Article thumbnail

Antibacterial treatment of bacterial vaginosis: current and emerging therapies

By Jean-Pierre Menard


Bacterial vaginosis is a common cause of malodorous vaginal discharge. It is also associated with sexually transmitted infections and adverse pregnancy outcomes. The magnitude of the gynecological and obstetrical consequences has stimulated therapeutic research and led to the testing of several therapies. The objective of this work is to present the currently available therapeutic strategies for the treatment of bacterial vaginosis and associated recommendations, and discuss the emerging therapies

Topics: Review
Publisher: Dove Medical Press
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. A randomized trial of metronidazole in asymptomatic bacterial vaginosis to prevent the acquisition of sexually transmitted diseases.
  2. (2007). A randomized trial of the duration of therapy with metronidazole plus or minus azithromycin for treatment of symptomatic bacterial vaginosis. Clin Infect Dis.
  3. (2004). A randomized, double-blind clinical trial of vaginal acidification versus placebo for the treatment of symptomatic bacterial vaginosis. Sex Transm Dis.
  4. (1996). A review of its antimicrobial activity, pharmacokinetic properties and therapeutic use in the management of protozoal infections and bacterial vaginosis.
  5. (2008). An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole.
  6. (2006). Antibiotic susceptibility of Atopobium vaginae. BMC Infect Dis.
  7. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev.
  8. (2009). Antimicrobial activity, inhibition of urogenital pathogens, and synergistic interactions between lactobacillus strains. Curr Microbiol.
  9. (2006). Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial. Microbes Infect.
  10. (2011). Available at: http://www.accessdata.
  11. Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection.
  12. Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birthweight and perinatal infections.
  13. (1999). Bacterial vaginosis: review of treatment options and potential clinical indications for therapy. Clin Infect Dis.
  14. (2009). Boric acid addition to suppressive antimicrobial therapy for recurrent bacterial vaginosis. Sex Transm Dis.
  15. (2002). CDC BV Working Group. Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: a synthesis of data. Clin Infect Dis.
  16. (2006). Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect.
  17. Comparative study on vaginal or oral treatment of bacterial vaginosis.
  18. Comparison of different metronidazole therapeutic regimens for bacterial vaginosis. A meta-analysis.
  19. Comparison of local metronidazole and a local antiseptic in the treatment of bacterial vaginosis. Arch Gynecol Obstet.
  20. Comparison of tinidazole given as a single dose and on 2 consecutive days for the treatment of nonspecific bacterial vaginosis. Gynecol Obstet Invest.
  21. Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial.
  22. Controlled study on thymol + eugenol vaginal douche versus econazole in vaginal candidiasis and metronidazole in bacterial vaginosis.
  23. Design and in vitro evaluation of a novel bioadhesive vaginal drug delivery system for clindamycin phosphate. Pharm Dev Technol.
  24. Directed shift of vaginal flora after topical application of sucrose gel in a phase III clinical trial: a novel treatment for bacterial vaginosis.
  25. (2001). Drug Administration, World Health Organization
  26. (2009). Effect of consistent condom use on 6-month prevalence of bacterial vaginosis varies by baseline BV status. Trop Med Int Health.
  27. Effect of lyophilized lactobacilli and 0.03 mg estriol (Gynoflor®) on vaginitis and vaginosis with disrupted vaginal microflora: a multicenter, randomized, singleblind, active-controlled pilot study. Gynecol Obstet Invest.
  28. (2009). Effect of treatment of asymptomatic bacterial vaginosis on HIV-1 shedding in the genital tract among women on antiretroviral therapy: a pilot study. Clin Infect Dis.
  29. (2007). Effectiveness of two tinidazole regimens in treatment of bacterial vaginosis: a randomized controlled trial. Obstet Gynecol.
  30. (2001). Efficacy of clindamycin vaginal ovule (3-day treatment) vs clindamycin vaginal cream (7-day treatment) in bacterial vaginosis. Infect Dis Obstet Gynecol.
  31. Efficacy of the combination of 2 g oral tinidazole and acidic buffering vaginal gel in comparison with vaginal clindamycin alone in bacterial vaginosis: a randomized, investigator-blinded, controlled trial.
  32. Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebocontrolled study.
  33. (2008). Evidence on the benefits and harms of screening and treating pregnant women who are asymptomatic for bacterial vaginosis: an update review for the US Preventive Services Task Force. Ann Intern Med.
  34. Factors associated with recurrent bacterial vaginosis.
  35. FG90 chitosan as a new polymer for metronidazole mucoadhesive tablets for vaginal administration.
  36. (2010). for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines
  37. Formulation and in vitro evaluation of in situ gels containing secnidazole for vaginitis. Yakugaku Zasshi.
  38. Glycerol monolaurate inhibits Candida and Gardnerella vaginalis in vitro and in vivo but not Lactobacillus. Antimicrob Agents Chemother.
  39. Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified non-specific vaginitis.
  40. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence.
  41. (2008). Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebo-controlled study. BMC Womens Health.
