Lessons from Suppressive Therapy and Periodic Presumptive Treatment for Bacterial Vaginosis

  • Jennifer E. BalkusEmail author
  • Kayla A. Carter
  • R. Scott McClelland
Female Genital Tract Infections (J Sobel, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Female Genital Tract Infections


Purpose of Review

Suppressive therapy and periodic presumptive treatment (PPT) are distinct but related strategies that have been used to reduce the incidence of bacterial vaginosis (BV). Here, we review clinical trial evidence of the effectiveness of suppressive therapy and PPT to reduce BV, and discuss their roles for women who frequently experience symptomatic or asymptomatic BV.

Recent Findings

Among women who were recently and successfully treated for symptomatic BV, suppressive therapy with twice-weekly metronidazole gel for 16 weeks reduces the likelihood of recurrent symptomatic BV and is currently recommended by the Centers for Disease Control and Prevention for prevention of recurrent BV. The premise of PPT is to provide regimens used to treat BV at regular intervals to reduce the overall frequency of BV, regardless of symptoms. Three PPT trials were conducted using different routes (oral or intravaginal), doses, and frequencies of administration. Each trial demonstrated a significant reduction in BV over the course 12 months, ranging from a 10 to 45% decrease. PPT regimens that substantially reduce the frequency of BV over time could be evaluated in clinical trials to assess whether a reduced frequency of BV leads to subsequent reductions in BV-associated sequelae. While both suppressive therapy and PPT reduce BV, their impact wanes following cessation of the regimen.


Given the high prevalence of BV globally and burden of adverse reproductive health outcomes among women with BV, there is a critical need for more effective treatments that produce durable shifts in the microbiota towards vaginal health.


Bacterial vaginosis Periodic presumptive treatment Suppressive therapy Symptomatic Asymptomatic 


Compliance with Ethical Standards

Conflict of Interest

JEB has received honoraria for consulting from BD and Lupin Pharmaceuticals. RSM currently receives research funding from Hologic/Gen-Probe and has received honoraria for consulting from Lupin Pharmaceuticals.

All other authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jennifer E. Balkus
    • 1
    • 2
    • 3
    Email author
  • Kayla A. Carter
    • 1
  • R. Scott McClelland
    • 1
    • 2
    • 4
  1. 1.Department of EpidemiologyUniversity of WashingtonSeattleUSA
  2. 2.Department of Global HealthUniversity of WashingtonSeattleUSA
  3. 3.Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  4. 4.Department of MedicineUniversity of WashingtonSeattleUSA

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