adding clindamycin or a probiotic to
oral metronidazole failed to improve the
effectiveness of the drug against
bacterial vaginosis at a congress of the
International Society for sexually
transmitted disease research in Quebec
City Canada
dr. Catriona Bradshaw discussed her
randomized trial beibei's a really
common condition in fact it's the most
common cause of vaginal infections in
women worldwide and it's associated with
important adverse pregnancy outcomes in
increased risk of sexually transmitted
infections but current treatments are
not highly effective and up to fifty to
sixty percent of women get their BV back
within six to twelve months of being
treated with first-line recommended
therapies so clean clinic as a clinician
you see a lot of women with recurrent
infection who are fairly desperate to
get rid of their their BV and you're
fairly came to get rid of it as well and
and so sometimes a combination of the
first-line therapies oral metronidazole
in vagina vagina linda myosin is used
but there's been no evidence base to
support this practice so we conducted a
randomized trial to combine oral
metronidazole with vaginal clindamycin
we also evaluated a probiotic at the
same time and we had a placebo arm just
to see if a combination of therapies was
going to be more effective and reduced
these high longer-term recurrence rates
what were some of your key findings well
the main finding was that combining the
two first-line regimen so combining
vaginal therapy with oral metronidazole
did not improve or reduce the recurrence
rates from oral metronidazole alone and
adding a pro by a vaginal probiotic
didn't improve the recurrence rates
either so it tells us really that
combination therapy is
not the way to go in terms of trying to
reduce relapse for women what are the
clinical implications for doctors
I guess the clinical implications at the
moment are firstly that mono therapy is
still first-line therapy and we have it
improved on that the other implications
really are that we're doing a behavioral
analysis at the moment and looking at
epidemiological risk factors so
behavioral characteristics that might be
driving recurrence we don't understand
the cause of BV there are many teams
internationally working on this but
there is a sense that there may be
behavioral practices that may be
implicated in reinfection and some of
our preliminary work indicated that
hormonal contraceptive use was
potentially protective against
recurrence and that's been supported by
some observational studies and also that
sex with the same partner may increase
your risk of recurrence now all that
data requires confirmation but I guess
the implications for clinicians are to
keep an open mind about Vivi to keep a
keen eye on the literature to look for
improved therapies and to be honest with
your patients about the potential risks
of recurrence with current therapies
because I think many women are quite
disappointed when their baby's baby is
back again for global medical news
network I'm Heidi sleeve