Comparison of intravaginal and oral metronidazole in patients with bacterial vaginosis

Authors

  • Sang Won Han Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
  • Jae Eun Chung Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20174396

Keywords:

Bacterial vaginosis, Metronidazole ointment, Metronidazole gel, Vaginitis

Abstract

Background: Metronidazole is considered an effective treatment for bacterial vaginosis. Only oral preparations were available until 2014, but an intravaginal gel preparation recently became commercially available in South Korea. In this report, the efficacy and safety of metronidazole intravaginal gel application was compared to that of the conventional oral metronidazole preparation.

Methods: Patients who were treated with either intravaginal metronidazole or oral metronidazole after diagnosis of bacterial vaginosis were included in this study. Patient characteristics, mode of treatment, recurrence rate, and complications including gastro-intestinal discomfort and concomitant vulvovaginal candidiasis were analyzed.

Results: There were no differences in patient characteristics, except the mean age was older in the intravaginal group. Treatment outcomes were similar in both groups. In the oral metronidazole group, 6.3% of patients reported ongoing symptoms of bacterial vaginosis within one month of treatment and required a refill, while 7.3% of the intravaginal group required a refill. Significantly more patients on oral metronidazole treatment complained about gastro-intestinal discomfort including nausea (13.4%) and diarrhea (9.4%). Patients who took intravaginal metronidazole complained about increased watery vaginal discharge (26.8%). The comparatively high cost of metronidazole intravaginal gel was another factor that could affect patient access to this treatment versus the oral preparation. The incidence of vulvovaginal candidiasis was similar between groups (oral 3.9%, intravaginal 4.9%).

Conclusions: Intravaginal metronidazole usage can be considered as an effective alternative treatment for bacterial vaginosis in patients with gastro-intestinal complications. However, the increased incidence of watery vaginal discharge and high cost remain obstacles to widespread use of the intravaginal preparation.

References

Allsworth H, Peipert J. Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data. Obstet Gynecol. 2007;109:114-20.

ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis. Obstet Gynecol. 2006;107:1195-1206.

Faro S, Martens M, Maccato M. Vaginal flora and Pelvic Inflammatory Disease. Am J Obstet Gynecol. 1993;169:470-4.

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR;51(RR-6):1-80.

Swedberg J, Steiner JF, Deiss F. Comparison of single-dose versus one-week course of metronidazole for symptomatic bacterial vaginosis. JAMA. 1985;1254:1046-9.

Brabin L. Interactions of the female hormonal environment, susceptibility to viral infections, and disease progression. AIDS Patient Care STDs. 2002;15:211-21.

Klebanoff M, Schwebke J, Zhang J, Nansel T. Vulvovaginal symptoms in women with bacterial vaginosis. Obstet Gynecol. 2004;104:267-72.

Polatti F. Bacterial Vaginosis, Atopobium vaginae and Nifuratel. Current clinical pharmacol. 2012;7:36-40.

Haggerty C, Gottilieb S. Risk of sequele after chlamydia trachomatis genital infection in women. J Infect Dis. 2010;201(suppl 2):S134-55.

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR;55:1-94.

Simpson T, Merchant J, Grimley DM, Kim O. Vaginal douching among adolescents and young women: more challenges than progress. J Pediatr Adolesc Gynecol. 204;17:249-55.

Eckert L, Hawes S, Stevens C. Vulvovaginal candidiasis: Clinical manifestations, risk factors, management algorithm. Obstet Gynecol. 1998;92:757-65.

Vallor A, Antonia M, Hawes S, Hillier S. Factors associated with acquisition of, or persistent colonization by, vaginal lactobacilli: Role of hydrogen peroxide production. J Infec Dis 2001;184:1431-6.

Hughes VL, Hillier SL. Microbiologic characteristics of Lactobacillus products used for colonization of the vagina. Obstet Gynecol. 1990;75244-248.

Donders G, Van Calsteren K, Bellen G. Predictive value for preterm birth on abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG. 2009;116:1315-24.

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Published

2017-09-23

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Original Research Articles