Abstract
Objectives: A pilot efficacy and tolerability trial of suppressive metronidazole vaginal gel in reducing recurrent symptomatic relapses of bacterial vaginosis (BV). Study design: A prospective open labeled study. Women with recurrent BV were assigned to metronidazole gel 3 times monthly for 24 weeks. The mean episodes of relapses of recurrence of BV after metronidazole suppression was compared to historical mean obtained from the same participants by a paired-sample T test. An exit interview was used to record patient satisfaction. Results: The mean symptomatic relapses of BV was 0.44 (SD1.09). Historically, participants had a mean of 6.5 (SD3.09) by clinical or laboratory criteria, and a mean of 3.75 (1.06) by laboratory criteria only. Compared with each of the historical means by paired-sample T test, the difference is significant in both at P<0.0001. Adverse effects were uncommon. Conclusions: Suppressive therapy of BV with metronidazole gel for 3 days after the menstrual cycle resulted in significant reduction in symptomatic relapses. Adverse effects were uncommon. A randomized controlled trial is needed to further validate these results.
Highlights
Bacterial vaginosis (BV) is the commonest cause of abnormal vaginal discharge in women of reproductive age
Suppressive therapy of bacterial vaginosis (BV) with metronidazole gel for 3 days after the menstrual cycle resulted in significant reduction in symptomatic relapses
More recently novel bacteria associated with BV such as Atopobium vaginae have been discovered by utilizing modern molecular biology techniques [9,10]
Summary
Bacterial vaginosis (BV) is the commonest cause of abnormal vaginal discharge in women of reproductive age. Several studies showed that women with BV are at an increased risk of developing endometritis or pelvic inflammatory disease following termination of pregnancy; pregnant women have a significantly increased incidence of intrauterine death, late miscarriage and preterm birth [3,4,5,6] These complications and associations were mostly reported in the absence of BV symptoms [7]. More recently novel bacteria associated with BV such as Atopobium vaginae have been discovered by utilizing modern molecular biology techniques [9,10]. This disruption of the normal vaginal flora can be temporarily corrected by antibiotics but the rate of recurrence is high and, in symptomatic cases, recurrence can be up to monthly [11,12]
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