Purpose To evaluate the efficacy of nifuratel plus nystatin combination in the treatment of patients with bacterial vaginosis (BV) associated with A. vaginae.

Methods A prospective comparative study on the clinical efficacy, safety and tolerability of nifuratel plus nystatin combination was performed in patients with A. vaginae-associated BV. A total of 197 women meeting the inclusion/exclusion criteria and 20 healthy women (the control group) were examined. BV was diagnosed in 148 out of 197 women with vaginal discharge (according to Amsel criteria). The diagnosis of BV was not confirmed in 49 patients and they were excluded from the study. Patients were randomised to receive intravaginal treatment with suppositories containing a combination of nifuratel (500 mg) and nystatin (200,000 IU) at night for 8 days (group 1) or standard treatment with suppositories containing metronidazole (500 mg) twice daily (in the morning and at night) for 10 consecutive days (group 2). Treatment results in both groups were compared one week after the end of therapy. Control test of cure with respect to A. vaginae was carried out by PCR one month after the end of therapy.

Results PCR assay detected A. vaginae in 83 (56%) out of 148 BV cases and in none from the control group (p < 0.01). In patients with A. vaginae-associated BV efficacy of the nifuratel plus nystatin combination was 90.3%, while standard metronidazole therapy was ineffective (cure in only 10% of cases).

Conclusion A. vaginae may be an additional marker of BV. Combination of nifuratel with nystatin was much more effective than standard intravaginal administration of metronidazole in the treatment of A. vaginae-associated BV.