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Bacterial Vaginosis Management

This treatment plan reviews the risks and benefits of the treatment we are recommending. Please make sure to read it and the manufacturer's pamphlet that comes with the medicine. The manufacturer's pamphlet contains the full information on interactions, side effects, and other important information you should know about the medicine before you start.

Instructions

You have stated that you wish to take a medication for your symptoms of bacterial vaginitis/vaginosis. Metronidazole, which you are to take 1 Tablet (500mg) 2 times each day (morning and evening) for 7 days, will decrease the overgrowth of this bacteria, which commonly lives in women’s reproductive organs. Signs of this infection include foul-smelling discharge, especially after intercourse, a thin white, gray, or green vaginal discharge, pain, itching, or burning in the vagina, external burning with urination, and itching around the outside of the vagina.

Bacterial vaginosis alone typically does not cause pain or discomfort during intercourse. Intercourse with a male partner can throw off the vaginal microbiome causing BV, but it is not considered an STI. It can be transferred between female/female sexual partners, but colonization does not mean overgrowth.

It is the overgrowth of this bacteria that causes the change in discharge with odor. This bacteria can cause inflammation making you more susceptible to other STIs or pelvic inflammatory disease.

Refills

[Subscription patients only] You will automatically be sent a refill every 90 days (subject to a refill visit to help screen for side effects). You may request a refill early by logging into your Account (Subscriptions > Next Refill) or placing a new one-time order.

It is not wise to continue taking successive courses of oral antibiotics for any condition, particularly BV. Metronidazole has a black box warning issued by the FDA that it can be carcinogenic (cancer-causing), and is recommended against “unnecessary use”. Additionally, Recurrent oral antibiotics can result in bacterial mutation, even in other parts of your body, and can contribute to antibacterial resistance.

If your symptoms aren’t getting better after you start taking the medicine or if you develop new or worsending symptoms such as fever, chills, increasing lower abdominal pain, or other concerning symptoms you should see a doctor in-person and call or message us immediately. Furthermore, if your symptoms are not simply vaginal odor and discharge, then an in-person pelvic exam with a physician is necessary to determine a correct diagnosis.

Active Ingredients

This medicine contains the following active ingredients. If you are allergic to any of these components, similar components, or any of the others components listed in the manufacturer's pamphlet do not take it and call or message us immediately:

• Metronidazole
  
  

Allergies/Contraindications

This medicine, like all medications, may cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following please do not take the medicine and call or message us or see your doctor in person:

• Metronidazole (often prescribed to treat trichomoniasis)
• Nitroimidazole derivatives, or any component of the formulation
• Use of disulfiram within the past 2 weeks
• Use of alcohol or propylene glycol during therapy and for 24 hours after therapy
  
  

Conditions

We have evaluated your health history and the specific health information you provided us, however if anything changes and you develop or discover that one of these conditions applies to you please stop taking this medicine and call or message us immediately:

• Pregnancy
• Use of any alcohol or Antabuse
• Central nervous system problems
• Liver problems
• Blood disorders
• Cockayne syndrome
• Seizure disorders
• Kidney problems
• Blood dycrasias- clotting, formation, etc.
  
  

Pregnancy and Breastfeeding

Cleft lip with or without cleft palate has been reported following first trimester exposure to Metronidazole, however, most studies have not shown an increased risk of congenital anomalies or other adverse events to the fetus following maternal use during pregnancy. It is rated a pregnancy class B. In these cases treatment may be beneficial but topical treatment is preferred. We do not provide treatment to pregnant patients on our platform and recommend seeking care with your OB/GYN for continued care throughout your pregnancy.

Metronidazole is present in breast milk, but is safe to use while breastfeeding when taking 500mg twice daily for 7 days. However, if you receive a 2g single day dosage it's recommended to not breastfeed for 24 hours. Common side effects in infants include loose stools, and oral thrush, and anal or perianal yeast overgrowth.

Emergency Side Effects

This medicine can cause dangerous and potentially life-threatening side effects. If any of the emergency side effects listed in the manufacturer’s pamphlet or those below happen to you please stop taking the medicine and call 911 or seek immediate medical help in person:

• Sudden onset of chest pain
• Shortness of breath
• Difficulty or painful swallowing
• Severe skin rash and/or itching
• Facial or throat swelling
• Blurred vision
• Severe bloody diarrhea
• Passing out
• Increasing or severe abdominal pain
  
  

Other Side Effects

This medicine can also cause other side effects including (this list is not all inclusive):

• Abdominal pain
• Dizziness
• Dark red urine
• Headache
• Lightheadedness
• Nausea
• Vomiting
• Metallic taste
• Yeast Infection (Fungal Vaginitis)
  
  

Medicines, Supplements, and Foods

We have evaluated the specific health information you provided us, however if you are taking any of the medicines, foods, or supplements listed below call or message us before you take the medicine. Some of these can cause dangerous interactions with the medicine we are prescribing you and we will help you evaluate that risk and decide on an appropriate treatment plan. Please ensure your chart is up to date with your current medications, allergies, and medical conditions so your provider can safely treat you as this list may not be all inclusive:

• Disulfiram
• Warfarin or other blood thinners
• Lithium
• Phenytoin
• Medications that can affect your heartbeat
  
  

Accurate Information

We have evaluated your health history and your specific health information you provided and determined it is safe to proceed with this treatment at this time. If your health history changes including diagnoses or medications please message or call us before you take the medicine to ensure it's safe to proceed. Some medications and conditions can cause dangerous interactions with the medicine we are prescribing and we will help you evaluate that risk and decide on an appropriate treatment plan.

Treatment Failure

This treatment is not 100% effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If the treatment is not working, or if you are experiencing new or worsening symptoms, give us a call or message us anytime. If it is an emergency call 911 or seek immediate medical help in-person. You may need to seek alternative treatment such as those listed below or in the follow-up plan.

Misdiagnosis or Delayed Diagnosis

There is also a risk that we may incorrectly diagnose or fail to diagnose the correct conditions that you may have, thereby affecting our recommendation for treatment. This risk exists with in-person care as well, but they may have additional clinical history, physical exam findings and tests to aid their evaluation. We use evidence-based practice guidelines and clinical decision making to try to minimize these risks. Here are some other diagnoses that we attempt to rule out:

• Sexally transmitted Infections (STI)
• Yeast Infections
• Urinary Tract Infections (UTI)
  
  

Accepting or Declining Our Recommendation

We are recommending this treatment for you because the potential benefits of treatment outweigh the risks. You should evaluate this information as well as the manufacturer's pamphlet, and any input from your in-person healthcare team, or other relevant information to decide if this treatment plan is appropriate for you. You are free to decline our treatment recommendations although doing so may prolong symptoms and can be associated with other risks or negative outcomes.

Alternative Treatment

We have based our recommendation on your specific case and current medical guidelines, but there may be alternative treatments or strategies that may be helpful to you. Some may be more or less effective than what we provide. Some treatments may require an in-person exam or procedure which we can't provide. Message us or talk to your doctor in-person to discuss alternative treatments. Here are some other treatments or strategies that you might consider:

• In-person Pelvic exam with testing
  
  

Share with Your In-Person Healthcare Team

You can access your records anytime. We strongly recommend that you update your in-person doctor, pharmacist, and the rest of your healthcare team to let them know about any new medicines you are taking or other changes in your health.

You can also ask us questions anytime and we are happy to help you share any information about your health with your in-person healthcare team.