Abstract
Background: Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge among women of reproductive age, resulting from a shift in vaginal microbiota from lactobacilli-dominant flora to anaerobic organisms such as Gardnerella vaginalis and Atopobium vaginae. It is associated with adverse gynecological and obstetric outcomes, including pelvic inflammatory disease, preterm labor, low birth weight, and increased susceptibility to sexually transmitted infections. Topical metronidazole and clindamycin are recommended first-line treatments; however, comparative data on efficacy, tolerability, and patient satisfaction remain inconsistent.
Objective: To compare the efficacy, safety, and patient satisfaction of topical metronidazole versus clindamycin in the treatment of bacterial vaginosis.
Methods: A randomized controlled trial was conducted at Benazir Bhutto Hospital, Rawalpindi, from March 2023 to February 2024. A total of 140 women aged 18–45 years diagnosed with BV using Amsel’s criteria were randomly allocated into two groups. Group A received topical metronidazole 0.75% gel once daily for 5 days, while Group B received topical clindamycin 2% cream once daily for 7 days. The primary outcome was clinical cure assessed at day 7 post-treatment. Secondary outcomes included adverse effects and patient satisfaction. Data were analyzed using SPSS version 26, with p < 0.05 considered statistically significant.
Results: Clinical cure was achieved in 85.7% (60/70) of the metronidazole group and 78.6% (55/70) of the clindamycin group (p = 0.20). Adverse effects were significantly higher in the clindamycin group (28.6% vs. 15.7%, p = 0.04). Patient satisfaction was higher in the metronidazole group due to shorter treatment duration and fewer side effects.
Conclusion: Both topical metronidazole and clindamycin are effective for the treatment of BV. Metronidazole demonstrated better tolerability and higher patient satisfaction, making it a preferable first-line option in routine clinical practice.