Alternative treatment strategies for bacterial vaginosis: the role of lactic acid in combating antibiotic resistance

BACKGROUND: Bacterial vaginosis is a common infectious non-inflammatory vaginal condition that increases susceptibility to sexually transmitted diseases, negatively impacts perinatal outcomes, and reduces overall quality of life. Considering the low long-term effectiveness of antibiotic therapy, the high recurrence rates, and the frequent side effects associated with its use, there is a growing need to explore alternative approaches for bacterial vaginosis treatment.

AIM: To evaluate the efficacy and tolerability of a two-step treatment approach for bacterial vaginosis, which includes clindamycin or dequalinium chloride and lactic acid, in women of reproductive age.

MATERIALS AND METHODS: An open-label randomized clinical trial was conducted, including 93 women aged 18–45 years diagnosed with bacterial vaginosis according to Amsel’s criteria. Participants were randomly assigned to three groups: 31 women in the first group received lactic acid monotherapy, 31 in the second group received a combination of clindamycin and lactic acid, and 31 in the third group were treated with dequalinium chloride and lactic acid. Treatment efficacy was assessed after 14 days using Amsel’s criteria. Three months post-treatment, patient-reported symptoms and vaginal pH levels were evaluated.

RESULTS: Two weeks post-treatment, bacterial vaginosis symptoms persisted in 3 (9.7%) patients from the first group and in 1 (3.2%) patient from the second group. A positive trend in vaginal pH normalization was observed in all groups both at the two-week and three-month follow-ups. At the three-month follow-up, vaginal discharge complaints persisted in one patient from the first group, one from the second, and two from the third. The efficacy of lactic acid monotherapy at day 14 was 90.3%, increasing to 96.4% at three months. The two-step therapy combining clindamycin and lactic acid demonstrated an efficacy of 96.8% and 96.7%, respectively. The two-step therapy with dequalinium chloride and lactic acid demonstrated 100% efficacy after 14 days and 93.3% at the three-month follow-up. A case of vulvovaginal candidiasis was reported in the second group three months after treatment.

CONCLUSION: This study demonstrated the sustained high efficacy of the two-step treatment approach in both short-term and long-term perspectives. Whereas monotherapy initially showed lower efficacy, its long-term outcomes became comparable, highlighting the importance of lactic acid in combination therapy.