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      High-Dose Vaginal Maintenance Metronidazole for Recurrent Bacterial Vaginosis : A Pilot Study

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          Targeted PCR for detection of vaginal bacteria associated with bacterial vaginosis.

          Several novel bacterial species have been detected in subjects with bacterial vaginosis (BV) by using broad-range PCR assays, but this approach is insensitive for detecting minority species. We developed a series of taxon-directed 16S rRNA gene PCR assays for more sensitive detection of key vaginal bacteria. We sought to determine the prevalence of each species in the vagina, its association with BV, and the utility of PCR for the microbiological diagnosis of BV. Targeted PCR assays were developed for 17 vaginal bacterial species and applied to 264 vaginal-fluid samples from 81 subjects with and 183 subjects without BV. The results were compared to those of two widely accepted methods for diagnosing BV, the use of clinical findings (Amsel criteria) and the interpretation of vaginal-fluid Gram stains (Nugent criteria). Leptotrichia/Sneathia, Atopobium vaginae, an Eggerthella-like bacterium, Megasphaera species, and three novel bacteria in the order Clostridiales are among the bacterial species significantly associated with BV. PCR detection of either a Megasphaera species or one of the Clostridiales bacteria yielded a sensitivity of 99% and a specificity of 89% for diagnosis of BV compared to the Amsel clinical criteria and a sensitivity of 95.9% and a specificity of 93.7% compared to the Nugent criteria (Gram stain). PCR detection of one or more fastidious bacterial species is a more reliable indicator of BV than detection of bacteria, such as Gardnerella vaginalis, previously linked to BV, highlighting the potential of PCR for the diagnosis of BV.
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            Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis.

            Efficacy study of suppressive vaginal metronidazole in reducing recurrent symptomatic episodes of bacterial vaginosis. Multicenter prospective study with initial 10-day open-label metronidazole gel in which asymptomatic responders randomly assigned to receive twice weekly metronidazole vaginal gel or placebo for 16 weeks and off therapy for 12 weeks. Of 157 eligible women with recurrent bacterial vaginosis, 112 of 127 returning evaluable women (88.2%) responded clinically and were randomly assigned. During suppressive therapy, recurrent bacterial vaginosis occurred in 13 women (25.5%) receiving metronidazole and 26 (59.1%) receiving placebo (MITT analysis, relative risk [RR] 0.43, CI = 0.25-0.73, P = .001). During the entire 28-week follow-up, recurrence occurred in 26 (51.0%) on treatment compared with 33 (75%) on placebo (RR 0.68, CI = 0.49-0.93, P = .02). Probability for remaining cured was 70% for metronidazole compared with 39% on placebo, which declined to 34% and 18%, respectively, by 28 weeks follow-up. Adverse effects were uncommon; however, secondary vaginal candidiasis occurred significantly more often in metronidazole-treated women (P = .02). Suppressive therapy with twice-weekly metronidazole gel achieves a significant reduction in the recurrence rate of bacterial vaginosis; however, secondary vaginal candidiasis is common.
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              Bacterial vaginosis: review of treatment options and potential clinical indications for therapy.

              We reviewed data on the treatment of bacterial vaginosis published from 1993 through 1996. For nonpregnant women, we recommend use of metronidazole (500 mg orally twice daily for 7 days), clindamycin vaginal cream (2%, once daily for 7 days), or metronidazole vaginal gel (0.75%, twice daily for 5 days) as the preferred treatment for bacterial vaginosis. For pregnant high-risk women (women with a prior preterm birth), the objective of the treatment is to prevent adverse outcomes of pregnancy, in addition to relief of symptoms. Thus, systemic therapy for possible subclinical upper tract infection as well as medication that has been studied in pregnant women are preferable. Therefore, we recommend metronidazole (250 mg orally three times a day for 7 days). For pregnant low-risk women (women without a prior preterm birth) with symptomatic disease, the main objective of the treatment is to relieve symptoms. We recommend metronidazole (250 mg orally three times a day for 7 days). Data do not support routine treatment of male sex partners.
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                Author and article information

                Journal
                Sexually Transmitted Diseases
                Sexually Transmitted Diseases
                Ovid Technologies (Wolters Kluwer Health)
                0148-5717
                2014
                May 2014
                : 41
                : 5
                : 290-291
                Article
                10.1097/OLQ.0000000000000123
                24722380
                ce03aa3b-d90a-4af4-a002-d3a5feec9483
                © 2014
                History

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