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Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: a randomized trial

2003; Lippincott Williams & Wilkins; Volume: 102; Issue: 3 Linguagem: Inglês

10.1016/s0029-7844(03)00566-0

1873-233X

Mark H. Yudin, Daniel V. Landers, Leslie A. Meyn, Sharon L. Hillier,

Syphilis Diagnosis and Treatment

To compare the efficacy of oral versus vaginal metronidazole treatment in pregnant women with bacterial vaginosis, and to compare cytokine profiles (interleukin-1β, -6, and -8) in the cervical secretions of these women before and after treatment. Pregnant women with bacterial vaginosis diagnosed both by Gram stain and clinical criteria were randomized to receive oral (n = 52) or vaginal (n = 50) metronidazole therapy. Cervical specimens for cytokine analysis and vaginal fluid for evaluation of bacterial vaginosis were obtained at baseline and 4 weeks after treatment. There was no significant difference in therapeutic cure rates (defined as a Gram stain score of 0–3 and the absence of all four clinical signs of bacterial vaginosis) between the two groups (71% and 70% for the oral and vaginal groups, respectively, P = 1.0). Cervical levels of interleukin-1β, -6, and -8 were significantly lower after treatment among the 72 women cured of bacterial vaginosis (P < .001, P = .001, and P = .02, respectively) but not among women who failed to respond to therapy. For interleukin-1β and -6, a significant decrease in cytokine level was observed in both the oral and vaginal treatment groups. One week of oral metronidazole and 5 days of intravaginal metronidazole are equally efficacious for treatment of bacterial vaginosis during pregnancy. The decrease in cervical interleukin-1β, -6, and -8 levels among women who established a normal flora after treatment but not among those with persistent bacterial vaginosis suggests a direct linkage between vaginal flora abnormalities and elevated cervical levels of interleukin-1β, -6, and -8.