Bacterial vaginosis

Vaginal flora dysbiosis with anaerobic predominance and reduced lactobacilli. Symptoms — grayish-white discharge with a fishy odor. Treatment — oral or vaginal metronidazole.

ICD-10 N762 drugs

Also known as: BV

Drugs used for this condition

AMetronidazoleFirst line · Imidazole derivatives (antiprotozoal / antibacterial)First-line for bacterial vaginosis per CDC STI 2021 and ACOG. Oral 500 mg twice daily for 7 days or intravaginal 0.75 % gel 5 g once daily for 5 days. Alternative – clindamycin. Partner treatment is not indicated in BV (BV is not strictly an STI).

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

DLactobacillus rhamnosus GG (LGG)Not recommended · Probiotic, Lacticaseibacillus rhamnosus GG strain. Supplement in Russia and Spain; in the EU and US available as food supplement or medical food; AEMPS does not register it as a medicineLGG is offered in bacterial vaginosis as «vaginal microbiota restoration after metronidazole» or monotherapy. WHO STI 2021 and IUSTI 2018 list metronidazole 500 mg twice daily × 7 days oral or metronidazole 0.75% vaginal gel × 5 days or clindamycin 2% cream × 7 days first-line for bacterial vaginosis. Probiotics (including LGG and L. crispatus) – option with limited evidence base; small RCTs showed heterogeneous results with adjunct post-antibiotic use to reduce recurrence rates. In women with recurrent BV, STI workup (chlamydia, gonorrhoea, trichomoniasis) and risk factor discussion (new or multiple sexual partners, douching) are mandatory. If LGG was recommended as a metronidazole substitute or without diagnostic confirmation (Amsel criteria or Nugent score), consider seeking a second opinion from a gynaecologist.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit