Treatment of bacterial vaginosis: What we have and what we miss

Expert Opinion on Pharmacotherapy

Volumn 15, Issue 5, 2014, Pages 645-657

  Donders, Gilbert Gg ^a,b,c   Zodzika, Jana ^d   Rezeberga, Dace ^e  

^a Tienen Regional Hospital   (Belgium)

^b Regionaal Ziekenhuis Heilig Hart Tienen   (Belgium)

^c ANTWERP UNIVERSITY HOSPITAL   (Belgium)

^d RIGA STRADINS UNIVERSITY   (Latvia)

^e RIGA EAST UNIVERSITY HOSPITAL   (Latvia)

Author keywords

Abnormal vaginal flora; Aerobic vaginitis; Prophylaxis; Recurrent vaginitis

Indexed keywords

ACETIC ACID; ASCORBIC ACID; AZITHROMYCIN; BENZYDAMINE; CARBOMER; CEFADROXIL; CHLORHEXIDINE; CLINDAMYCIN; DEQUALINIUM; ERYTHROMYCIN; HYDROGEN PEROXIDE; LACTIC ACID; METRONIDAZOLE; NIFURATEL; NITROFURAN; OFLOXACIN; ORNIDAZOLE; POLY(HEXAMETHYLENEBIGUANIDE); POLYCARBOPHIL; POVIDONE IODINE; PREBIOTIC AGENT; PROBIOTIC AGENT; RIFAMYCIN; RIFAXIMIN; SECNIDAZOLE; TINIDAZOLE;

ADJUVANT THERAPY; ANTIBIOTIC THERAPY; BACTERIAL INFECTION; BACTERIAL TRANSMISSION; BACTERIAL VAGINOSIS; BACTERIUM CULTURE; DIFFERENTIAL DIAGNOSIS; ESCHERICHIA COLI; GARDNERELLA; HETEROSEXUALITY; HUMAN; LACTOBACILLUS REUTERI; LACTOBACILLUS RHAMNOSUS; MAINTENANCE THERAPY; MIXED INFECTION; MOBILUNCUS; PAPANICOLAOU TEST; PHASE CONTRAST MICROSCOPY; PREGNANCY; RECURRENT DISEASE; REVIEW; SEXUALLY TRANSMITTED DISEASE; STAPHYLOCOCCUS AUREUS; VAGINA DISCHARGE; VAGINA DISEASE; VAGINA EPITHELIUM; VAGINA FLORA; VAGINAL LAVAGE; WOMEN WHO HAVE SEX WITH WOMEN;

ANTI-BACTERIAL AGENTS; ANTI-INFECTIVE AGENTS, LOCAL; CLINDAMYCIN; COINFECTION; DRUG THERAPY, COMBINATION; FEMALE; HUMANS; METRONIDAZOLE; PREBIOTICS; PROBIOTICS; RECURRENCE; VAGINOSIS, BACTERIAL;

EID: 84896262701     PISSN: 14656566     EISSN: 17447666     Source Type: Journal    
DOI: 10.1517/14656566.2014.881800     Document Type: Review

References (180)

1. Bilardi JE, Walker S, Temple-Smith M, et al. The Burden of Bacterial Vaginosis: womens Experience of the Physical, Emotional, Sexual and Social Impact of Living with Recurrent Bacterial Vaginosis. PLoS One 2013;8:e74378
2. Donders GG, Vereecken A, Bosmans E, et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG 2002;109:34-43
3. Marrazzo JM, Antonio M, Agnew K, et al. Distribution of genital Lactobacillus strains shared by female sex partners. J Infect Dis 2009;199:680-3
4. Swidsinski A, Dorffel Y, Loening-Baucke V, et al. Desquamated epithelial cells covered with a polymicrobial biofilm typical for bacterial vaginosis are present in randomly selected cryopreserved donor semen. FEMS Immunol Med Microbiol 2010;59:399-404
5. Swidsinski A, Doerffel Y, Loening-Baucke V, et al. Gardnerella biofilm involves females and males and is transmitted sexually. Gynecol Obstet Invest 2010;70:256-63
6. Hou D, Zhou X, Zhong X, et al. Microbiota of the seminal fluid from healthy and infertile men. Fertil Steril 2013;100:1261-9
7. Gallo MF, Warner L, King CC, et al. Association between semen exposure and incident bacterial vaginosis. Infect Dis Obstet Gynecol 2011;2011: 842652. [Epub ahead of print]
8. Collins M. Whats the treatment for bacterial vaginosis? Nursing (Brux) 2008;38(12):22
9. Akinbiyi AA, Watson R, Feyi-Waboso P. Prevalence of Candida albicans and bacterial vaginosis in asymptomatic pregnant women in South Yorkshire, United Kingdom. Outcome of a prospective study. Arch Gynecol Obstet 2008;278:463-6
10. Oliveira FA, Pfleger V, Lang K, et al. Sexually transmitted infections, bacterial vaginosis, and candidiasis in women of reproductive age in rural Northeast Brazil: a population-based study. Mem Inst Oswaldo Cruz 2007;102:751-6
11. Fang X, Zhou Y, Yang Y, et al. Prevalence and risk factors of trichomoniasis, bacterial vaginosis, and candidiasis for married women of childbearing age in rural Shandong. Jpn J Infect Dis 2007;60:257-61
12. Koumans EH, Sternberg M, Bruce C, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007;34:864-9
13. Bhalla P, Chawla R, Garg S, et al. Prevalence of bacterial vaginosis among women in Delhi, India. Indian J Med Res 2007;125:167-72
14. Dan M, Kaneti N, Levin D, et al. Vaginitis in a gynecologic practice in Israel: causes and risk factors. Isr Med Assoc J 2003;5:629-32
15. Lamont RF, Morgan DJ, Wilden SD, et al. Prevalence of bacterial vaginosis in women attending one of three general practices for routine cervical cytology. Int J STD AIDS 2000;11:495-8
16. Schneider H, Coetzee DJ, Fehler HG, et al. Screening for sexually transmitted diseases in rural South African women. Sex Transm Infect 1998;74(Suppl 1):S147-52
17. Larsson PG, Platz-Christensen JJ, Forsum U, et al. Clue cells in predicting infections after abdominal hysterectomy. Obstet Gynecol 1991;77:450-2
18. Persson E, Bergstrom M, Larsson PG, et al. Infections after hysterectomy. A prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology. Acta Obstet Gynecol Scand 1996;75:757-61
19. Soper DE, Bump RC, Hurt WG. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. Am J Obstet Gynecol 1990;163:1016-21
20. Charonis G, Larsson PG. Use of pH/whiff test or QuickVue Advanced pH and Amines test for the diagnosis of bacterial vaginosis and prevention of postabortion pelvic inflammatory disease. Acta Obstet Gynecol Scand 2006;85:837-43
21. Lassey AT, Adanu KR, Newman MJ, et al. Potential pathogens in the lower genital tract at manual vacuum aspiration for incomplete abortion in Korle Bu Teaching Hospital, Ghana. East Afr Med J 2004;81:398-401
22. Miller L, Thomas K, Hughes JP, et al. Randomised treatment trial of bacterial vaginosis to prevent post-abortion complication. BJOG 2004;111:982-8
23. Larsson PG, Platz-Christensen JJ, Dalaker K, et al. Treatment with 2% clindamycin vaginal cream prior to first trimester surgical abortion to reduce signs of postoperative infection: a prospective, double-blinded, placebo-controlled, multicenter study. Acta Obstet Gynecol Scand 2000;79:390-6
24. Larsson PG, Platz-Christensen JJ, Thejls H, et al. Incidence of pelvic inflammatory disease after first-trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind, randomized study. Am J Obstet Gynecol 1992;166:100-3
25. Chohan VH, Baeten J, Benki S, et al. A prospective study of risk factors for herpes simplex virus type 2 acquisition among high-risk HIV-1 seronegative kenyan women. Sex Transm Infect 2009;85:489-92
