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    Normally, there are a lot of "good" bacteria and some "bad" bacteria in the vagina. The good types help control the growth of the bad types. In women with bacterial vaginosis, the balance is upset. There are not enough good bacteria and too many bad bacteria. Bacterial vaginosis is usually a mild problem that may go away on its own in a few days. So it's a good idea to see your doctor and get treatment. Experts are not sure what causes the bacteria in the vagina to get out of balance. Your risk of getting bacterial vaginosis is higher if you: You may be able to avoid bacterial vaginosis if you limit your number of sex partners and don't douche or smoke. Bacterial vaginosis is more common in women who are sexually active. Antibiotics are the mainstay of therapy for bacterial vaginosis. Medications include metronidazole (Flagyl), clindamycin (Cleocin) oral or vaginal suppositories, and metronidazole vaginal gel (Metro Gel-Vaginal). Metronidazole and clindamycin are the preferred medications used to treat Approval was based on two randomized, placebo-controlled studies which evaluated the efficacy of secnidazole in treatment of bacterial vaginosis. Efficacy was assessed by clinical outcomes evaluated 21-30 days following a single dose of secnidazole. A clinical responder was defined as having "normal" vaginal discharge, negative "whiff" test, and clue cells In both trials, a statistically significantly greater percentage of patients experienced clinical response (Trial 1: 67.7%; Trial 2: 53.3%), Nugent score cure (Trial 1: 40.3%; Trial 2: 43.9%), and therapeutic response (Trial 1: 40.3%; Trial 2: 34.6%) at 21-30 days following a single dose of Solosec compared to placebo. A double-blind, randomized controlled trial by Subtil et al that included 5630 pregnant women with bacterial vaginosis reported that systematic screening and subsequent treatment for bacterial vaginosis in women with low-risk pregnancies showed no evidence of risk reduction of late miscarriage or spontaneous very preterm birth. Bacteriostatic antibiotic used against gram-positive aerobes and gram-positive and gram-negative anaerobes.

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  6. J Reprod Med. 1999 Apr;444359-62. Oral metronidazole vs. Metrogel Vaginal for treating bacterial vaginosis. Cost-effectiveness evaluation. Ransom SB1.

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