Initial treatment of bacterial vaginosis

BV: bacterial vaginosis.

* We do not routinely treat asymptomatic individuals, including pregnant and lactating persons. However, others may reasonably elect to treat asymptomatic pregnant individuals as the supporting data conflict, particularly for those with a history of preterm birth.

¶ As treatment efficacy is similar between metronidazole and clindamycin, the choice of medication is based on availability, patient preference, side effects, cost, and history of response or adverse reactions.

Δ For additional treatment options, including secnidazole and tinidazole, please refer to related UpToDate content on treatment of bacterial vaginosis.

◊ Pregnant individuals who are unable to tolerate metronidazole 500 mg twice daily because of gastrointestinal symptoms may be able to tolerate metronidazole 250 mg three times daily.

§ Use of oral metronidazole 500 mg twice daily for seven days results in a low drug concentration in breast milk and is considered compatible with breastfeeding.

¥ Breastfeeding infants may develop side effects from maternal clindamycin treatment and should be monitored for possible symptoms, including diarrhea, candidiasis (thrush, diaper rash), or rarely, colitis.

‡ Until definitive data are available, we treat patients who have undergone gender-affirming surgery based on their revised anatomy. As example, patients with neo-vaginas are treated as female and those with neophalluses are treated as male.