26. Atashili J, Poole C, Ndumbe PM, et al. Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS 2008;22:1493-501
27. van de Wijgert JH, Morrison CS, Cornelisse PG, et al. Bacterial vaginosis and vaginal yeast, but not vaginal cleansing, increase HIV-1 acquisition in African women. J Acquir Immune Defic Syndr 2008;48:203-10
28. Gallo MF, Warner L, Macaluso M, et al. Risk factors for incident herpes simplex type 2 virus infection among women attending a sexually transmitted disease clinic. Sex Transm Dis 2008;35:679-85
29. Peipert JF, Lapane KL, Allsworth JE, et al. Bacterial vaginosis, race, and sexually transmitted infections: does race modify the association? Sex Transm Dis 2008;35:363-7
30. Kaul R, Nagelkerke NJ, Kimani J, et al. Prevalent herpes simplex virus type 2 infection is associated with altered vaginal flora and an increased susceptibility to multiple sexually transmitted infections. J Infect Dis 2007;196:1692-7
31. Brotman RM, Erbelding EJ, Jamshidi RM, et al. Findings associated with recurrence of bacterial vaginosis among adolescents attending sexually transmitted diseases clinics. J Pediatr Adolesc Gynecol 2007;20:225-31
32. Nagot N, Ouedraogo A, Defer MC, et al. Association between bacterial vaginosis and Herpes simplex virus type-2 infection: implications for HIV acquisition studies. Sex Transm Infect 2007;83:365-8
33. Schwebke JR. Abnormal vaginal flora as a biological risk factor for acquisition of HIV infection and sexually transmitted diseases. J Infect Dis 2005;192:1315-17
34. Oakeshott P, Hay P, Hay S, et al. Association between bacterial vaginosis or chlamydial infection and miscarriage before 16 weeks gestation: prospective community based cohort study. BMJ 2002;325(7376):1334
35. Donders GG, Van BB, Caudron J, et al. Relationship of bacterial vaginosis and mycoplasmas to the risk of spontaneous abortion. Am J Obstet Gynecol 2000;183:431-7
36. Ralph SG, Rutherford AJ, Wilson JD. Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. BMJ 1999;319:220-3
37. Donders GG, Van Calsteren K, Bellen G, et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG 2009;116:1315-24
38. Thorp JM Jr, Dole N, Herring AH, et al. Alteration in vaginal microflora, douching prior to pregnancy, and preterm birth. Paediatr Perinat Epidemiol 2008;22:530-7
39. Xu J, Holzman CB, Arvidson CG, et al. Midpregnancy vaginal fluid defensins, bacterial vaginosis, and risk of preterm delivery. Obstet Gynecol 2008;112:524-31
40. Leitich H, Kiss H. Asymptomatic bacterial vaginosis and intermediate flora as risk factors for adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2007;21:375-90
41. Guaschino S, De Seta F, Piccoli M, et al. Aetiology of preterm labour: bacterial vaginosis. BJOG 2006;113(Suppl 3):46-51
42. Svare JA, Schmidt H, Hansen BB, et al. Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birthweight and perinatal infections. BJOG 2006;113:1419-25
43. Vogel I, Thorsen P, Hogan VK, et al. The joint effect of vaginal Ureaplasma urealyticum and bacterial vaginosis on adverse pregnancy outcomes. Acta Obstet Gynecol Scand 2006;85:778-85
44. Guerra B, Ghi T, Quarta S, et al. Pregnancy outcome after early detection of bacterial vaginosis. Eur J Obstet Gynecol Reprod Biol 2006;128:40-5
45. Goyal R, Sharma P, Kaur I, et al. Bacterial vaginosis and vaginal anaerobes in preterm labour. J Indian Med Assoc 2004;102:548-50, 553
46. Romero R, Chaiworapongsa T, Kuivaniemi H, et al. Bacterial vaginosis, the inflammatory response and the risk of preterm birth: a role for genetic epidemiology in the prevention of preterm birth. Am J Obstet Gynecol 2004;190:1509-19
47. Leitich H, Bodner-Adler B, Brunbauer M, et al. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol 2003;189:139-47
48. Jacobsson B, Pernevi P, Chidekel L, et al. Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis. Acta Obstet Gynecol Scand 2002;81:1006-10
49. Purwar M, Ughade S, Bhagat B, et al. Bacterial vaginosis in early pregnancy and adverse pregnancy outcome. J Obstet Gynaecol Res 2001;27:175-81
50. McDonald HM, OLoughlin JA, Jolley PT, et al. Changes in vaginal flora during pregnancy and association with preterm birth. J Infect Dis 1994;170:724-8
51. Gravett MG, Hummel D, Eschenbach DA, et al. Preterm labor associated with subclinical amniotic fluid infection and with bacterial vaginosis. Obstet Gynecol 1986;67:229-37
