Treatment of bacterial vaginosis in adults

For treatment of symptomatic bacterial vaginosis in adults, useMenard, 2011Oduyebo, 2009Ong, 2023Workowski, 2021:

1metronidazole 400 mg orally, 12-hourly for 7 days metronidazole metronidazole metronidazole

OR

1metronidazole 0.75% vaginal gel, 1 applicatorful intravaginally, once daily at bedtime for 5 nights metronidazole metronidazole metronidazole

OR

2clindamycin 2% vaginal cream, 1 applicatorful intravaginally, once daily at bedtime for 7 nights clindamycin clindamycin clindamycin

OR

2clindamycin 300 mg orally, 12-hourly for 7 days clindamycin clindamycin clindamycin

OR

3metronidazole 2 g orally, as a single dose. metronidazole metronidazole metronidazole

Although the single-dose metronidazole regimen has better adherence than extended treatments, the cure rate is lower and retreatment may be necessary. For recurrent infection, use treatment regimens with a longer duration.

Clindamycin is preferred during pregnancy; oral clindamycin can be used at any stage of pregnancy. Alternatively, for pregnant patients before 20 weeks’ gestation, clindamycin 2% vaginal cream can be used. If clindamycin is not suitable, use either of the multiple-day metronidazole regimens above.

Contact tracing is not required; however, for patients with an ongoing female1 sexual partner, assess the partner for bacterial vaginosisOng, 2023Workowski, 2021. Treatment of ongoing male2 sexual partners is currently not recommended; however, clinical trials are ongoingOng, 2023Workowski, 2021.

1 In this topic, the term ‘female’ is used to include all people presumed female at birth. Return
2 In this topic, the term ‘male’ is used to include all people presumed male at birth. Return