Indications for Therapy and Treatment Recommendations for Bacterial Vaginosis in Nonpregnant and Pregnant Women: A Synthesis of Data

Koumans, Emilia H.; Markowitz, Lauri E.; Hogan, Vijaya K.

doi:10.1086/342103

Cited by 147 publications

(104 citation statements)

References 104 publications

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“…The prevalence of BV on women from low socioeconomic stratum in USA was slightly lower than that in other reports from sub-Saharan Africa which ranged between 11% -30%. [13] However, this may be attributable to low poverty index among women from sub-Saharan Africa. In addition, the magnitude of BV was slightly higher among women with no formal training 33.3% this being in agreement with a study among STI clients within Nairobi area, were prevalence of 35.0% was reported.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Vaginosis and Correlates in Women of Reproductive Age in Thika, Kenya

Nzomo¹,

Waiyaki²,

Waihenya³

2013

AiM

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Background: Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge among women of childbearing age which is associated with STI/HIV and adverse birth outcomes. The Main objective of this study was to determine the prevalence and correlates of BV among women of reproductive age in Thika. Methods: Between July 2010 and February 2011, 193 women of reproductive age (18 -49 years) were enrolled from family planning and ante-natal clinics in Thika District Hospital, Kenya. The study was descriptive cross sectional in which organisms were identified from vaginal specimens using culture, biochemical testing and Nugent score method. Statistical analyses included conventional descriptive statistics and multivariable analysis using regression. Results: Of one hundred and ninety three specimens, 9.3% were Mobiluncus isolates, 23.0% Bacteriodes species and 67.7% Gardnerella vaginalis. Among the study participants, 77.7% had non-classical BV with a score of 7 -8 while 22.3% classical BV with a score of 9 -10 indicating complete depletion of Lactobacillus species. Whiff test was positive for 89.1% (74) of the 83 patients with BV. Though, 32.5% of women with BV had a vaginal pH of more than 4.5, only 66.0% of women fulfilling the criteria of BV had a characteristic discharge. Conclusions: In this population, the prevalence of BV was relatively high when compared with other community settings. BV was associated with condom use and multiple sexual partners. Further research is needed to understand their role in BV and the socioeconomic context surrounding the condition in Kenya.

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Section: Discussionmentioning

confidence: 99%

Bacterial Vaginosis and Correlates in Women of Reproductive Age in Thika, Kenya

Nzomo¹,

Waiyaki²,

Waihenya³

2013

AiM

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“…15 This management is based on evidence of optimal treatment effect for each condition, and would minimize metronidazole use in pregnancy if the women were treated for only one of the conditions. 13,37,42 However, as an etiological diagnosis cannot be made in primary health care, this strategy requires the prescription of two regimens to pregnant women with vaginal discharge -a situation that is both confusing and unnecessary. According to recently updated guidelines from the Centers for Disease Control and Prevention, metronidazole 500 mg twice daily for 7 days is the only regimen which effectively treats both conditions.…”

Section: Adherence To the Syndromic Management Treatment Guidelinesmentioning

confidence: 99%

“…5,[10][11][12] However, antibiotic treatment for BV may reduce the risk of low birth weight and preterm rupture of the membranes among pregnant women with previous preterm deliveries. 13 Provision of treatment for TV or BV in symptomatic pregnant women has not been adequately evaluated. 11,12 Diagnosis of TV and BV in women in sub-Saharan Africa is based on the vaginal discharge syndrome -the most common syndrome in the syndromic approach (i.e.…”

Section: Introductionmentioning

confidence: 99%

Trichomoniasis and bacterial vaginosis in pregnancy: inadequately managed with the syndromic approach

