign of bacterial vaginosis are a “fishy” odor and the microscopic presence of “clue cells,” vaginal epithelial cells whose borders are obscured by attached bacteria.

Numerous studies have shown that bacterial vaginosis is associated with an increased incidence of pelvic inflammatory disease, endometritis, urinary tract infection, premature rupture of membranes and chorioamnionitis. Currently, it is general practice to treat symptomatic women. However, the risks and benefits of therapy in asymptomatic women and asymptomatic pregnant women are unclear. In view of current research, the authors recommend that asymptomatic women with bacterial vaginosis who are planning to undergo procedures such as placement of an intrauterine device or endometrial biopsy or who are about to undergo vaginal or abdominal surgery first be treated for the infection.

Because of the spontaneous cure rates reported in some asymptomatic patients, clinical trials are needed to evaluate the usefulness of treatment in asymptomatic women. In the meantime, the authors suggest that physicians inform asymptomatic women when bacterial vaginosis is discovered and weigh with the patient the risks

Antibiotic Therapy

for Bacterial Vaginosis

Effective

Metronidazole, 500 mg orally twice daily for

seven days

Clindamycin, 300 mg orally twice daily for

seven days

Clindamycin, 2 percent intravaginal cream*

Metronidazole, 0.75 percent intravaginal gel*

Questionable

Ciprofloxacin

Amoxicillin-clavulanate potassium

Metronidazole, single 2-g dose

Triple sulfa cream

Lactate gel

Ineffective

Erythromycin

Tetracyclines

Ampicillin

Povidone iodine

Acetic acid

Dienestrol

and benefits of treatment. Although it has not been proved that bacterial vaginosis is sexually transmitted, and the Centers for Disease Control does not recommend routine treatment of sexual partners, women with intractable or recurrent disease should be counseled about the possible benefits by treatment of their sexual partners.

A seven-day course of oral metronidazole or clindamycin appears to be the most effective therapy. Preliminary research suggests that intravaginal formulations of metronidazole and clindamycin are also effective. The table lists effective therapies, as well as those that are considered questionable or ineffective. (American Journal of Obstetrics and Gynecology, October 1991, vol. 165, p. 1210.)

COPYRIGHT 1992 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group