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Hot Topics in Sexually Transmitted Infections and Associated Conditions

(Published November 2013)

Bacterial Vaginosis

  • Key facts about the condition
    • It is not clear whether BV is sexually acquired, but the condition is associated with STI risk factors and with elevated risk for other STIs.9
    • BV involves loss of indigenous Lactobacillus species with overgrowth of anaerobes.
    • BV is the most common cause of abnormal vaginal discharge or odor.10
    • BV is linked to premature rupture of membranes, preterm labor, preterm birth, and complications after gynecologic surgery.9,11,12
    • Typical symptoms
      • Vaginal malodor, often more prominent following vaginal intercourse
      • Increased vaginal discharge, typically thin, white or gray, usually without itching or irritation
  • Screening and diagnosis
    • Screening for BV is not recommended in asymptomatic women, even in pregnancy.
    • In symptomatic women, BV can be diagnosed clinically by the presence of at least three of the following:9
      • Homogeneous, thin, white discharge that smoothly coats the vaginal walls
      • Clue cells on microscopic examination of vaginal fluid
      • Positive “whiff” or amine test (characteristic fishy odor after the addition of 10 percent potassium hydroxide)
      • pH > 4.5
    • In lieu of wet mount microscopy, Gram stained vaginal fluid can be examined microscopically by experienced and trained clinicians to identify clue cells and evaluate vaginal bacteria.
  • Treatment and management
    • See the following recommended regimens.

Table 2: Recommended Regimens for the Treatment of Bacterial Vaginosis9

Medication Dosage Duration Comments
Metronidazole tablets 500 mg twice daily by mouth 7 days Avoid alcohol consumption
Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once a day 5 days  
Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime 7 days May weaken latex condoms
    • Patients should be advised to avoid the consumption of alcohol while taking metronidazole and for 24 hours after completing treatment.
    • Clindamycin cream is oil based and might weaken latex condoms and diaphragms for 5 days after use (refer to clindamycin product labeling for additional information).
    • Treatment of asymptomatic sex partners has not been demonstrated to prevent recurrent BV and is not recommended.