Historical review of the treatment of bacterial vaginosis.

The review of the treatment of bacterial vaginosis parallels the history of this syndrome. Before the syndrome was defined, treatment was local and nonspecific. Gardner and Dukes defined nonspecific vaginitis in 1955 as an infection caused by Haemophilus vaginalis. Therapy was directed toward this aerobic "pathogen" and included oral tetracycline and a triple sulfa vaginal cream. Subsequent studies indicated success with this regimen as well as with ampicillin, a drug with good aerobic activity. Since 1977, studies have shown the importance of anaerobes in this clinical syndrome. Both metronidazole and clindamycin have been found to have clinical success. The clinical definition of the disease makes evaluation of treatment difficult, because it includes women without symptoms.