Bacterial Vaginosis

• Bacterial vaginosis is the most common cause of vaginal discharge in women of reproductive age.
• It is a polymicrobial clinical syndrome characterised by a decrease in lactobacilli and an overgrowth of mixed anaerobic organisms.
• Supportive evidence includes a characteristic vaginal discharge (malodorous), raised vaginal pH and the presence of clue cells.
• Many women (~50%) with bacterial vaginosis are asymptomatic and do not usually need treatment. Spontaneous resolution occurs often.
• Male sexual partners need not be treated.
• Screen for all other sexually transmitted infections.

Pathogens

• Common: Gardnerella vaginalis, and mixed anaerobes including Prevotella species, and Bacteroides species.

Drug Treatment

• Duration: See below.

Empiric

metronidazole HMLSchedNZFPMLnoids Metronidazole F: 1 Half life: 8 hours Elimination: oxidation, glucuronidation fe: 0.1

PO 400 mg twice a day for 7 days

• Metabolised by unknown pathways. (fe = 0.1).

OR

• Metabolised by unknown pathways. (fe < 0.1).

If non-compliant (less effective than a longer course):

• Not suitable for treatment in pregnancy.
• Administer in the evening to minimise side effects.

• Metabolised by unknown pathways. (fe = 0.1).

• Metabolised by unknown pathways. (fe = 0.1).

Alternatives such as oral clindamycin and metronidazole vaginal gel may be available. Discuss with Sexual Health/Infectious Diseases/Clinical Microbiology/Obstetrics and Gynaecology.

Topic Code: 99239

must be prescribed or recommended by a consultant.