Comparison of Treatment Success in Women Treated with Intravaginal Metronidazole versus Probiotics Bacterial Vaginosis

Background: Bacterial vaginosis (BV) is the most common cause of vaginal discharge among women of reproductive age, affecting nearly one-third of the female population worldwide. It is associated with significant gynecological and obstetric complications, including increased risk of preterm labor, pelvic inflammatory disease, and post-surgical infections. Metronidazole remains the mainstay of therapy; however, it is often limited by adverse effects, microbial resistance, and high recurrence rates. Probiotics, particularly Lactobacillus species, have emerged as a promising alternative treatment due to their ability to restore normal vaginal flora and inhibit pathogenic organisms. Objective: To compare the frequency of treatment success in women receiving intravaginal metronidazole versus probiotics for the management of bacterial vaginosis. Methods: This randomized controlled trial will be conducted at the Department of Obstetrics and Gynecology, Bolan Medical College Hospital, Quetta, over six months. A total of 280 women diagnosed with bacterial vaginosis according to Amsel’s criteria will be enrolled using consecutive sampling. Participants will be randomized into two equal groups: Group A will receive intravaginal metronidazole gel (10 g) once daily for seven days, and Group B will receive one Lactobacillus tablet intravaginally at bedtime for seven days. Treatment success will be defined as complete resolution of Amsel’s criteria features at one month follow-up. Data will be analyzed using SPSS version 25, with chi-square test applied to compare treatment success rates between groups, considering p < 0.05 as statistically significant. Results: A total of 280 women meeting inclusion criteria were enrolled and randomized equally into two groups (140 in each arm). Baseline demographic and clinical characteristics were comparable between the groups, with no statistically significant differences observed. Conclusion: These findings suggest that probiotics may play a pivotal role in the long-term management of BV, particularly for women experiencing recurrent infections or those seeking non-antibiotic therapies. Clinicians should consider patient preference, tolerance, and history of recurrence when selecting therapy. Moreover, combination regimens incorporating both antibiotics and probiotics may represent the most effective approach to achieving immediate relief while sustaining long-term vaginal health.