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Lessons from Suppressive Therapy and Periodic Presumptive Treatment for Bacterial Vaginosis

  • Female Genital Tract Infections (J Sobel, Section Editor)
  • Published:
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Abstract

Purpose of Review

Suppressive 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 Findings

Among 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 frequency 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.

Summary

Given the high prevalence of BV globally and burden of adverse reproductive health outcomes among women with BV, there is a critical need for more effective treatments that produce durable shifts in the microbiota towards vaginal health.

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Authors and Affiliations

  1. Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Box 357236, Seattle, WA, 98195, USA

    Jennifer E. Balkus, Kayla A. Carter & R. Scott McClelland

  2. Department of Global Health, University of Washington, Seattle, WA, USA

    Jennifer E. Balkus & R. Scott McClelland

  3. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Jennifer E. Balkus

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    R. Scott McClelland

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Correspondence to Jennifer E. Balkus.

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JEB has received honoraria for consulting from BD and Lupin Pharmaceuticals. RSM currently receives research funding from Hologic/Gen-Probe and has received honoraria for consulting from Lupin Pharmaceuticals.

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Balkus, J.E., Carter, K.A. & McClelland, R.S. Lessons from Suppressive Therapy and Periodic Presumptive Treatment for Bacterial Vaginosis. Curr Infect Dis Rep 21, 34 (2019). https://doi.org/10.1007/s11908-019-0688-3

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