New Hope for BV: Antiseptic May Replace Antibiotics

The results of a new study have scientists wondering if dequalinium chloride, a broad-spectrum, non-antibiotic antiseptic applied directly to the vagina, should be a first-line treatment for bacterial vaginosis.

Bacterial vaginosis (BV) is a common vaginal infection caused by the overgrowth of "bad" bacteria. Symptoms of BV include vaginal discharge with an off, fishy odor, which can negatively impact a woman's wellbeing and sex life. The condition can also increase the risk of HIV and other sexually transmitted infections (STIs).

Though BV is common, it can be challenging to treat. In the United States, healthcare providers typically prescribe antibiotics, including metronidazole and clindamycin, as first-line treatments or use secnidazole and tinidazole as alternatives.

Alternative prevention and treatment options, such as probiotic supplements, may benefit some women with BV, though more research is needed.

Although prescription medications are effective, up to 60% of women experience a recurrence of BV within 12 months after treatment. In addition, long-term antibiotic therapy to control BV can lead to vaginal yeast infections.

However, results from a new European study show that dequalinium chloride (DQC), a non-antibiotic antiseptic medication already recommended by several international and European guidelines as an alternative treatment for BV, is just as effective for treating the vaginal condition as metronidazole.

The findings follow previous research that showed DQC cures BV as effectively as clindamycin.

DQC is a tablet placed in the vagina and not a vaginal cream or oral pill like the other treatments.

In the phase 4, triple-blind, randomized clinical trial, published on May 2 in JAMA Network Open, 147 European premenopausal women with BV were given either 10 mg of dequalinium chloride vaginal tablets once daily for 6 days or 500 mg of oral metronidazole twice daily for 7 days.

Up to 11 days after starting treatment, cure rates for both medications were virtually the same, with more than 90% of the participants experiencing no symptoms of BV.

Moreover, 60% of participants who took DQC rated the drug's tolerability as "very good," while only 39% of women in the metronidazole group said the same.

The scientists suggest that DQC warrants consideration as a first-line treatment for BV due to its efficacy, safety, tolerability, and lower likelihood of microbial resistance.

Research gaps leave unanswered questions

In a commentary accompanying the study, scientists from the Institute for Genome Sciences (IGS) at the University of Maryland School of Medicine (UMSOM) and Johns Hopkins University School of Medicine (JHUSOM) say more research is needed to confirm these findings and determine whether DQC is a better option than current treatments offered in the U.S.

Future studies, the scientists say, need to address three primary gaps in European research. For example, European women may have different vaginal bacterial populations than women in other regions of the world, which could change DQC treatment outcomes.

Moreover, BV recurrence rates after treatment with DQC are unclear, as few studies have looked at long-term outcomes. DQC use during pregnancy also needs more investigation.

"If DQC is shown to effect a more lasting cure than current first-line antibiotics, it could mark a major advancement," the authors wrote. "However, if research continues to demonstrate that DQC is at least comparable to current treatments, it could still be a useful addition to the BV management toolkit for several reasons."

These reasons include DQC's tablet form, which some women might find more acceptable, the medicine's ability to fight yeast infections, and a lower risk of bacterial resistance associated with the antiseptic drug.

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