Romøren

Velauthapillai

Rahman³

et al. 2007

Bull World Health Organ

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Objective To measure the prevalence of Trichomonas vaginalis (TV) infection and bacterial vaginosis (BV) among pregnant women in Botswana, and to evaluate the syndromic approach and alternative management strategies for these conditions in pregnancy. Methods In a cross-sectional study, 703 antenatal care attendees were interviewed and examined, and specimens were collected to identify TV, BV, Candida species, Chlamydia trachomatis and Neisseria gonorrhoeae. Information on reproductive tract infections earlier in pregnancy was obtained from a structured interview and the antenatal record. Findings TV was found in 19% and BV in 38% of the attendees. Three-fourths of women with TV or BV were asymptomatic. Syndromic management according to the vaginal discharge algorithm would lead to substantial under-diagnosis and over-treatment of TV and BV. Signs of vaginal discharge were more predictive of the presence of these conditions than were symptoms. Among the 546 attendees on a repeat antenatal visit, 142 (26%) had been diagnosed with vaginal discharge earlier in their pregnancy -14 of them twice. In 143 cases, an attendee was diagnosed with vaginal discharge in the second or third trimester; however, metronidazole had been prescribed only 17 times (12%). Conclusion Diagnosis and treatment of TV and BV among pregnant women in sub-Saharan Africa presents major challenges. Half the pregnant women in this study were diagnosed with TV or BV, but these conditions were not detected and treated during antenatal care with syndromic management. Also, health workers did not adhere to treatment guidelines. These results indicate that management guidelines for TV and BV in antenatal care should be revised.

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“…17,18 We defined BV using the Nugent score which, compared to the Amsel criteria, is simpler, more reproducible, and has reasonable sensim m tivity and specificity. 15,[19][20][21] The standard treatment of BV is a 7mday course of metronidazole; singlemdose metronidam m zole is slightly less effective. 2,[20][21][22][23] The effectiveness of singlemdose metronidam m zole in women with BV is lower among those who are seropositive for HIV than in those who are seronegative.…”

Section: Discussionmentioning

confidence: 99%

“…15,[19][20][21] The standard treatment of BV is a 7mday course of metronidazole; singlemdose metronidam m zole is slightly less effective. 2,[20][21][22][23] The effectiveness of singlemdose metronidam m zole in women with BV is lower among those who are seropositive for HIV than in those who are seronegative. 18 BV, an infection characterized by frequent relapses after initial improvement, has been the limiting step in the overall management of vaginal discharge with singlemdose therapies.…”

Section: Discussionmentioning

confidence: 99%

The syndromic management of vaginal discharge using only single-dose treatments: a randomized controlled trial in West Africa

Pépin

Sobela²,

Khonde³

et al. 2006

Bull World Health Organ

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Objective To evaluate whether single-dose treatments are as effective as standard therapy in the syndromic management of vaginal discharge. Methods A randomized controlled effectiveness trial compared single-dose tinidazole plus fluconazole (TF) with treatment for 7 days with metronidazole plus 3 days of treatment with vaginal clotrimazole (MC) among 1570 women presenting with vaginal discharge at primary health care institutions in Ghana, Guinea, Mali and Togo. Participants were randomly allocated to one of the two treatments by research nurses or physicians using precoded envelopes. Effectiveness was assessed by symptomatic response on day 14. Clinical identifier ClinicalTrials.gov NCT00313131. Findings The two treatment regimens had similar effectiveness: complete resolution was seen in 66% (TF) and 64% (MC) and partial resolution in 33% (TF) and 34% (MC) of participants (P = 0.26). Effectiveness was similar among subgroups with vulvovaginal candidiasis, Trichomonas vaginalis vaginitis or bacterial vaginosis. The two treatment regimens had a similar effectiveness among human immunodeficiency virus (HIV)-infected (TF: n = 76, 71% complete resolution, 28% partial; MC: n = 83, 72% complete resolution, 25% partial, P = 0.76) and HIV-uninfected women (TF: n = 517, 68% complete, 32% partial; MC: n = 466, 65% complete, 33% partial, P = 0.20). Cervical infections with Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium were uncommon among women not involved in sex work, were associated with bacterial vaginosis or T. vaginalis vaginitis, and did not alter response to treatment with agents active against vaginal infections. Four-fifths of women not relieved by a single dose of TF had a favourable response when MC was administered as second-line treatment. Conclusion Single-dose TF is as effective as multiple-dose MC in the syndromic management of vaginal discharge, even among women with HIV-infection. Given its low price and easier adherence, TF should be considered as a first-line treatment for vaginal discharge syndrome. Voir page 736 le résumé en français. En la página 736 figura un resumen en español.

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Indications for Therapy and Treatment Recommendations for Bacterial Vaginosis in Nonpregnant and Pregnant Women: A Synthesis of Data

Cited by 147 publications

References 104 publications

Bacterial Vaginosis and Correlates in Women of Reproductive Age in Thika, Kenya

Bacterial Vaginosis and Correlates in Women of Reproductive Age in Thika, Kenya

Trichomoniasis and bacterial vaginosis in pregnancy: inadequately managed with the syndromic approach

The syndromic management of vaginal discharge using only single-dose treatments: a randomized controlled trial in West Africa

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