52. Forsum U, Jakobsson T, Larsson PG, et al. An international study of the interobserver variation between interpretations of vaginal smear criteria of bacterial vaginosis. APMIS 2002;110:811-18
53. Donders GG, Larsson PG, Platz-Christensen JJ, et al. Variability in diagnosis of clue cells, lactobacillary grading and white blood cells in vaginal wet smears with conventional bright light and phase contrast microscopy. Eur J Obstet Gynecol Reprod Biol 2009;145:109-12
54. Donders GG. Definition and classification of abnormal vaginal flora. Best Pract Res Clin Obstet Gynaecol 2007;21:355-73
55. Donders GG, Vereecken A, Dekeersmaecker A, et al. Wet mount microscopy reflects functional vaginal lactobacillary flora better than Gram stain. J Clin Pathol 2000;53:308-13
56. Donders GG, Desmyter J, Vereecken A. Vaginitis. N Engl J Med 1998;338:1548
57. Hillier SL, Krohn MA, Nugent RP, et al. Characteristics of three vaginal flora patterns assessed by gram stain among pregnant women. Vaginal Infections and Prematurity Study Group. Am J Obstet Gynecol 1992;166:938-44
58. Ison CA, Hay PE. Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics. Sex Transm Infect 2002;78:413-15
59. Chawla R, Bhalla P, Chadha S, et al. Comparison of Hays criteria with Nugents scoring system for diagnosis of bacterial vaginosis. Biomed Res Int 2013;2013:365194
60. Biagi E, Vitali B, Pugliese C, et al. Quantitative variations in the vaginal bacterial population associated with asymptomatic infections: a real-time polymerase chain reaction study. Eur J Clin Microbiol Infect Dis 2009;28:281-5
61. Oakley BB, Fiedler TL, Marrazzo JM, et al. Diversity of human vaginal bacterial communities and associations with clinically defined bacterial vaginosis. Appl Environ Microbiol 2008;74:4898-909
62. Srinivasan S, Fredricks DN. The human vaginal bacterial biota and bacterial vaginosis. Interdiscip Perspect Infect Dis 2008;2008:750479
63. De BE, Verhelst R, Verstraelen H, et al. Quantitative determination by real-time PCR of four vaginal Lactobacillus species, Gardnerella vaginalis and Atopobium vaginae indicates an inverse relationship between L. gasseri and L. iners. BMC Microbiol 2007;7:115
64. Kalra A, Palcu CT, Sobel JD, et al. Bacterial Vaginosis: culture- and PCRbased Characterizations of a Complex Polymicrobial Diseases Pathobiology. Curr Infect Dis Rep 2007;9:485-500
65. Vitali B, Pugliese C, Biagi E, et al. Dynamics of vaginal bacterial communities in women developing bacterial vaginosis, candidiasis, or no infection, analyzed by PCR-denaturing gradient gel electrophoresis and real-time PCR. Appl Environ Microbiol 2007;73:5731-41
66. Verhelst R, Verstraelen H, Claeys G, et al. Cloning of 16S rRNA genes amplified from normal and disturbed vaginal microflora suggests a strong association between Atopobium vaginae, Gardnerella vaginalis and bacterial vaginosis. BMC Microbiol 2004;4:16
67. Arya SC. New diagnostic test for vaginal infection. BMJ 1994;309:807
68. Brown HL, Fuller DD, Jasper LT, et al. Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species in vaginitis/vaginosis. Infect Dis Obstet Gynecol 2004;12:17-21
69. Chaijareenont K, Sirimai K, Boriboonhirunsarn D, et al. Accuracy of Nugents score and each Amsels criteria in the diagnosis of bacterial vaginosis. J Med Assoc Thai 2004;87:1270-4
70. Davis JD, Connor EE, Clark P, et al. Correlation between cervical cytologic results and Gram stain as diagnostic tests for bacterial vaginosis. Am J Obstet Gynecol 1997;177:532-5
71. Hay P, Tummon A, Ogunfile M A, et al. Evaluation of a novel diagnostic test for bacterial vaginosis: the electronic nose. Int J STD AIDS 2003;14:114-18
72. Money D. The laboratory diagnosis of bacterial vaginosis. Can J Infect Dis Med Microbiol 2005;16:77-9
73. West B, Morison L, Schim van der Loeff M, et al. Evaluation of a new rapid diagnostic kit (FemExam) for bacterial vaginosis in patients with vaginal discharge syndrome in The Gambia. Sex Transm Dis 2003;30:483-9
74. Donders GG, Marconi C, Bellen G. Easiness of use and validity testing of VS-SENSE device for detection of abnormal vaginal flora and bacterial vaginosis. Infect Dis Obstet Gynecol 2010;2010:504972
75. Bistoletti P, Fredricsson B, Hagstrom B, et al. Comparison of oral and vaginal metronidazole therapy for nonspecific bacterial vaginosis. Gynecol Obstet Invest 1986;21:144-9
76. Oduyebo OO, Anorlu RI, Ogunsola FT. The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev 2009;(3):CD006055
