Management of Vaginosis

Abstract

Although trichomoniasis and bacterial vaginosis represent opposite ends of the clinical spectrum (vaginitis versus vaginosis) and are due to entirely different pathogenic mechanisms, they nevertheless share several characteristics. Common manifestations include a malodorous vaginal discharge, a massive disruption of the normal lactobacillus-dominant flora, elevated pH, and overgrowth of vaginal anaerobes. What these 2 conditions have most in common is an exquisite susceptibility to nitroimidazole agents. For many years, oral multidose metronidazole was the only available nitroimidazole for the indication; however, the recent availability of single dose, long-acting secnidazole offers a useful alternative to conventional therapy. Moreover, although several new options are now available for the treatment of bacterial vaginosis, namely vaginal clindamycin and metronidazole gel, no vaginal regimens are available for the treatment of trichomoniasis. Finally, while clindamycin availability ensures safe treatment of bacterial vaginosis in pregnancy, nitroimidazole therapy is not endorsed for use in the first trimester of pregnancy, and this therapeutic need remains unanswered.