What is the first-line treatment for bacterial vaginosis?

The first-line treatment for bacterial vaginosis is metronidazole. This is because bacterial vaginosis is caused by an imbalance of normal bacterial flora in the vagina, leading to an overgrowth of certain bacteria. Metronidazole is an effective antibiotic that specifically targets the anaerobic bacteria often involved in this condition.

Metronidazole can be used both orally and topically, with studies showing similar efficacy for each route. It works by disrupting the DNA synthesis of anaerobic bacteria, thereby eliminating organisms that contribute to the state of vaginosis.

While clindamycin is also an effective treatment for bacterial vaginosis, it is typically considered a second-line agent after metronidazole. Fluconazole, on the other hand, is primarily used to treat fungal infections, such as yeast infections, and does not address the bacterial nature of vaginosis. Azithromycin is an antibiotic that is generally used for other bacterial infections, particularly those caused by specific pathogens like Chlamydia or for respiratory infections, but it is not appropriate for treating bacterial vaginosis.