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Clinical and Cervical Cytokine Response to Treatment With Oral or Vaginal Metronidazole for Bacterial Vaginosis During Pregnancy: A Randomized Trial

From St. Michael’s Hospital, Toronto, Ontario, Canada; University of Minnesota, Minneapolis, Minnesota; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine; and Magee-Womens Research Institute, Pittsburgh, Pennsylvania.

Address reprint requests to: Sharon L. Hillier, PhD, Magee-Womens Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213; E-mail: shillier{at}mail.magee.edu.

OBJECTIVE: To compare the efficacy of oral versus vaginal metronidazole treatment in pregnant women with bacterial vaginosis, and to compare cytokine profiles (interleukin-1ß, -6, and -8) in the cervical secretions of these women before and after treatment.

METHODS: Pregnant women with bacterial vaginosis diagnosed both by Gram stain and clinical criteria were randomized to receive oral (n = 52) or vaginal (n = 50) metronidazole therapy. Cervical specimens for cytokine analysis and vaginal fluid for evaluation of bacterial vaginosis were obtained at baseline and 4 weeks after treatment.

RESULTS: There was no significant difference in therapeutic cure rates (defined as a Gram stain score of 0–3 and the absence of all four clinical signs of bacterial vaginosis) between the two groups (71% and 70% for the oral and vaginal groups, respectively, P = 1.0). Cervical levels of interleukin-1ß, -6, and -8 were significantly lower after treatment among the 72 women cured of bacterial vaginosis (P < .001, P = .001, and P = .02, respectively) but not among women who failed to respond to therapy. For interleukin-1ß and -6, a significant decrease in cytokine level was observed in both the oral and vaginal treatment groups.

CONCLUSION: One week of oral metronidazole and 5 days of intravaginal metronidazole are equally efficacious for treatment of bacterial vaginosis during pregnancy. The decrease in cervical interleukin-1ß, -6, and -8 levels among women who established a normal flora after treatment but not among those with persistent bacterial vaginosis suggests a direct linkage between vaginal flora abnormalities and elevated cervical levels of interleukin-1ß, -6, and -8.

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				T L Cherpes, J M Marrazzo, L A Cosentino, L A Meyn, P J Murray, and S L Hillier Hormonal contraceptive use modulates the local inflammatory response to bacterial vaginosis Sex. Transm. Inf., February 1, 2008; 84(1): 57 - 61. [Abstract] [Full Text] [PDF]