Symptomatic cases should be treated. Treatment is not required for asymptomatic disease, as this condition can often resolve spontaneously, but is recommended before gynaecological procedures and considered in pregnant women with a history of preterm labour.
- Metronidazole 400 mg orally, 12-hourly with food for 5 days
- Metronidazole 2 g orally, as a single dose (less effective)
- Metronidazole gel 0.75 per cent gel 5 g, nocte for 5 nights (not on PBS)
- Tinidazole 2 g orally, as a single dose with food
- Clindamycin 2 per cent vaginal cream 5 g, daily for 7 days (not on PBS)
- Clindamycin 300 mg orally, 12-hourly for 7 days (not on PBS).
Advise avoidance of alcohol with either metronidazole or tinidazole treatment and for 24 hours thereafter. Clindamycin cream is oil-based and may weaken latex condoms and diaphragms.
Single dose therapy is not recommended.
- Clindamycin 300 mg orally, 12-hourly for 7 days (category A)
- metronidazole 400 mg orally, 12-hourly for 5 days (category B2). Metronidazole can be used in the first trimester of pregnancy where the benefits outweigh the potential risks.
- Medicines in pregnancy.
Systemic treatment is better in pregnancy and as clindamycin cream may not treat the upper genital tract adequately, oral therapy is preferred.