  42. (2000). Identification of collagen-binding proteins in Lactobacillus spp. with surface-enhanced laser desorption/ionization-time of flight proteinchip technology. Appl Environ Microbiol.
  43. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial.
  44. Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial.
  45. In vitro activity of nifuratel on vaginal bacteria: could it be a good candidate for the treatment of bacterial vaginosis? Antimicrob Agents Chemother.
  46. Incidence of pelvic inflammatory disease after first-trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind, randomized study.
  47. Inhibitory activity of thymol on native and mature Gardnerella vaginalis biofilms: in vitro study.
  48. Intravaginal metronidazole gel versus metronidazole plus nystatin ovules for bacterial vaginosis: a randomized controlled trial.
  49. Intravaginally applied metronidazole is as effective as orally applied in the treatment of bacterial vaginosis, but exhibits significantly less side effects.
  50. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 to prevent or cure bacterial vaginosis among women with HIV .
  51. Lactobacillus rhamnosus L60, a potential probiotic isolated from the human vagina.
  52. Long-term vaginal administration of Lactobacillus rhamnosus as a complementary approach to management of bacterial vaginosis.
  53. Low-dose secnidazole in the treatment of bacterial vaginosis.
  54. Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs oral therapy.
  55. Metronidazole is still the drug of choice for treatment of anaerobic infections. Clin Infect Dis. 2010; 50(Suppl 1):S16–S23.
  56. Metronidazole with Lactacyd vaginal gel in bacterial vaginosis.
  57. (2002). Microbiological and pharmaco-toxicological profile of nifuratel and its favourable risk/benefit ratio for the treatment of vulvo-vaginal infections. A review. Arzneimittelforschung.
  58. Molecular identification of bacteria associated with bacterial vaginosis.
  59. (2008). Molecular quantification of Gardnerella vaginalis and Atopobium vaginae loads to predict bacterial vaginosis. Clin Infect Dis.
  60. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations.
  61. (1998). of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research
  62. Oral metronidazole vs Metrogel Vaginal for treating bacterial vaginosis. Cost-effectiveness evaluation. J Reprod Med.
  63. (2003). Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol.
  64. Phase 2a study assessing colonization efficiency, safety, and acceptability of Lactobacillus crispatus CTV-05 in women with bacterial vaginosis. Sex Transm Dis.
  65. Pilot randomized trial for treatment of bacterial vaginosis using in situ forming metronidazole vaginal gel.
  66. Prebiotic effects of oligosaccharides on selected vaginal lactobacilli and pathogenic microorganisms.
  67. Preparation and anti-bacterial properties of a temperature-sensitive gel containing silver nanoparticles.
  68. (2007). Probiotic effects on inflammatory bowel disease.
  69. (2001). Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immunol Med Microbiol.
  70. Probiotic strategies for the treatment and prevention of bacterial vaginosis. Expert Opin Pharmacother.
  71. Probiotics for the treatment of bacterial vaginosis. Cochrane Database Syst Rev.
  72. Probiotics for the treatment of women with bacterial vaginosis.
  73. Recurrent bacterial vaginosis: the use of maintenance acidic vaginal gel following treatment.
  74. Recurrent bacterial vaginosis. Curr Opin Infect Dis.
  75. (2010). Reeves MF; Society of Family Planning. Prevention of infection after induced abortion: release date
  76. (1991). Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation.
  77. (2005). Skokos CK; Clindesse Investigators Group. The efficacy and safety of a single dose of Clindesse vaginal cream versus a seven-dose regimen of Cleocin vaginal cream in patients with bacterial vaginosis. Infect Dis Obstet Gynecol.
  78. (2004). Social and sexual risk factors for bacterial vaginosis. Sex Transm Infect.
  79. The aetiology of bacterial vaginosis.
  80. (2006). The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy. J Infect Dis.
  81. The effect of antifungal treatment on the vaginal flora of women with vulvo-vaginal yeast infection with or without bacterial vaginosis.
  82. (2009). The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev.
  83. The effects of male circumcision on female partners’ genital tract symptoms and vaginal infections in a randomized trial in Rakai,
  84. (2009). The efficacy of retreatment with the same medication for early treatment failure of bacterial vaginosis. Sex Transm Dis.
  85. The prevalence of bacterial vaginosis in the United States, 2001–2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis.
  86. The role of Lactobacillus casei rhamnosus Lcr 35 in restoring the normal vaginal flora after antibiotic treatment of bacterial vaginosis.
  87. The vaginal microbiome: new information about genital tract flora using molecular based techniques.
  88. Tinidazole in the treatment of bacterial vaginosis.
  89. Tinidazole vs metronidazole for the treatment of bacterial vaginosis.
  90. Treatment of bacterial vaginosis: a multicenter, double-blind, double-dummy, randomised phase III study comparing secnidazole and metronidazole. Infect Dis Obstet Gynecol.
  91. Viral sexually transmitted infections and bacterial vaginosis: 2001–2004 National Health and Nutrition Examination Survey data. Sex Transm Dis.