Treatment of sexually transmitted vaginosis/vaginitis

Although much has been learned about sexually transmissible forms of vaginitis/vaginosis during the past decade, therapeutic options for these disorders remain limited. A single 2-g oral dose of metronidazole still remains highly effective against most Trichomonas vaginalis infections. Mildly resistant infections can usually be cured with metronidazole oral doses of 2 g daily for 3-7 days. When highly resistant infections occur, toxic levels of metronidazole may be needed for the drug to cure the infection. Metronidazole (500 mg twice daily for 7 days) continues to be highly efficacious in the treatment of bacterial vaginosis. Shorter oral treatment regimens that use single 2-g doses of metronidazole for 2-3 days appear promising but may be associated with higher relapse rates. Oral clindamycin (300 mg twice daily) or local 2% clindamycin cream (once daily for 7 days) also may be effective. Metronidazole intravaginal sponges (250-1,000 mg) used for 3 days may also be effective in the treatment of bacterial vaginosis.