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Monthly treatment reduced risk for recurrent bacterial vaginosis
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Monthly treatment with a regimen of intravaginal metronidazole and miconazole reduced the risk for recurrent bacterial vaginosis, according to study findings published in the Journal of Infectious Diseases.
“Vaginal infections are common, frequently recur, and have been associated with increased risk for HIV and other sexually transmitted infections,” R. Scott McClelland, MD, MPH, professor of medicine, epidemiology and global health at the University of Washington, told Infectious Disease News. “The results of this trial are an intermediate step in research designed to understand whether preventing vaginal infections, particularly bacterial vaginosis, can reduce women’s risk of acquiring STDs.”
R. Scott McClelland
McClelland and colleagues evaluated periodic presumptive treatment among 234 HIV-negative women aged 18 to 45 years with at least one vaginal infection, including bacterial vaginosis, vulvovaginal candidiasis or Trichomonas vaginalis. The women were randomly assigned to treatment with vaginal suppositories that included 750 mg metronidazole plus 200 mg miconazole or placebo. They received the treatment for 5 consecutive nights monthly for 12 months. The researchers tested for bacterial vaginosis and vulvovaginal candidiasis at follow-up visits in months 2, 4, 6, 8, 10 and 12.
The monthly treatment reduced the risk for bacterial vaginosis by 35% (RR=0.65; 95% CI, 0.48-0.87) compared with placebo, but did not change the risk for vulvovaginal candidiasis. The risk for any vaginal infection was lower in the treatment arm compared with the placebo arm (RR=0.7; 95% CI, 0.57-0.86). Adverse events did not vary significantly, except for vaginal discharge and headache, which occurred less frequently in the treatment arm.
“This phase 2 trial suggests that the intervention could be evaluated in a phase 3 trial to determine whether periodic presumptive treatment to reduce bacterial vaginosis results in lower incidence of other STDs, such as gonorrhea, chlamydia, Mycoplasma genitalium and herpes,” McClelland said. – by Emily Shafer
Disclosure: McClelland has received honoraria, consulting and donated study products for this study from Embil Pharmaceutical, and he received research funding from Hologic/Gen-Probe.
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