Ridley's The Vulva

Treatment of asymptomatic women is not necessary, although if diagnosed incidentally they may choose to be treated. Patients should be advised to avoid vaginal douching, use of shower gel, and use of antiseptic agents or shampoo in the bath. The following treatment regimens are recommended by the British Association for Sexual Health and HIV (BASHH) [ 13]:

Metronidazole 400 mg orally twice daily for 5–7 days

Metronidazole 2 g orally as a single dose

Metronidazole gel (0.75%) intravaginally once daily for 5 days

Clindamycin cream (2%) intravaginally once daily for 7 days

Clindamycin 300 mg orally twice daily for 7 days

Tinidazole 2 g orally as a single dose

There is no need to perform a test of cure if symptoms resolve. A clear verbal and written explanation of BV should be provided by the clinician. When giving information to patients, the clinician should inform the patient about the treatment being given, how to take it and its possible adverse effects, that BV can recur following treatment but will respond to standard treatments, and that there is no need to screen and treat sexual partners for BV. Routine sexually transmitted infections (STIs) screening should be offered in accordance with current testing guidelines.

BASHH guidelines

https://www.bashhguidelines.org/media/1041/bv‐2012.pdf

Patient information leaflet

https://www.bashhguidelines.org/media/1028/bv‐pil‐screen‐edit.pdf

Last accessed September 2021.

1 1 Hay, P.E., Lamont, R.F., Taylor‐Robinson, D. et al. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. Br Med J. 1994; 308(6924): 295–298.

2 2 Blackwell, A.L., Thomas, P.D., Wareham, K. and Emery, S.J. Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy. Lancet. 1993; 342(8865): 206–210.

3 3 Brand, J.M. and Galask, R.P. Trimethylamine: the substance mainly responsible for the fishy odour often associated with bacterial vaginosis. Obstet Gynecol. 1986; 63: 682–685.

4 4 Larsson, P.G. Treatment of bacterial vaginosis. Int J STD AIDS. 1992; 3: 239–247.

5 5 Colli, E., Landoni, M. and Parazzini, F. Treatment of male partners and recurrence of bacterial vaginosis: A randomised trial. Genitourin Med. 1997; 73: 267–270.

6 6 Amsel, R., Totten, P.A., Spiegel, C.A. et al. Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983; 74: 14–22.

7 7 Ison, C.A. and Hay, P.E. Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics. Sex Trans Inf. 2002; 7: 413–415.

8 8 Nugent, R.P., Krohn, M.A. and Hillier, S.L. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991; 29: 297–301.

9 9 Ness, R.B., Hillier, S.L., Kip, L.E. et al. Bacterial vaginosis and risk of pelvic inflammatory disease. Obstet Gynecol Surv 2005; 60: 99–100.

10 10 Larsson, P.G., Platz‐Christensen, J.J., Thejls, H. et al. Incidence of pelvic inflammatory disease after first‐trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double blind, randomized study. Am J Obstet Gynecol 1992; 166: 100–103.

11 11 Hay, P.E., Lamont, R.F., Taylor‐Robinson, D. et al. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. Br Med J. 1994; 308: 295–298.

12 12 Hillier, S.L. The vaginal microbial ecosystem and resistance to HIV. AIDS Res. Hum. Retrovir. 1998; 14(Suppl. 1): S17–S21.

13 13 Hay, P. National guideline for the management of bacterial vaginosis (2012). Available from: https://www.bashhguidelines.org/media/1041/bv‐2012.pdf. Last accessed September 2021.

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