Contributor: MFM Division
Last Update: 1/1/2007
Symptomatic women should be treated for bacterial vaginosis. The most widely used diagnostic test involves the use of composite criteria (Hillier & Holmes 1990), of which three of four should be present, including:
- Vaginal pH of greater than 4.5
- Grey homogenous vaginal discharge
- Presence of clue cells in a wet prep of vaginal fluid
- Amine test, in which a fishy odor is released after the addition of 10% KOH to the vaginal fluid
Treatment during pregnancy:
Either Metronidazole 500 mg po bid x 7 days OR Clindamycin 300 mg po bid x 7 days
There is currently no known contraindication for using Metronidazole in the first trimester based on Reprotox data.
The evidence that treatment of asymptomatic pregnant women will prevent adverse pregnancy outcomes is not convincing. The United States Health Prevention Services Task Force recommend against routine screening for BV in pregnancy for this reason.
Hillier S, Holmes KIK. Bacterial vaginosis. In Sexually Transmitted Diseases (KK Holmes, PA Mardh, PF Sparling & PJ Wiesner, eds), McGraw-Hill, New York, 1990:pp547-559.