TREATMENT OF BACTERIAL VAGINOSIS

OBJECTIVE: The purpose of this article is to review the treatment opti ons 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 transmit ted disease and whether asymptomatic women should be treated. DATA SOU RCE: A MEDLINE search was conducted to identify pertinent literature, including review articles. DATA SELECTION: Emphasis was placed on thos e clinical trials using metronidazole gel or clindamycin cream. Studie s addressing the complications of bacterial vaginosis in pregnancy, th e risk of treatment in pregnancy, and the method of transmission of th e disease also were reviewed. DATA EXTRACTION: Clinical studies evalua ting clindamycin cream and metronidazole gel were scarce; therefore, d ata from all available trials were reviewed. The objectives, methodolo gy, and results from other studies were reviewed; those addressing com plications of the disease and risks and benefits of treatment were inc luded. DATA SYNTHESIS: There is evidence both for and against bacteria l vaginosis being a sexually transmitted disease. Potential complicati ons of the disease may wan-ant treatment of certain asymptomatic women , especially during pregnancy. Treatment options include oral or vagin al metronidazole or clindamycin, all of which provide high cure rates. Vaginal antibiotics result in minimal risk to the fetus in pregnant p atients. CONCLUSIONS: Complications of bacterial vaginosis may be asso ciated with significant morbidity, especially among pregnant women. Tr eatment of asymptomatic women with the disease is controversial, but m ay be justified in certain high-risk populations. The topical agents, clindamycin vaginal cream 2% and metronidazole vaginal gel 0.75% provi de a safe, effective, but expensive alternative to oral antibiotic reg imens for the treatment of bacterial vaginosis.