Bacterial vaginosis (BV)
Canadian Guidelines on Sexually Transmitted Infections - Vaginal Discharge
- Risk for BV:
- new and/or multiple sex partners (male/female)
- lack of condom use
- douching.
- Treatment of male sexual partner not recommended.
Pregnancy
- No need to screen and/or treat low-risk pregnant women.
- Treatment of asymptomatic BV in women with previous preterm birth may reduce the risk of preterm premature rupture of membranes and stillbirth.
Usual Pathogens
Non-inflammatory alteration of normal vaginal flora:
- ↓ Lactobacillus spp
- ↑ Gardnerella vaginalis
- ↑ anaerobes
- ↑ Metamycoplasma hominis (previously Mycoplasma hominis)
Treatment not required unless:
- high-risk pregnancy (previous pre-term delivery)
- pre-IUD insertion
- pre-gynecologic surgery or upper tract instrumentation
- pre-induced abortion
Symptomatic
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Metronidazole tablet | 500mg PO bid | 7 days |
| or | ||
| Topical agents: | ||
| Metronidazole 0.75% intravag gel | 5g intravag hs | 5 days |
| or | ||
| Clindamycin 2% cream | 5g intravag hs | 7 days |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Clindamycin | 300mg PO bid | 7 days |
| or | ||
| Metronidazole | 2g PO | 1 dose |
Pregnancy/lactation
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Metronidazole | 500mg PO bid | 7 days |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Clindamycin | 300mg PO bid | 7 days |