Bacterial Vaginosis: Treatment

The established benefits of therapy for Bacterial Vaginosis in non-pregnant women are to a) relieve vaginal symptoms and signs of infection and b) reduce the risk for infectious complications after abortion or hysterectomy. Other potential benefits include the reduction of other infectious complications (e.g., human immunodeficiency virus [HIV] and other STDs). All women who have symptomatic disease require treatment.

Bacterial Vaginosis during pregnancy is associated with adverse pregnancy outcomes, including premature rupture of the membranes, preterm labor, preterm birth, and postpartum endometritis. The established benefit of therapy for BV in pregnant women is to relieve vaginal symptoms and signs of infection. Additional potential benefits of therapy include a) reducing the risk for infectious complications associated with BV during pregnancy and b) reducing the risk for other infections (e.g., other STDs or HIV). The results of several investigations indicate that treatment of pregnant women who have BV and who are at high risk for preterm delivery (i.e., those who previously delivered a premature infant) may reduce the risk for prematurity. Therefore, high-risk pregnant women who have asymptomatic BV may be evaluated for treatment.

The bacterial flora that characterizes BV have been recovered from the endometria and salpinges of women who have pelvic inflammatory disease (PID). BV has been associated with endometritis, pelvic inflammatory disease, and vaginal cuff cellulitis after invasive procedures, including endometrial biopsy, hysterectomy, hysterosalpingography, placement of an intrauterine device (IUD), cesarean section, and uterine curettage. The results of two randomized controlled trials indicated that treatment of BV with metronidazole substantially reduced postabortion pelvic inflammatory disease.

Three trials that evaluated the use of anaerobic antimicrobial coverage (metronidazole) for routine operative prophylaxis before abortion and seven trials that evaluated this additional coverage for women undergoing hysterectomy found a substantial reduction (range: 10%--75%) in post-operative infectious complications. Because of the increased risk for postoperative infectious complications associated with BV, some specialists recommend that before performing surgical abortion or hysterectomy, providers screen and treat women with BV in addition to providing routine prophylaxis. However, more information is needed before recommending treatment of asymptomatic BV before other invasive procedures.

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National Guideline Clearinghouse