77. Cunningham FE, Kraus DM, Brubaker L, et al. Pharmacokinetics of intravaginal metronidazole gel. J Clin Pharmacol 1994;34:1060-5
78. Schindler EM, Thamm H, Ansmann EB, et al. [Treatment of bacterial vaginitis. Multicenter, randomized, open study with tinidazole in comparison with metronidazole]. Fortschr Med 1991;109:138-40
79. Voorspoels J, Casteels M, Remon JP, et al. Local treatment of bacterial vaginosis with a bioadhesive metronidazole tablet. Eur J Obstet Gynecol Reprod Biol 2002;105:64-6
80. Hanson JM, McGregor JA, Hillier SL, et al. Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy. J Reprod Med 2000;45:889-96
81. Schmitt C, Sobel JD, Meriwether C. Bacterial vaginosis: treatment with clindamycin cream versus oral metronidazole. Obstet Gynecol 1992;79:1020-3
82. Andres FJ, Parker R, Hosein I, et al. Clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis: a prospective double-blind clinical trial. South Med J 1992;85:1077-80
83. Fischbach F, Petersen EE, Weissenbacher ER, et al. Efficacy of clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis. Obstet Gynecol 1993;82:405-10
84. Paavonen J, Mangioni C, Martin MA, et al. Vaginal clindamycin and oral metronidazole for bacterial vaginosis: a randomized trial. Obstet Gynecol 2000;96:256-60
85. Livengood CH III, Ferris DG, Wiesenfeld HC, et al. Effectiveness of two tinidazole regimens in treatment of bacterial vaginosis: a randomized controlled trial. Obstet Gynecol 2007;110:302-9
86. Buranawarodomkul P, Chandeying V, Sutthijumtroon S. Seven Day Metronidazole versus single day tinidazole as therapy for non-specific vaginitis. J Med Assoc Thai 1990;73:283-7
87. Milani M, Barcellona E, Agnello A. Efficacy of the combination of 2 g oral tinidazole and acidic buffering vaginal gel in comparison with vaginal clindamycin alone in bacterial vaginosis: a randomized, investigator-blinded, controlled trial. Eur J Obstet Gynecol Reprod Biol 2003;109:67-71
88. Heikkinen J, Vuopala S. Anaerobic vaginosis: treatment with tinidazole vaginal tablets. Gynecol Obstet Invest 1989;28:98-100
89. Wang FM, Qian XD, Xu H, et al. [Efficacy of 5-nitroimidazole derivatives in treatment of bacterial vaginosis]. Zhonghua Yi Xue Za Zhi 2008;88:2201-3
90. Saracoglu F, Gol K, Sahin I, et al. Treatment of bacterial vaginosis with oral or vaginal ornidazole, secnidazole and metronidazole. Int J Gynaecol Obstet 1998;62:59-61
91. Brandt M, Abels C, May T, et al. Intravaginally applied metronidazole is as effective as orally applied in the treatment of bacterial vaginosis, but exhibits significantly less side effects. Eur J Obstet Gynecol Reprod Biol 2008;141:158-62
92. Ferris DG, Litaker MS, Woodward L, et al. Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream. J Fam Pract 1995;41:443-9
93. Mikamo H, Kawazoe K, Izumi K, et al. Comparative study on vaginal or oral treatment of bacterial vaginosis. Chemotherapy 1997;43:60-8
94. Wathne B, Holst E, Hovelius B, et al. Erythromycin versus metronidazole in the treatment of bacterial vaginosis. Acta Obstet Gynecol Scand 1993;72:470-4
95. Covino JM, Black JR, Cummings M, et al. Comparative evaluation of ofloxacin and metronidazole in the treatment of bacterial vaginosis. Sex Transm Dis 1993;20:262-4
96. Schwebke JR, Desmond RA. A randomized trial of the duration of therapy with metronidazole plus or minus azithromycin for treatment of symptomatic bacterial vaginosis. Clin Infect Dis 2007;44:213-19
97. Wathne B, Hovelius B, Holst E. Cefadroxil as an alternative to metronidazole in the treatment of bacterial vaginosis. Scand J Infect Dis 1989;21:585-6
98. Larsson PG, Brandsborg E, Forsum U, et al. Extended antimicrobial treatment of bacterial vaginosis combined with human lactobacilli to find the best treatment and minimize the risk of relapses. BMC Infect Dis 2011;11:223
99. Krulewitch CJ. An unexpected adverse drug effect. J Midwifery Womens Health 2003;48:67-8
100. Rosen AD, Rosen T. Study of condom integrity after brief exposure to over-the-counter vaginal preparations. South Med J 1999;92:305-7
101. Voeller B, Coulson AH, Bernstein GS, et al. Mineral oil lubricants cause rapid deterioration of latex condoms. Contraception 1989;39:95-102
102. Trexler MF, Fraser TG, Jones MP. Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream. Am J Gastroenterol 1997;92:2112-13
103. Austin MN, Beigi RH, Meyn LA, et al. Microbiologic response to treatment of bacterial vaginosis with topical clindamycin or metronidazole. J Clin Microbiol 2005;43:4492-7
