Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: A randomized trial

Mark H. Yudin, Daniel V. Landers, Leslie Meyn, Sharon L. Hillier

Research output: Contribution to journalArticlepeer-review

84 Scopus citations

Abstract

OBJECTIVE: To compare the efficacy of oral versus vaginal metronidazole treatment in pregnant women with bacterial vaginosis, and to compare cytokine profiles (interleukin-1β, -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-1β, -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-1β 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-1β, -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-1β, -6, and -8.

Original languageEnglish (US)
Pages (from-to)527-534
Number of pages8
JournalObstetrics and gynecology
Volume102
Issue number3
DOIs
StatePublished - Sep 2003

Bibliographical note

Funding Information:
Supported in part by an unrestricted grant from 3M Pharmaceuticals and by National Institutes of Health grant U01 AI 47785.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

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