Lessons from Suppressive Therapy and Periodic Presumptive Treatment for Bacterial Vaginosis

AbstractPurpose of ReviewSuppressive therapy and periodic presumptive treatment (PPT) are distinct but related strategies that have been used to reduce the incidence of bacterial vaginosis (BV). Here, we review clinical trial evidence of the effectiveness of suppressive therapy and PPT to reduce BV, and discuss their roles for women who frequently experience symptomatic or asymptomatic BV.Recent FindingsAmong women who were recently and successfully treated for symptomatic BV, suppressive therapy with twice-weekly metronidazole gel for 16  weeks reduces the likelihood of recurrent symptomatic BV and is currently recommended by the Centers for Disease Control and Prevention for prevention of recurrent BV. The premise of PPT is to provide regimens used to treat BV at regular intervals to reduce the overall frequency of BV, regardless of symptoms. Three PPT trials were conducted using different routes (oral or intravaginal), doses, and frequencies of administration. Each trial demonstrated a significant reduction in BV over the course 12 months, ranging from a 10 to 45% decrease. PPT regimens that substantially reduce the freque ncy of BV over time could be evaluated in clinical trials to assess whether a reduced frequency of BV leads to subsequent reductions in BV-associated sequelae. While both suppressive therapy and PPT reduce BV, their impact wanes following cessation of the regimen.SummaryGiven the high prevalence of BV globally and burden of adverse reproductive health ...
Source: Current Infectious Disease Reports - Category: Infectious Diseases Source Type: research