Antibiotics called best cure for gynecologic infections

Monday, May 12, 1997 | 11:59 a.m.

Findings that bacteria migrate into a woman's womb, fallopian tubes and other tissues may encourage physicians to switch from topical ointments to oral antibiotics for gynecologic infections.

Dr. James McGregor, an obstetrics and gynecology professor at the University of Colorado School of Medicine, reported findings of a study he presented at the recent International Infectious Disease Society for Obstetrics and Gynecology conference in Las Vegas.

The study showed that of 709 patients, five- and seven-day courses of the drug Flagyl MR cured the women of bacterial vaginosis (BV) about 60 percent of the time. That rate is twice as high as using a topical treatment known as clindamycin.

"Until recently, the medical community considered BV to be a local condition that was treatable with topicals," McGregor said.

Current data indicate that the organisms travel from the lower genital area to the upper reproductive tract, out of reach of gels and creams.

The untreated infection could pose a threat to an unborn baby as well as to the woman herself, he said.

Flagyl MR is under review by the Food and Drug Administration as a treatment for techomoniasis, a sexually transmitted disease caused by trichomonas vaginalis. Results of McGregor's study also will be presented to the FDA to include treatment for BV.

"Although further study is necessary, these preliminary data suggest oral treatment may offer some benefits over topical treatment," he said.

Bacterial vaginosis affects one of six women in the United States and is the most common reproductive tract infection in women of child-bearing age. It is more common than yeast infections, producing a gray vaginal discharge with a fishy odor. Women who smoke have a greater risk to develop it.

It also occurs in pregnant women with a 12 to 22 percent infection rate.

The disease occurs when lactobacilli, protective bacteria in the vagina, are outnumbered by other microorganisms, such as gardnerella vaginalis, escherichia coli or mycoplasma hominis.

The exact cause of this bacterial imbalance is unknown, although research indicates that risk increases for a woman who has multiple sex partners.

In December 1995, BV became a national health issue when a University of Pittsburgh study, sponsored by the National Institutes of Health, was published in the New England Journal of Medicine. The study indicated pregnant women diagnosed with BV were 40 percent more likely to deliver their babies early and with low birth weights.

A University of Alabama study published in the same issue showed that pregnant patients with BV treated with oral metronidazole and erythromycin had 40 percent fewer premature births than untreated women.