{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:04:08Z","timestamp":1793325848901,"version":"4.5.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Bacterial vaginosis (BV) is a prevalent vaginal condition among reproductive-age women, characterized by off-white, thin vaginal discharge with a fishy odor. It increases susceptibility to sexually transmitted diseases (STDs) and pelvic inflammatory disease (PID). BV involves a shift in vaginal microbiota, with reduced lactobacilli and increased anaerobic bacteria. Standard treatment with oral metronidazole has been shown to have a limited long-term efficacy, possibly due to biofilm persistence. Alternative treatments, such as lactic acid vaginal gel, aim to restore vaginal pH and lactobacilli. This pilot study compares the efficacy and tolerability of lactic acid gel to standard oral metronidazole for acute BV treatment in non-pregnant women.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 32 women with acute BV were recruited and assigned to either the treatment group (<jats:italic>n<\/jats:italic>\u2009=\u200916) where they applied a lactic acid vaginal gel for 12 days, or the control group (<jats:italic>n<\/jats:italic>\u2009=\u200916) which received 500\u00a0mg oral metronidazole twice daily for seven days. A number of objective and subjective parameters including the Amsel score, the Nugent score and a subjective symptom score were recorded at day 0, three weeks, three months, and six months after the study start.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In the short-term, lactic acid vaginal gel showed inferior clinical (Amsel criteria) and microbiological (Nugent score) cure rates compared to metronidazole. However, it performed equally well regarding subjective symptom improvement and BV recurrence prevention after up to six months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Lactic acid vaginal gel was generally very well tolerated and showed mixed but promising results as a stand-alone treatment for acute BV.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration number<\/jats:title>\n                <jats:p>NCT02042287 (22.01.2014).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12905-024-03513-1","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T04:36:56Z","timestamp":1736138216000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effectiveness and tolerability of lactic acid vaginal gel compared to oral metronidazole in the treatment of acute symptomatic bacterial vaginosis: a multicenter, randomized-controlled, head-to-head pilot study"],"prefix":"10.1186","volume":"25","author":[{"given":"Fiona","family":"Tidbury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gr\u00e9gory","family":"Br\u00fclhart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Pavicic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Weidlinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerrit","family":"Eichner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"von Wolff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5591-1552","authenticated-orcid":false,"given":"Petra","family":"Stute","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"3513_CR1","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1146\/annurev.med.51.1.349","volume":"51","author":"JD Sobel","year":"2000","unstructured":"Sobel JD. Bacterial vaginosis. Annu Rev Med. 2000;51:349\u201356.","journal-title":"Annu Rev Med"},{"issue":"5","key":"3513_CR2","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1086\/367658","volume":"36","author":"HC Wiesenfeld","year":"2003","unstructured":"Wiesenfeld HC, Hillier SL, Krohn MA, Landers Dv, Sweet RL. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis. 2003;36(5):663\u20138.","journal-title":"Clin Infect Dis"},{"issue":"4","key":"3513_CR3","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S0889-8545(03)00086-X","volume":"30","author":"JR Schwebke","year":"2003","unstructured":"Schwebke JR. Gynecologic consequences of bacterial vaginosis. Obstet Gynecol Clin North Am. 2003;30(4):685\u201394.","journal-title":"Obstet Gynecol Clin North Am"},{"issue":"1","key":"3513_CR4","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s00404-020-05821-x","volume":"303","author":"FD Tidbury","year":"2021","unstructured":"Tidbury FD, Langhart A, Weidlinger S, Stute P. Non-antibiotic treatment of bacterial vaginosis-a systematic review. Arch Gynecol Obstet. 2021;303(1):37\u201345.","journal-title":"Arch Gynecol Obstet"},{"issue":"2 Pt 2","key":"3513_CR5","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1016\/0002-9378(93)90339-K","volume":"169","author":"GB Hill","year":"1993","unstructured":"Hill GB. The microbiology of bacterial vaginosis. Am J Obstet Gynecol. 1993;169(2 Pt 2):450\u20134.","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"3513_CR6","doi-asserted-by":"publisher","first-page":"20230826","DOI":"10.1515\/med-2023-0826","volume":"18","author":"A Despot","year":"2023","unstructured":"Despot A, Fure\u0161 R, Despot AM, et al. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development? Open Med (Wars). 