CDC Recommends Once-A-Day MetroGel-Vaginal® (metronidazole vaginal gel, 0.75%) as First-Line Therapy for BV
CDC Releases 2002 Treatment Guidelines for Sexually Transmitted Diseases
June 6, 2002 - The most widely prescribed intravaginal treatment for bacterial vaginosis (BV),
MetroGel-Vaginal® (metronidazole vaginal gel, 0.75%), is again recommended as first-line treatment for BV,
according to the newly released Sexually Transmitted Disease (STD) Treatment Guidelines from the
Centers for Disease Control (CDC) and the US Department of Health and Human Services.
Last released in 1998, the new guidelines uphold the CDC’s original treatment guidelines establishing
the recommended standard treatment for BV for health care professionals. “The CDC continues to support
the use of MetroGel-Vaginal as a first-line therapy for bacterial vaginosis,” says David Soper, MD,
Professor and Director of the Division of Gynecology at the Medical University of South Carolina and
CDC Guideline panelist. “The short five-day therapy can lend to improved patient compliance while maintaining
a high efficacy rate.”
MetroGel-Vaginal is an intravaginal formulation of metronidazole. MetroGel-Vaginal provides effective,
site-specific therapy with minimal incidence of common and sometimes severe side effects often associated with
oral metronidazole including nausea, vomiting, gastrointestinal upset and metallic after-taste.
The most commonly reported side effects for MetroGel-Vaginal include vaginal discharge [12%],
Candida cervicitis/vaginitis [6% to 10%], vulvovaginal irritation [9%], gastrointestinal discomfort [7%],
and headache [5%].
MetroGel-Vaginal is a water-based gel formulated to a pH of 4.0, the pH of a normal healthy vagina.
Moreover, unlike broad-spectrum antibiotics, MetroGel-Vaginal does not destroy protective bacteria such as
lactobacilli. Lactobacilli minimize the overgrowth of pathogenic bacteria and yeast in the normal vagina.
Bacterial vaginosis affects millions of women each year and is more common than yeast infections.
Yet BV is considered to be significantly underdiagnosed. Moreover, unlike yeast infections,
increasing clinical evidence may associate BV with pelvic inflammatory disease, cervicitis, abnormal cytology,
pregnancy complications, postoperative infection and an increased risk of acquiring HIV and other
sexually transmitted diseases.
In addition to MetroGel-Vaginal, the CDC also recommends the oral form of metronidazole or intravaginal clindamycin cream as first-line therapies for BV.
As for alternative treatment regimens, the CDC includes clindamycin ovules, a single-dose oral metronidazole and a seven-day oral clindamycin regimen. According to the guidelines, alternative regimens have lower efficacy for BV than do the first-line recommended regimens.
Women Often Mistake BV for Yeast
Recent studies suggest that many women with BV may incorrectly treat themselves with nonprescription yeast remedies and over-the-counter products, rather than seeking appropriate diagnosis and treatment from their health care providers.* The outward signs of BV may include increased vaginal discharge, foul or “fishy” odor and vaginal itching or burning. However, these signs can vary and may not be present at all times. The CDC Guidelines provide criteria for diagnosing BV, including a vaginal pH level 4.5 and above, a positive KOH whiff test, increased vaginal discharge and the presence of “clue” cells -- epithelial cells coated with bacteria -- seen in a vaginal discharge sample viewed under a microscope.
Bacterial vaginosis is caused by a disruption in the bacterial flora of the vagina. Women with the disease have mixed, predominantly anaerobic flora, including 100 to 1,000 times more bacteria than in a healthy vagina, which is usually dominated by lactobacilli that protect against infection.
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For the new STD Treatment Guidelines visit www.cdc.gov.
Health care professionals and patients interested in receiving additional information about MetroGel-Vaginal can call 1-800-4BV-NEWS (1-800-428-6397).
* Ferris DG, Nyirjesy P, Sobel JD, et al. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol (United States), Mar 2002, 99(3) p419-25.