What are the recommended first-line treatment options for bacterial vaginosis in pregnant women?

Recommended first-line treatment options for bacterial vaginosis in pregnant women who are symptomatic include:

• Oral metronidazole 400 mg twice daily for 5 to 7 days is the preferred treatment.
• High-dose single oral dose (2 g) metronidazole is not recommended during pregnancy.
• If oral metronidazole is not tolerated or the woman prefers topical treatment, intravaginal metronidazole gel 0.75% once daily for 5 days or intravaginal clindamycin cream 2% once daily for 7 days (only in the second or third trimester) can be prescribed.
• Oral clindamycin is an alternative in the second and third trimesters but is less preferred.

Asymptomatic pregnant women are not routinely screened or treated for bacterial vaginosis unless they are undergoing termination of pregnancy or advised by an obstetrician.

Repeat testing and further treatment may be considered if symptoms persist after initial therapy, in consultation with the woman’s obstetrician.

Women should also be advised to reduce exposure to contributing factors such as smoking, vaginal douching, and use of antiseptics or bubble baths.

These recommendations are based on UK national guidelines from the British Association for Sexual Health and HIV (BASHH) and other expert bodies.