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Bacterial vaginosis - Management
How should I manage a woman with persistent symptoms?
- Persistent symptoms are most likely to be due to misdiagnosis or to poor adherence to treatment.
- If symptoms persist after initial treatment:
- Reconsider the diagnosis.
- Perform a speculum examination and take swabs if this has not been previously done.
- Check for adherence to treatment.
- Ensure that the current episode is adequately managed.
- If a single 2 g dose of metronidazole has previously been used, a 7-day course of 400 mg metronidazole twice daily can be tried.
- If intravaginal preparations have previously been used, a course of oral metronidazole can be tried.
- In the unlikely event that a woman with confirmed bacterial vaginosis (BV) has not responded to a 7-day course of oral metronidazole (and you are confident that she has adhered to the treatment regimen), discussion with a gynaecologist or genito-urinary medicine specialist regarding further treatment is advised.
- For persistent BV in women with an intrauterine contraceptive device, consider removing the device and advising the use of an alternative form of contraception.
- Routine screening and treatment of male partners is not indicated.
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