Bacterial vaginosis (BV) is a common, complex clinical syndrome characterized by alterations
in the normal vaginal flora. Bacterial vaginosis has been associated with a variety of
adverse health outcomes including endometritis; post-abortion endometritis; nongonococcal,
nonchlamydial pelvic inflammatory disease; and an increased risk of acquiring and
transmitting HIV infection. In pregnancy, BV is associated with premature rupture of the
membranes, chorioamnionitis, amniotic fluid infection, preterm labor, preterm birth, and
postpartum endometritis. Several studies have documented increased postpartum complications
in the newborn and infants. The etiology of BV is poorly understood but recurrence is quite
common despite treatment. Documented recurrence rate of up to 30% within three months are
reported. Small studies have shown that adding vaginal acidifying gel to standard antibiotic
regimens may reduce recurrence rates of BV. We plan an RCT comparing standard antibiotic
therapy to antibiotics plus vaginal acidifying gel. Our hypothesis is that the addition of
an acidifying gel will decrease the chance of recurrence of BV within 3 months.
Women with recurrent BV will be randomly assigned to standard care of metronidazole vs
metronidazole plus vaginal acidifying gel. Symptoms and presence of BV will be measured at
1. All women of between 18-50 years of age.
2. Confirmed current diagnosis of BV using Amsel's criteria.
3. Women with at least total 2 confirmed episodes of BV including most recent episode
(by Amsel's criteria) within a six month period or at least total three or more in
the past twelve months
1. Patient who received antibiotic therapy within the past two weeks.
2. Patients who had co-existing gonorrhea or Chlamydia infection
3. Any contraindications or sensitivity to taking the vaginal gel.
4. Allergy to metronidazole
5. Alcoholics or those unable to abstain from alcohol consumption.