title: Extended antimicrobial treatment of bacterial vaginosis combined with human lactobacilli to find the best treatment and minimize the risk of relapses.
abstract: BACKGROUND
  The primary objective of this study was to investigate if extended antibiotic treatment against bacterial vaginosis (BV) together with adjuvant lactobacilli treatment could cure BV and, furthermore, to investigate factors that could cause relapse.
  
  
  METHODS
  In all, 63 consecutive women with bacterial vaginosis diagnosed by Amsel criteria were offered a much more aggressive treatment of BV than used in normal clinical practice with repeated antibiotic treatment with clindamycin and metronidazole together with vaginal gelatine capsules containing different strains of lactobacilli both newly characterised and a commercial one (109 freeze-dried bacteria per capsule). Oral clindamycin treatment was also given to the patient's sexual partner.
  
  
  RESULTS
  The cure rate was 74.6% after 6 months. The patients were then followed as long as possible or until a relapse. The cure rate was 65.1% at 12 months and 55.6% after 24 months. There was no significant difference in cure rate depending on which Lactobacillus strains were given to the women or if the women were colonised by lactobacilli. The most striking factor was a new sex partner during the follow up period where the Odds Ratio of having a relapse was 9.3 (2.8-31.2) if the patients had a new sex partner during the observation period.
  
  
  CONCLUSIONS
  The study shows that aggressive treatment of the patient with antibiotics combined with specific Lactobacillus strain administration and partner treatment can provide long lasting cure. A striking result of our study is that change of partner is strongly associated with relapse of BV.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01245322.
authors.affiliation: Department of Obstetrics and Gynaecology Kärnsjukhuset, Skaraborg hospital and University of Skövde, Sweden. p-g.larsson@vgregion.se
authors.forename: Per-Göran
authors.initials: PG
authors.lastname: Larsson
authors.forename: Erik
authors.initials: E
authors.lastname: Brandsborg
authors.forename: Urban
authors.initials: U
authors.lastname: Forsum
authors.forename: Sonal
authors.initials: S
authors.lastname: Pendharkar
authors.forename: Kasper Krogh
authors.initials: KK
authors.lastname: Andersen
authors.forename: Salmir
authors.initials: S
authors.lastname: Nasic
authors.forename: Lennart
authors.initials: L
authors.lastname: Hammarström
authors.forename: Harold
authors.initials: H
authors.lastname: Marcotte
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002981:Clindamycin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000254:growth & development*; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D019936:Probiotics / Q000008:administration & dosage*; D055502:Secondary Prevention; D016896:Treatment Outcome; D016585:Vaginosis, Bacterial / Q000188:drug therapy*
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D002981:Clindamycin