Acceptability of and treatment preferences for recurrent bacterial vaginosis—Topical lactic acid gel or oral metronidazole antibiotic: Qualitative findings from the VITA trial

Autoři: Jocelyn Anstey Watkins aff001;  Jonathan D. C. Ross aff002;  Sukhwinder Thandi aff003;  Clare Brittain aff003;  Joe Kai aff004;  Frances Griffiths aff001
Působiště autorů: Warwick Medical School, University of Warwick, Coventry, England, United Kingdom aff001;  University Hospitals Birmingham NHS Foundation Trust, Birmingham, England, United Kingdom aff002;  Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, England, United Kingdom aff003;  Division of Primary Care, University of Nottingham, Nottingham, England, United Kingdom aff004;  Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224964



Bacterial vaginosis (BV) is associated with an elevated vaginal pH and the presence of abnormal offensive discharge. It is common, often recurrent, and the most effective treatment regimen is unknown. ‘Metronidazole Versus lactic acId for Treating bacterial vAginosis’ (VITA) is a UK-based randomised controlled trial assessing clinical and cost-effectiveness of topical lactic acid gel compared to oral metronidazole antibiotic for treating second and subsequent BV episodes. Few BV trials report on women’s preferences for treatment in the context of their own experiences.


This qualitative study investigated the acceptability and tolerability of the two treatments. During the trial, semi-structured telephone interviews were undertaken between January—May 2018. A total of 33 women diagnosed with BV were consecutively sampled then interviewed from six sites across England. Thematic analysis was guided by the acceptability of health interventions framework. Potential causes of BV and its impact on women’s lives were explored in addition to women’s treatment preference and perceived treatment effectiveness.


Although women felt antibiotics treat BV effectively, and were associated with longer time periods between episodes, they generally preferred using the lactic acid gel because of ease of use, once daily application and less side-effects. Women would recommend the lactic acid gel to others for mild cases of BV but to take antibiotics when more severe. The risk of antibiotic drug resistance was a common concern. Self-help medicating or self-decision to not treat was also evident due to prior experience of poor outcomes from treatment. Triggers of BV were attributed to personal hygiene habits–soaps used to wash the vagina and sexual practices such as unprotected sex.


Acceptability and preference for topical lactic acid gel or oral metronidazole tablets in the treatment of recurrent BV was affected by personal choice relating to affective attitude, burden, ethicality, intervention coherence, opportunity costs, and self-efficacy. These differed depending on ease of use, tolerability and past experiences, but not necessarily based on perceived drug effectiveness. Knowledge of a patient preference for topical lactic acid gel therapy despite lower perceived effectiveness may be useful for clinicians when making treatment decisions.

Klíčová slova:

Antibiotic resistance – Antibiotics – Behavior – Drug therapy – Jaw – Lactic acid – Bacterial vaginosis


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Článek vyšel v časopise


2019 Číslo 11