However, at present, these methods are mainly used for research purposes. In genitourinary medicine clinics BV is usually diagnosed by microscopy in association with the other tests. Other hospital doctors and General Practitioners may not have access to on-site microscopy, and the condition is usually diagnosed by the culture of G. vaginalis or anaerobes on a high vaginal swab. In women who present with an offensive vaginal discharge, there is no doubt that treatment is worthwhile and will relieve their symptoms. Metronidazole was shown to be effective in 1978 and remains a mainstay of treatment.
Several studies demonstrate a slightly higher cure rate for the prolonged course of treatment.
Taking the drug after food reduces the likelihood of nausea or vomiting. Oral clindamycin is commonly used in the USA, but topical treatment is as effective 19 and may be preferable because of the lower risk of adverse effects, especially pseudomembranous colitis. The cure rate is high but a significant proportion of women suffer relapses and recurrences. There is some evidence that residual biochemical and microbiological abnormalities persist in these women. Using a longer course of metronidazole with the addition of tetracycline may eliminate associated Mycoplasma hominis or Ureaplasma urealyticum infection, and may reduce the likelihood of recurrence.