Effectiveness of oral probiotics and metronidazole compared with oral probiotics and metronidazole pessaries in the treatment of bacterial vaginosis in Chinese women.

Chinese guidelines recommend oral or metronidazole pessaries for treating bacterial vaginosis (BV). Although oral metronidazole has high bioavailability, it often causes adverse effects, which may be minimized by using the pessaries. This study compared the effectiveness, adverse effects, and recurrence rates between two groups of women receiving oral probiotics plus 200 mg metronidazole pessaries and those receiving oral probiotics plus 400 mg oral metronidazole. Women with BV were treated for 7 days with either regimen for one month. Both groups showed significant improvement in vaginal pH and Nugent scores (p < 0.0001), with greater improvement in vaginal pH in the pessary group. Oral metronidazole was associated with side effects, including metallic taste, headache, dizziness, and gastrointestinal disturbances, while pessaries caused vulvar itching. Recurrence at 12 months was lower in the pessary group compared to the oral group (24% vs. 37%, p = 0.0105). We conclude that probiotics combined with metronidazole (especially in pessary form) showed effective treatment outcomes with manageable side effects in Chinese women with BV.