TREATMENT/MANAGEMENT
Treatment is recommended for women with symptoms. The established benefit of therapy in nonpregnant women is relief of vaginal symptoms and signs of infection. Other potential benefits to treatment include reduction in the risk for Chlamydia trachomatis or Neisseria gonorrhea infection, HIV, and other viral STIs. Table 2 includes the recommended and alternative treatment regimens for BV, according to the CDC’s 2015 treatment guidelines for sexually transmitted infections.7 These regimens are also recommended by the American Congress of Obstetricians and Gynecologists (ACOG).16
Treatment is also recommended for all symptomatic pregnant women. Older CDC guidelines noted a preference for oral therapy in pregnant women with BV, due to the possibility of subclinical upper genital tract infection.17 However, the 2015 CDC guidelinesstate that symptomatic pregnant women can be treated with either the oral or vaginal regimens recommended for nonpregnant women, as oral therapy has not been shown to outperform vaginal therapy in effecting cure or preventing adverse outcomes.7
PATIENT EDUCATION AND FOLLOW-UP
Patient preferences, possible adverse effects, drug interactions, and other coinfections should be considered when selecting a treatment regimen. Women should be advised to refrain from sexual intercourse or to use condoms consistently and correctly during treatment. Douching may increase the risk for relapse, and no data support its use for treatment or relief of symptoms. Follow-up visits are unnecessary unless symptoms do not resolve. Because recurrence of BV is common, however, women should be advised to return for evaluation if symptoms recur.1,8,18
Continue for when BV recurs >>