OBJECTIVE: A randomized double blind controlled trial was undertaken to compare the efficacy of oral probiotics and oral metronidazole in the treatment of symptomatic bacterial vaginosis (BV) among non-pregnant women.

METHODS: A total of 66 patients were included in this investigative study. Thirty five patients were assigned to oral metronidazole (500mg twice a day for 7 days) and 31 patients to oral probiotics (1 capsule three times a day for 10 days). Symptoms of abnormal vaginal discharge, vaginal pruritis, vaginal burning sensation, and dyspareunia were recorded. Diagnosis of BV was based on Amsel's criteria: homogenous vaginal discharge; pH of vaginal fluid >4.5; positive whiff test; and presence of clue cells. Patients were seen 10 days from initiation of treatment. Review of symptoms and Amsel's criteria were re-evaluated including a Gram stain for Nugent's score.

RESULTS: There were significantly more patients still with symptoms of abnormal vaginal discharge and presence of homogenous vaginal discharge on examination in the oral probiotics group (77.8% vs 28.57%, P = 0.001, RR = 5.25). Based on the Nugent's score, there were significantly more patients evaluated with positive results for BV in the oral probiotics group (77.14% vs 33.33% , P = 0.001, RR = 7.4) after treatment. Giving oral probiotics shows a relative risk of 309%, a negative RRR and a negative ARR.

CONCLUSION: Based on resolution of symptoms and Amsel's criteria, oral metronidazole was superior to oral probiotics. Oral probiotics were not beneficial in eradicating the organisms causing BV. Oral probiotics should not be offered as treatment for bacterial vaginosis.