TREATMENT OF BACTERIAL VAGINOSIS - A COMPARISON OF ORAL METRONIDAZOLE, METRONIDAZOLE VAGINAL GEL, AND CLINDAMYCIN VAGINAL CREAM

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.