104. Beigi RH, Austin MN, Meyn LA, et al. Antimicrobial resistance associated with the treatment of bacterial vaginosis. Am J Obstet Gynecol 2004;191:1124-9
105. Bahar H, Torun MM, Ocer F, et al. Mobiluncus species in gynaecological and obstetric infections: antimicrobial resistance and prevalence in a Turkish population. Int J Antimicrob Agents 2005;25:268-71
106. Nagaraja P. Antibiotic resistance of Gardnerella vaginalis in recurrent bacterial vaginosis. Indian J Med Microbiol 2008;26:155-7
107. Schwebke JR. Metronidazole: utilization in the obstetric and gynecologic patient. Sex Transm Dis 1995;22:370-6
108. Simoes JA, Aroutcheva A, Heimler I, et al. Bacteriocin susceptibility of Gardnerella vaginalis and its relationship to biotype, genotype, and metronidazole susceptibility. Am J Obstet Gynecol 2001;185:1186-90
109. Pelosini I, Scarpignato C. Rifaximin, a peculiar rifamycin derivative: established and potential clinical use outside the gastrointestinal tract. Chemotherapy 2005;5:122-30
110. Donders GG, Guaschino S, Peters K, et al. A multicenter, double-blind, randomized, placebo-controlled study of rifaximin for the treatment of bacterial vaginosis. Int J Gynaecol Obstet 2013;120:131-6
111. Cruciani F, Brigidi P, Calanni F, et al. Efficacy of rifaximin vaginal tablets in treatment of bacterial vaginosis: a molecular characterization of the vaginal microbiota. Antimicrob Agents Chemother 2012;56:4062-70
112. Cruciani F, Wasinger V, Turroni S, et al. Proteome profiles of vaginal fluids from women affected by bacterial vaginosis and healthy controls: outcomes of rifaximin treatment. J Antimicrob Chemother 2013;68:2648-59
113. Verstraelen H, Verhelst R, Roelens K, et al. Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review. BMC Infect Dis 2012;12:148
114. Stray-Pedersen B, Bergan T, Hafstad A, et al. Vaginal disinfection with chlorhexidine during childbirth. Int J Antimicrob Agents 1999;12:245-51
115. Della CV, Noll H, Gonser S, et al. Antimicrobial activity of dequalinium chloride against leading germs of vaginal infections. Arzneimittelforschung 2002;52:699-705
116. Petersen EE, Weissenbacher ER, Hengst P, et al. Local treatment of vaginal infections of varying etiology with dequalinium chloride or povidone iodine. A randomised, double-blind, active-controlled, multicentric clinical study. Arzneimittelforschung 2002;52:706-15
117. Weissenbacher ER, Donders GG, Unzeitig V, et al. A comparison of dequalinium chloride vaginal tablets (Fluomizin(R)) and clindamycin vaginal cream in the treatment of bacterial vaginosis: a single-blind, randomized clinical trial of efficacy and safety. Gynecol Obstet Invest 2012;73:8-15
118. Wewalka G, Stary A, Bosse B, et al. Efficacy of povidone-iodine vaginal suppositories in the treatment of bacterial vaginosis. Dermatology 2002;204(Suppl 1):79-85
119. Polatti F. Bacterial vaginosis, Atopobium vaginae and nifuratel. Curr Clin Pharmacol 2012;7:36-40
120. Togni G, Battini V, Bulgheroni A, et al. In vitro activity of nifuratel on vaginal bacteria: could it be a good candidate for the treatment of bacterial vaginosis? Antimicrob Agents Chemother 2011;55:2490-2
121. Mendling W, Caserini M, Palmieri R. A randomized, controlled study to assess the efficacy and safety of nifuratel vaginal tablets on bacterial vaginosis. 8th European conference of the European Society of Infectious Diseases in Obstrics and Gynecology. 25 - 27 October 2013; London; FC VV17, 2013. p.42-3
122. Gomberg MA, Chernova NI, Perlamutrov YN, et al. Is there an alternative to a standard therapy in BV. 8th European conference of the European Society of Infectious Diseases in Obstrics and Gynecology, London, 25 - 27 October 2013 FC VV17, 42- 43.2013. IL28, 59-60. 2013.
123. Verstraelen H, Verhelst R. Bacterial vaginosis: an update on diagnosis and treatment. Expert Rev Anti Infect Ther 2009;7:1109-24
124. Holley RL, Richter HE, Varner RE, et al. A randomized, double-blind clinical trial of vaginal acidification versus placebo for the treatment of symptomatic bacterial vaginosis. Sex Transm Dis 2004;31:236-8
125. Chaithongwongwatthana S, Limpongsanurak S, Sitthi-Amorn C. Single hydrogen peroxide vaginal douching versus single-dose oral metronidazole for the treatment of bacterial vaginosis: a randomized controlled trial. J Med Assoc Thai 2003;86(Suppl 2):S379-84
126. Boeke AJ, Dekker JH, van Eijk JT, et al. Effect of lactic acid suppositories compared with oral metronidazole and placebo in bacterial vaginosis: a randomised clinical trial. Genitourin Med 1993;69:388-92
