Metronidazole Gel Called Best Option for Recurrent BV, for Now


SAN DIEGO — Long-term use of metronidazole gel remains the mainstay of treatment for women with recurrent bacterial vaginosis, said Dr. Jeanne Marrazzo of the division of allergy and infectious disease at the University of Washington, Seattle.

Patients are instructed to use intravaginal metronidazole gel 0.75% at bedtime for 10–14 days, then biweekly—Monday and Thursday, for example—for approximately 6 months before retesting, Dr. Marrazzo said at Perspectives in Women's Health, a conference sponsored by FAMILY PRACTICE NEWS, OB.GYN. NEWS, and INTERNAL MEDICINE NEWS.

“The problem is cost,” she said. Generic products exist in the gel formulation, but they offer little cost advantage over the branded products.

The mechanism of action in this regimen remains uncertain, although it may suppress overall anaerobic overgrowth for so long that the patient's lactobacillus population can recover. Suppression of an unknown pathogen may also be at work, she said.

Dr. Marrazzo said research suggests benefit from condom use during intercourse in the initial and suppression treatment regimens, again, for reasons that are not fully understood. “Condom use … in my mind, should be part of the counseling of patients with recurrent BV,” she said.

As of today, there are no good alternatives to metronidazole gel for these patients, she explained. Over-the-counter lactobacillus remedies and yogurt are not good options.

“You don't want to use bovine lactobacilli in the human vagina. It's really not a very good thing,” she stressed. “These [remedies] really aren't going to work, although some people will say anecdotally that they do.”

Early trials assessing the efficacy of intravaginal capsules containing the probiotic Lactobacillus crispatus have proven “very disappointing,” she said. The organism nonetheless remains under evaluation as a potentially useful agent for repletion of normal vaginal lactobacilli, since it is one of the three most common lactic-acid-producing bacteria in the healthy vagina.

Research demonstrates that it adheres well to vaginal epithelial cells; in 2006, Dr. Marrazzo and her associates reported a high rate of satisfaction among 232 women who were “very willing” to use an intravaginal capsule containing lactobacillus (J. Womens Health 2006;15:1053–60).

Women in Dr. Marrazzo's study said they were willing to use the product again, regardless of the clinical response they received.

Dr. Marrazzo stated that she had no financial disclosures.

OB.GYN. NEWS is published by the International Medical News Group, a division of Elsevier.

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