For Recurrent Bacterial Vaginosis, Simplified Once-Weekly Treatment Found More Effective than CDC-Recommended Regimen
Secnidazole granules reduced recurrence rates to 20% over a period of 28 weeks in a small prospective pilot study, outperforming cumbersome daily regimens.
A simplified treatment regimen of once-weekly oral secnidazole granules reduced the recurrence rate of bacterial vaginosis (BV) to 20% over a 28-week period in a small pilot study. Researchers emphasized the marked improvement when compared to recurrence rates of 35% to 70% reported in treatment guidelines for recurrent BV (RBV) from the US CDC.1
The study of the streamlined suppressive regimen and the results were presented at the 2025 American College of Obstetricians and Gynecologists (ACOG) Clinical & Scientific Meeting, May 16 t o18, 2025, in Minneapolis, MN.
Current CDC guidelines for treatment of RBV recommend metronidazole 500 mg orally 2 times/day for 7 days or metronidazole gel 0.75% one full applicator (5 g) intravaginally, once a day for 5 days or Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days.2 “Patient compliance with complicated treatment regimens is a barrier to successful outcomes,” wrote authors in the study abstract. They stress that simplified treatment protocols could help improve patient compliance and reduce recurrent disease.1
For the prospective longitudinal study, presenting author Chemen M Neal, MD, associate clinical professor in obstetrics and gynecology at Indiana University School of Medicine, and colleagues enrolled 24 women aged 18 to 50 years, excluding those who failed initial therapy, had co-infections, were pregnant or breastfeeding, or had contraindications to secnidazole. Four patients were deemed ineligible, and five failed initial therapy. The remaining 15 participants entered the suppressive treatment phase, receiving once-weekly secnidazole for 16 weeks. The group was followed for 3 months post-treatment.
Diagnosis and response rate were determined using Amsel’s criteria (score of 3 or higher) and Nugent score (7 or greater), Neal et al reported. Three of 15 participants (20%) experienced recurrence during the total 28-week study period, markedly favorable to historic recurrence rates of 51% (26/51), 70% (7/10), and 35%, cited in CDC guidelines, the researchers reported. The side effect reported most frequently among study participants was yeast infection.
Secnidazole is an orally administered broad-spectrum nitroimidazole antimicrobial used to treat BV and trichomoniasis. While structurally related to mentonidazole and tinidazole, secnidazole exhibits superior oral absorption and longer terminal elimination half-life.3
BV remains the most prevalent cause of vaginal symptoms in women nationwide, with recurrence rates exceeding 50%. Women with BV are at increased risk for sexually transmitted infections, complications after gynecologic surgery and complications of pregnancy and for recurrence following an initial infection.2
