Bacterial vaginosis in pregnancy or breast feeding

Antimicrobial prescribing: NHS Lothian
NHS Lothian

If discharge is thin/watery, white/grey and offensive/fishy with no discomfort or itch, and pH >4 likely diagnosis is bacterial vaginosis. 

Antibiotic Recommendation

Metronidazole 400mg every 12 hours orally for 7 days

OR

Metronidazole  (0.75%) gel 5g at night intravaginally for 5 days

OR

Clindamycin  (2%) cream 5g at night intravaginally for 7 days

Notes

  • Expect to see Clue cells reported in HVS. 
  • Screening or treatment of partners is not required.
  • Clindamycin cream can weaken condoms.
  • There is insufficient evidence to recommend routine treatment of asymptomatic pregnant women who attend a GU clinic and are found to have BV. Women with additional risk factors for preterm birth may benefit from treatment before 20 week gestation.
  • For lactating women topical treatment preferred, as metronidazole may affect taste of breast milk.