Clinical Guidelines:Bacterial Vaginosis



BACTERIAL VAGINOSIS (BV)INTRODUCTIONBV is a polymicrobial clinical syndrome. BV is the most prevalent cause of malodorous vaginal discharge. BV is associated with having multiple male or female sex partners, a new sex partner, douching, lack of condom use and lack of vaginal lactobacilli; women who have never been sexually active are rarely affected. Treatment of male sex partners has not been beneficial in preventing recurrence.SUBJECTIVE DATAHistory may include: Recent change in sexual partnerPartner symptoms of STDsMultiple partnersLack of STD protection (condom use)Vaginal hygiene practicesSymptoms may include:Abnormal vaginal discharge (foul “fishy “odor which intensifies after intercourse)Vulvar/vaginal pruritus, burning, irritationOBJECTIVE DATAAssessment may include: Vulvar inflammationHomogeneous, thin, white discharge that smoothly coats the vaginal wallsAmine odor ASSESSMENTLaboratory testing: Clinical criteria can be used and require three of the four following symptoms or signs:Homogeneous, thin, white discharge that smoothly coats the vaginal walls“Clue cells” (vaginal epithelial cells with borders obscured by coccoobacilli) on microscope examFishy odor of vaginal discharge before or after addition of 10% KOH (Positive “whiff” test)pH of vaginal fluid >4.5NOTE: Pap screening tests have no clinical utility for the diagnosis of BVPLANTreatment: Recommended RegimensMetronidazole 500 mg orally twice a day for 7 days*ORMetronidazole gel, 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days*ORClindamycin cream, 2%, one full applicator (5 g) intravaginally at bedtime for 7 days+Alternative RegimensTinidazole 2 g orally once daily for 2 days*ORTinidazole 1 g orally once daily for 5 days*ORClindamycin 300 mg orally twice daily for 7 daysORClindamycin ovules 100 mg intravaginally once at bedtime for 3 days. ORSecnidazole 2g Oral granules *Consuming alcohol should be avoided during treatment and for 24 hours thereafter when using Metronidazole. When using Tinidazole alcohol needs to be avoided for 72 hours thereafter. +Clindamycin ovules is oil-based and might weaken latex condoms and diaphragms for 72 hours following treatment (refer to clindamycin product labeling for additional information).SPECIAL CONSIDERATIONAllergy or intolerance to the recommended therapy:Intravaginal clindamycin cream is preferred in case of allergy/intolerance to metronidazole or tinidazole. Intravaginal metronidazole gel can be considered for women who do not tolerate systemic metronidazole. Intravaginal metronidazole should not be administered to women allergic to metronidazole.Infection in Pregnancy: Treatment for pregnant women is the same as non-pregnant women. All pregnant women who have symptomatic disease require treatment due to association of adverse pregnancy outcomes including premature rupture of membranes, preterm birth, intra-amniotic infection, and postpartum endometritis. Tinidazole should be avoided in pregnant women. Recommended Regimens for Pregnant WomenMetronidazole 500 mg orally twice a day for 7 daysORMetronidazole 250 mg orally three times a day for 7 daysOR Clindamycin 300 mg orally twice a day for 7 daysORMetronidazole gel 0.75%, one full applicator (5 g) intravaginally once a day for 5 daysORClindamycin cream 2%, one full applicator (5 g) intravaginally twice daily for 7 daysCLIENT EDUCATION/COUNSELINGAvoid alcohol during treatment and after completion of treatment with Metronidazole (24 hrs.) and Tinidazole (72 hrs.) Clindamycin ovules (oil based) may weaken latex condoms and diaphragms for 72 hrs. following treatmentSexual partner treatment is not recommendedProvide Medication Information SheetProvide STD education informationOffer other STD testingDiscourage douching (does not treat or relieve symptoms) Provide current educational information on Bacterial VaginosisProvide contraceptive information, if requestedEncourage correct and consistent condom use to prevent STD exposureFOLLOW-UPUnnecessary if symptoms resolve after medication treatmentIf symptoms continue, client needs to be seenREFERRALClients with multiple recurrencesClients who are pregnant (refer to prenatal care)REPORTINGMandated state reporting is NOT requiredREFERENCESCDC: Sexually Transmitted Disease Treatment Guidelines, 2015Reportable Diseases in Michigan: A Guide for Physicians, Health Care Providers and Laboratories, 2019Reviewed/Revised: 2020 ................
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