Bacterial vaginosis diagnosis and management

Last updated: June 2005

Diagnosis

Clinical and microscopy

Diagnosis requires all of the following criteria:

  • homogeneous white vaginal discharge
  • "clue" cells on wet prepor Gram stain
  • vaginal fluid pH³ 4.5

Treatment

If candida or trichomonas are present, treat for these conditions and reassess.Treatment is only offered to patients with clinical symptoms or signs, or if intrauterine instrumentation like termination of pregnancy is anticipated and to some pregnant women.

Standard therapy

Metronidazole 400 mg orally 12 hourly for 5 days (B2)

or

Tinidazole 2 g orally as one dose (B2)

or

Metronidazole intravaginal gel 0.75% one applicator at night for 5 days

Alcohol should not be consumed during treatment with metronidazole or tinidazole and for 3 days after completion of treatment.

For patients intolerant of metronidazole

Clindamycin cream 2%, 5 g intravaginally at night for 7 days (A).

Recurrent bacterial vaginosis

Bacterial vaginosis should be documented on 3 separate occasions within a 12 month period.

Metronidazole 400mg orally 12 hourly for 7-10 days

plus

Boric Acid 600mg intravaginal pessary at night for 21 days

followed by

Metronidazole Intravaginal Gel 0.75% twice a week for 4-6 months

Patient education

The following points should be discussed:

  • the nature of the condition
  • it is not proven to be sexually transmitted and partners do not need treatment
  • explain the need to avoid alcohol until 3 days after metronidazole or tinidazole treatment is completed.

Follow up

Required only if symptoms do not resolve.

Further information

For further information on the diagnosis and management of bacterial vaginosis contact Adelaide Sexual Health Centre.

Disclaimer

These guidelines are based on review of current literature, current recommendations of the United States Centers for Disease Control and Prevention, World Health Organization, the British Association for Sexual Health and HIV and local expert opinion.

They are written primarily for use by Adelaide Sexual Health Centre staff and some flexibility is required in applying them to certain private practice situations.