127. Fiorilli A, Molteni B, Milani M. Successful treatment of bacterial vaginosis with a policarbophil-carbopol acidic vaginal gel: results from a randomised double-blind, placebo-controlled trial. Eur J Obstet Gynecol Reprod Biol 2005;120:202-5
128. Polatti F, Rampino M, Magnani P, et al. Vaginal pH-lowering effect of locally applied vitamin C in subjects with high vaginal pH. Gynecol Endocrinol 2006;22:230-4
129. Petersen EE, Magnani P. Efficacy and safety of vitamin C vaginal tablets in the treatment of non-specific vaginitis. A randomised, double blind, placebocontrolled study. Eur J Obstet Gynecol Reprod Biol 2004;117:70-5
130. Petersen EE, Genet M, Caserini M, et al. Efficacy of vitamin C vaginal tablets in the treatment of bacterial vaginosis: a randomised, double blind, placebo controlled clinical trial. Arzneimittelforschung 2011;61:260-5
131. Zodzika J, Rezeberga D, Donders G, et al. Impact of vaginal ascorbic acid on abnormal vaginal microflora. 2013;288:1039-44
132. Witkin SS, Alvi S, Bongiovanni AM, et al. Lactic acid stimulates interleukin- 23 production by peripheral blood mononuclear cells exposed to bacterial lipopolysaccharide. FEMS Immunol Med Microbiol 2011;61:153-8
133. Mossop H, Linhares IM, Bongiovanni AM, et al. Influence of lactic acid on endogenous and viral RNA-induced immune mediator production by vaginal epithelial cells. Obstet Gynecol 2011;118:840-6
134. Coste I, Judlin P, Lepargneur JP, et al. Safety and efficacy of an intravaginal prebiotic gel in the prevention of recurrent bacterial vaginosis: a randomized double-blind study. Obstet Gynecol Int 2012;2012:147867
135. Reid G, Bocking A. The potential for probiotics to prevent bacterial vaginosis and preterm labor. 2003;189:1202-8
136. Reid G, Charbonneau D, Erb J, et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol 2003;35:131-4
137. Mastromarino P Brigidi P, Macchia S, et al. Characterization and selection of vaginal Lactobacillus strains for the preparation of vaginal tablets. J Appl Microbiol 2002;93:884-93
138. Mastromarino P, Macchia S, Meggiorini L, et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clin Microbiol Infect 2009;15:67-74
139. Anukam KC, Osazuwa E, Osemene GI, et al. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect 2006;8:2772-6
140. Donders GG, Van Bulck B, Van de Walle P, et al. Effect of lyophilized lactobacilli and 0.03 mg estriol (Gynoflor(R)) on vaginitis and vaginosis with disrupted vaginal microflora: a multicenter, randomized, single-blind, active-controlled pilot study. Gynecol Obstet Invest 2010;70:264-72
141. Ozkinay E, Terek MC, Yayci M, et al. The effectiveness of live lactobacilli in combination with low dose oestriol (Gynoflor) to restore the vaginal flora after treatment of vaginal infections. BJOG 2005;112:234-40
142. Petricevic L, Witt A. The role of Lactobacillus casei rhamnosus Lcr35 in restoring the normal vaginal flora after antibiotic treatment of bacterial vaginosis. BJOG 2008;115:1369-74
143. Martinez RC, Franceschini SA, Patta MC, et al. Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial. Can J Microbiol 2009;55:133-8
144. Anukam K, Osazuwa E, Ahonkhai I, et al. Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial. Microbes Infect 2006;8:1450-4
145. Larsson PG, Stray-Pedersen B, Ryttig KR, et al. Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebocontrolled study. BMC Womens Health 2008;8:3-6
146. Falagas ME, Betsi GI, Athanasiou S. Probiotics for the treatment of women with bacterial vaginosis. Clin Microbiol Infect 2007;13:657-64
147. Sobel JD, Ferris D, Schwebke J, et al. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol 2006;194:1283-9
148. Hay PE, Lamont RF, Taylor-Robinson D, et al. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ 1994;308(6924):295-8
149. Krasnopolsky VN, Prilepskaya VN, Polatti F, et al. Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis: a randomised, double-blind, placebo-controlled clinical trial. J Clin Med Res 2013;5:309-15
150. Banhidy F, Acs N, Puho EH, et al. Rate of preterm births in pregnant women with common lower genital tract infection: a population-based study based on the clinical practice. J Matern Fetal Neonatal Med 2009;22:410-18
151. Lee SE, Romero R, Kim EC, et al. A high Nugent score but not a positive culture for genital mycoplasmas is a risk factor for spontaneous preterm birth. J Matern Fetal Neonatal Med 2009;22:212-17
