TRIP

A patient is having recurrent bacterial vaginosis, resolves on metronidazole but comes straight back off treatment. Is there any evidence to suggest prolonged course of treatment or prophylactic treatment with metronidazole

TRIP Answers, 2012

A patient is having recurrent bacterial vaginosis, resolves on metronidazole but comes straight back off treatment.
Is there any evidence to suggest prolonged course of treatment or prophylactic treatment with metronidazole
A patient is having recurrent bacterial vaginosis, resolves on metronidazole but comes straight back off treatment.
Is there any evidence to suggest prolonged course of treatment or prophylactic treatment with metronidazole
“In women of childbearing age, bacterial vaginosis (BV) is the commonest cause of abnormal discharge.
Whilst not regarded as a sexually transmitted infection it is more prevalent amongst those who are sexually active.
It is characterised by an overgrowth of anaerobic organisms leading to an increase in vaginal PH and can occur and remit spontaneously.
Both the British Association for Sexual Health and HIV (BASHH) and the Faculty of Sexual and Reproductive Healthcare (FSRH) have produced guidance which provides advice in this area.
The National Guideline for the Management of Bacterial Vaginosis produced by BASHH in 2006 indicates that in 2006 there were few published studies evaluating the optimal approach to women with frequent recurrences of BV but indicated that:
Metronidazole gel 0.75%, twice weekly for 4-6months to decrease symptoms, after an initial treatment daily for 10 days was being evaluated
• Metronidazole orally 400mg bd for 3 days at the start and end of menstruation combined with flucondazole 150mg as a single does if there is a history of dandidiasis also