2023;18(1):20230826.","journal-title":"Open Med (Wars)"},{"key":"3513_CR7","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.ejogrb.2019.12.035","volume":"245","author":"MS Coudray","year":"2020","unstructured":"Coudray MS, Madhivanan P. Bacterial vaginosis\u2014A brief synopsis of the literature. Eur J Obstet Gynecol Reprod Biol. 2020;245:143\u20138.","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"3513_CR8","doi-asserted-by":"crossref","unstructured":"Swidsinski A, Mendling W, Loening-Baucke V et al. An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole. Am J Obstet Gynecol. 2008;198(1):97.e1-97.e6.","DOI":"10.1016\/j.ajog.2007.06.039"},{"issue":"1","key":"3513_CR9","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1111\/1471-0528.14209","volume":"124","author":"D Nasioudis","year":"2017","unstructured":"Nasioudis D, Linhares I, Ledger W, Witkin S. Bacterial vaginosis: a critical analysis of current knowledge. BJOG. 2017;124(1):61\u20139.","journal-title":"BJOG"},{"key":"3513_CR10","doi-asserted-by":"crossref","unstructured":"O\u2019Hanlon DE, Moench TR, Cone RA. In vaginal fluid, bacteria associated with bacterial vaginosis can be suppressed with lactic acid but not hydrogen peroxide. BMC Infect Dis. 2011;11.","DOI":"10.1186\/1471-2334-11-200"},{"key":"3513_CR11","doi-asserted-by":"crossref","unstructured":"Plummer EL, Bradshaw CS, Doyle M et al. Lactic acid-containing products for bacterial vaginosis and their impact on the vaginal microbiota: A systematic review. PLoS ONE. 2021;16(2 February).","DOI":"10.1371\/journal.pone.0246953"},{"key":"3513_CR12","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2022https:\/\/www.R-project.org\/. Accessed 24 Apr 2024."},{"key":"3513_CR13","unstructured":"Sarkar D. Lattice: Trellis Graphics for r; 2021 http:\/\/lattice.r-forge.r-project.org\/. Accessed 24 Apr 2024."},{"key":"3513_CR14","unstructured":"Fox J, Weisberg S, Price B. Car: Companion to Applied Regression; 2022https:\/\/CRAN.R-project.org\/. Accessed 24 Apr 2024."},{"issue":"6","key":"3513_CR15","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1002\/1521-4036(200010)42:6<663::AID-BIMJ663>3.0.CO;2-7","volume":"42","author":"E Brunner","year":"2000","unstructured":"Brunner E, Langer F. Nonparametric Analysis of Ordered Categorical Data in Designs with Longitudinal Observations and Small Sample Sizes. Biom J. 2000;42(6):663\u201375.","journal-title":"Biom J"},{"key":"3513_CR16","volume-title":"Nichtparametrische Analyse Longitudinaler Daten","author":"E Brunner","year":"1999","unstructured":"Brunner E, Langer F. Nichtparametrische Analyse Longitudinaler Daten. M\u00fcnchen: Oldenbourg; 1999."},{"issue":"10","key":"3513_CR17","doi-asserted-by":"publisher","first-page":"5170","DOI":"10.1128\/IAI.67.10.5170-5175.1999","volume":"67","author":"ER Boskey","year":"1999","unstructured":"Boskey ER, Telsch KM, Whaley KJ, Moench TR, Cone RA. Acid production by vaginal flora in vitro is consistent with the rate and extent of vaginal acidification. Infect Immun. 1999;67(10):5170\u20135.","journal-title":"Infect Immun"},{"issue":"2","key":"3513_CR18","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.ajog.2007.02.027","volume":"197","author":"JL Patterson","year":"2007","unstructured":"Patterson JL, Girerd PH, Karjane NW, Jefferson KK. Effect of biofilm phenotype on resistance of Gardnerella vaginalis to hydrogen peroxide and lactic acid. Am J Obstet Gynecol. 2007;197(2):170.e1-170.e7.","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"3513_CR19","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1159\/000298923","volume":"21","author":"B Andersch","year":"1986","unstructured":"Andersch B, Forssman L, Lincoln K, Torstensson P. Treatment of Bacterial Vaginosis with an Acid Cream: A Comparison between the Effect of Lactate-Gel and Metronidazole. Gynecol Obstet Invest. 1986;21(1):19\u201325.","journal-title":"Gynecol Obstet Invest"},{"key":"3513_CR20","doi-asserted-by":"crossref","unstructured":"Janulaitiene M, Paliulyte V, Grinceviciene S et al. Prevalence and distribution of Gardnerella vaginalis subgroups in women with and without bacterial vaginosis. BMC Infect Dis. 2017;17(1).","DOI":"10.1186\/s12879-017-2501-y"},{"issue":"2","key":"3513_CR21","first-page":"243","volume":"32","author":"DCD Decena","year":"2006","unstructured":"Decena DCD, Co JT, Manalastas RM, et al. Metronidazole with Lactacyd vaginal gel in bacterial vaginosis. JOGN Res. 2006;32(2):243\u201351.","journal-title":"JOGN Res"}],"container-title":["BMC Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-024-03513-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12905-024-03513-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-024-03513-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T17:02:47Z","timestamp":1736182967000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcwomenshealth.biomedcentral.com\/articles\/10.1186\/s12905-024-03513-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3513"],"URL":"https:\/\/doi.org\/10.1186\/s12905-024-03513-1","relation":{},"ISSN":["1472-6874"],"issn-type":[{"value":"1472-6874","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,6]]},"assertion":[{"value":"30 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 December 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was granted by the cantonal ethics committee Bern (No. 2016_01992). Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"FT, GB, GM, GE, EP, MvW and SW declare no relevant financial or non-financial interests. PS has received honoraria from Tentan AG for presentations at conferences.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"7"}}