152. Donati L, Di VA, Nucci M, et al. Vaginal microbial flora and outcome of pregnancy. Arch Gynecol Obstet 2010;281(4):589-600
153. Verstraelen H, Verhelst R, Claeys G, et al. Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and/or L. iners are more conducive to the occurrence of abnormal vaginal microflora. BMC Microbiol 2009;9:116-20
154. Villar J, Gulmezoglu AM, de Onis M. Nutritional and antimicrobial interventions to prevent preterm birth: an overview of randomized controlled trials. Obstet Gynecol Surv 1998;53:575-85
155. McDonald H, Brocklehurst P, Parsons J. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2005;(1):CD000262
156. Nygren P, Fu R, Freeman M, et al. Evidence on the benefits and harms of screening and treating pregnant women who are asymptomatic for bacterial vaginosis: an update review for the U.S. Preventive Services Task Force. Ann Intern Med 2008;148:220-33
157. Okun N, Gronau KA, Hannah ME. Antibiotics for bacterial vaginosis or Trichomonas vaginalis in pregnancy: a systematic review. Obstet Gynecol 2005;105:857-68
158. Riggs MA, Klebanoff MA. Treatment of vaginal infections to prevent preterm birth: a meta-analysis. Clin Obstet Gynecol 2004;47:796-807
159. Simcox R, Sin WT, Seed PT, et al. Prophylactic antibiotics for the prevention of preterm birth in women at risk: a meta-analysis. Aust N Z J Obstet Gynaecol 2007;47:368-77
160. Varma R, Gupta JK. Antibiotic treatment of bacterial vaginosis in pregnancy: multiple meta-analyses and dilemmas in interpretation. Eur J Obstet Gynecol Reprod Biol 2006;124:10-14
161. Guise JM, Mahon SM, Aickin M, et al. Screening for bacterial vaginosis in pregnancy. Am J Prev Med 2001;20(3 Suppl 1):62-72
162. McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2007;(1):CD000262
163. Morency AM, Bujold E. The effect of second-trimester antibiotic therapy on the rate of preterm birth. J Obstet Gynaecol Can 2007;29:35-44
164. Carey JC, Klebanoff MA, Hauth JC, et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med 2000;342:534-40
165. Klebanoff MA, Carey JC, Hauth JC, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med 2001;345:487-93
166. Odendaal HJ, Popov I, Schoeman J, et al. Preterm labour-is bacterial vaginosis involved? S Afr Med J 2002;92:231-4
167. Kurkinen-Raty M, Vuopala S, Koskela M, et al. A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis. BJOG 2000;107:1427-32
168. Guaschino S, Ricci E, Franchi M, et al. Treatment of asymptomatic bacterial vaginosis to prevent pre-term delivery: a randomised trial. Eur J Obstet Gynecol Reprod Biol 2003;110:149-52
169. Joesoef MR, Hillier SL, Wiknjosastro G, et al. Intravaginal clindamycin treatment for bacterial vaginosis: effects on preterm delivery and low birth weight. Am J Obstet Gynecol 1995;173:1527-31
170. Kekki M, Kurki T, Pelkonen J, et al. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001;97:643-8
171. Lamont RF, Jones BM, Mandal D, et al. The efficacy of vaginal clindamycin for the treatment of abnormal genital tract flora in pregnancy. Infect Dis Obstet Gynecol 2003;11:181-9
172. Larsson PG, Fahraeus L, Carlsson B, et al. Late miscarriage and preterm birth after treatment with clindamycin: a randomised consent design study according to Zelen. BJOG 2006;113:629-37
173. Ugwumadu A, Manyonda I, Reid F, et al. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial. Lancet 2003;361:983-8
174. Brocklehurst P, Gordon A, Heatley E, et al. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2013;(1):CD000262
175. Holst E, Brandberg A. Treatment of bacterial vaginosis in pregnancy with a lactate gel. Scand J Infect Dis 1990;22:625-6
176. Othman M, Neilson JP, Alfirevic Z. Probiotics for preventing preterm labour. Cochrane Database Syst Rev 2007;(1):CD005941
177. Pheifer TA, Forsyth PS, Durfee MA, et al. Nonspecific vaginitis: role of Haemophilus vaginalis and treatment with metronidazole. N Engl J Med 1978;298:1429-34
178. Baloglu E, Ozyazici M, Baloglu A, et al. A randomized controlled trial of a new ovule formulation of ornidazole for the treatment of bacterial vaginosis. J Clin Pharm Ther 2003;28:131-6
179. Nunez JT, Gomez G. Low-dose secnidazole in the treatment of bacterial vaginosis. Int J Gynaecol Obstet 2005;88:281-5
180. Greaves WL, Chungafung J, Morris B, et al. Clindamycin versus metronidazole in the treatment of bacterial vaginosis. Obstet Gynecol 1988;72:799-802