Dg. Ferris et al., TREATMENT OF BACTERIAL VAGINOSIS - A COMPARISON OF ORAL METRONIDAZOLE, METRONIDAZOLE VAGINAL GEL, AND CLINDAMYCIN VAGINAL CREAM, Journal of family practice, 41(5), 1995, pp. 443-449
Background. Treatment options for bacterial vaginosis are numerous. Th
e purpose of this study was to compare the efficacy of oral metronidaz
ole, metronidazole vaginal gel, and clindamycin vaginal cream for the
treatment of bacterial vaginosis using traditional clinical and labora
tory methods, as well as a new DNA probe test. We also determined the
percentage of patients receiving each treatment who developed posttrea
tment vaginal candidiasis, a potential complication of treating bacter
ial vaginosis. Methods. One hundred one women in whom bacterial vagino
sis was diagnosed by standard criteria were randomly assigned to recei
ve: oral metronidazole 500 mg twice daily for 1 week, 0.75% metronidaz
ole vaginal gel 5 g twice daily for 5 days, or 2% clindamycin vaginal
cream 5 g once daily for 7 days. Women with coexisting vulvovaginal ca
ndidiasis or vaginal trichomoniasis were excluded. Tests of cure by va
ginal saline wet prep and potassium hydroxide microscopic examinations
, Gram's stain, pH and DNA probe tests for Gardnerella vaginalis and C
andida species were scheduled 7 to 14 days following treatment. Result
s. There were no statistically significant differences in cure rates f
or oral metronidazole (84.2%), metronidazole vaginal gel (75.0%), or c
lindamycin vaginal cream (86.2%) (chi=1.204, df=2, P=.548) using tradi
tional clinical and laboratory criteria. Cure rates were lower based o
n DNA testing, indicating that Gardnerella vaginalis may remain after
a clinical cure. This would explain cases of recurrent disease. Posttr
eatment vulvovaginal candidiasis was experienced by 12.5% of subjects
treated with oral metronidazole, 14.8% of subjects treated with clinda
mycin vaginal cream, and 30.4% of subjects treated with metronidazole
vaginal gel (chi(2)=2.607, df=2, P=.272). Conclusions. Oral metronidaz
ole, metronidazole vaginal gel, and clindamycin vaginal cream achieved
nearly equivalent cure rates for the treatment of bacterial vaginosis
. Patients treated with these agents experienced similar rates of post
treatment vulvovaginal candidiasis, but those using the intravaginal p
roducts reported being more satisfied with the treatment.