Treatment options for bacterial vaginosis (nonpregnant females or persons with a vagina)

Drugs of choice

Metronidazole 500 mg orally twice daily for 7 days OR

Metronidazole gel 0.75% 5 g* (one full applicator) intravaginally once daily for 5 days OR

Clindamycin 2% cream 5 g^¶ (one full applicator) intravaginally at bedtime for 7 days

Alternatives

Clindamycin 300 mg orally twice daily for 7 days OR

Clindamycin ovule (vaginal suppository) 100 mg intravaginally once daily for 3 days OR

Tinidazole 2 g orally for 2 days OR

Tinidazole 1 g orally once daily for 5 days OR

Secnidazole 2 g packet orally once

Although data are limited, metronidazole 750 mg extended release tablets once daily for 7 days OR a single vaginal dose of clindamycin 2% bioadhesive cream (United States trade name: Clindesse) 5 g^¶, one full applicator, also appear to be effective. Tinidazole and secnidazole are alternative therapies as they tend to be less available and more costly.

* 5 grams of metronidazole 0.75% vaginal gel contains 37.5 mg of metronidazole.
¶ 5 grams of clindamycin 2% vaginal cream contains 100 mg of clindamycin.

Adapted from: Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.

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Treatment options for bacterial vaginosis (nonpregnant females or persons with a vagina)