Bacterial Vaginosis

First Line or in pregnancy

Metronidazole PO 400mg twice daily for 5-7 days 

Second Line

Metronidazole PO 2g oral single dose (avoid if pregnant or breastfeeding)

Notes

Patients will report offensive fishy-smelling vaginal discharge, not associated with soreness, itching, or irritation. A vaginal pH > 4.5 is consistent with a diagnosis of BV. If empirical treatment is not considered appropriate, or if the diagnosis is uncertain, send a high or low vaginal swab for Gram staining and to exclude other causes of vaginal discharge. Routine screening and treatment of male partners is not indicated.

Any symptomatic patient should be offered treatment. Asymptomatic pregnant women may be considered for treatmentbut the evidence for treatment of BV in pregnancy is conflicting. Asymptomatic patients undergoing gynaecological surgery may require treatment prior to the procedure.

General advice: Advise patients to avoid vaginal douching, use of shower gel in the genital area, and use of antiseptic agents or shampoo in the bath.