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Vaginitis is an infectious and inflammatory disease that affects vagina and is associated with abnormal vaginal discharge (1). Lactobacilli is the most common vaginal microorganism. The decrease of lactobacilli may lead to symptomatic changes in vagina. Bacterial vaginosis (BV) is the most common vaginitis that is known by a reduction in vaginal lactobacilli and an increased growth of other anaerobic species of bacteria (2). BV can be observed in 64% of women with sexually transmitted infections, 15% to 20% of pregnant women, and 10% to 15% of women who refer to gynecologic clinics (3,4). BV is widespread in different parts of the world and among different ethnicities. For example, it was detected by 5%-15% among Caucasian women and 45%-55% among African and black Americans. It is estimated that the total prevalence of BV around the world is 20%-30%. The prevalence of BV in Iran varies. It is reported by 16% in central, 40% in southern, and 50% in tribes of Iran (among high-risk population) which is a significant value (5-7). BV is a strong risk factor for acquiring and transmission of sexually transmitted diseases, including human immunodeficiency virus (HIV) and pelvic inflammatory disease (8). Moreover, it infects amniotic fluid and fetal membranes and causes premature rupture of membranes during pregnancy and post-partum fever (9,10). The selected treatment of BV is oral metronidazole (11). However, more than half of patients have 2 to 3 recurrences per year (12). BV affects varying degrees of self-confidence and sexual life of women (13). One of the challenges of physicians is to find the effective treatment of BV, because the long-term effectiveness of antibiotics is weak and recurrence is common (13). The aim of BV treatment is to preserve the vaginal pH at 4.5 and lower and to prevent the over growth of pathogens until normal vaginal flora is reconstructed and maintain normal vaginal pH (14,15). The relationship between BV and increased level of vaginal pH has made the use of vagina acidifier materials as an attempt to build an unsuitable area for the growth of pathogens, reasonable (16). One of the effective materials in maintaining vaginal pH lower than 4.5 is vaginal vitamin C; vaginal vitamin C maintains vaginal pH at low range and is effective in treatment of BV through producing lactic acid (17). Abstract Objectives: Bacterial vaginosis (BV) is the most common vaginitis, which is derived from a reduction in vaginal lactobacilli and an increased growth of other anaerobic species of bacteria. Vitamin C can be effective in treatment of BV through the production of lactic acid. The aim of the present study was to determine the efficacy of adding vitamin C vaginal to metronidazole in treatment of BV. Materials and Methods: This study was a triple-blind randomized clinical trial. The study was carried out from July 2015 to November 2015 on 160 women who referred to gynecologic clinic of Mashhad with pure BV. They randomized into intervention and control groups. The intervention group received 500 mg of oral metronidazole tablets twice a day along with 250 mg vitamin C vaginal tablets for 7 days and the control group received the same dose of oral metronidazole along with placebo for 7 days. Amsel and Nugent criteria were analyzed prior, 10 ± 3, and 30 ± 3 days after the treatment. Results: The cure rate, based on Amsel and Nugent criteria was 85.9% in intervention group and 52.3% in control group on day 10 ± 3 (odds ratio [OR]: 5.3, 95% CI: 2.4 to 11.6) and 87.7% in intervention group and 41.9% in control group on day 30 ± 3 (OR: 9. 8, 95% CI: 4.2 to 22.4). Conclusion: According to the results, it seems that the two-drug treatment of BV with oral metronidazole and vitamin C vaginal tablets is more effective than one-drug treatment of BV by oral metronidazole for recovery and non-recurrence.

international journal of women's health and reproduction sciences

The Addition of Vitamin C Vaginal Tablets to Oral Metronidazole and its Effect on the Treatment and Recurrence of Bacterial Vaginosis: A Randomized Triple-Blind Clinical Trial