Chemen M. Neal, MD, discusses weekly secnidazole for bacterial vaginosis treatment

In a recent interview with Contemporary OB/GYN, Chemen M. Neal, MD, associate clinical professor at the Indiana University School of Medicine, discussed the efficacy of once-weekly secnidazole granules for the management of recurrent bacterial vaginosis (BV).

BV is an infection of the lower genital tract that causes distressing symptoms such as a strong odor, increased discharge, and sometimes irritation. These symptoms can lead to embarrassment, social withdrawal, and diminished interest in relationships and physical activity. The condition is notoriously difficult to treat and often returns shortly after completing antibiotic treatment, necessitating prolonged and complex therapy regimens.

Traditional treatment protocols for recurrent BV are burdensome, involving daily oral antibiotics followed by twice-weekly doses, or the use of intravaginal gels that can cause discomfort. Some regimens even combine oral and intravaginal treatments, making adherence particularly challenging. Neal emphasized that many patients struggle with such complex regimens, especially over the extended periods needed for suppressive therapy.

To address these challenges, once-weekly secnidazole granules are being investigated as a simpler, potentially more patient-friendly treatment. Unlike other regimens, this approach requires only a single oral dose each week, which could improve patient compliance. Secnidazole is already approved for treating acute, non-recurrent BV, but its use for recurrent BV had not been extensively studied until recently.

Neal led a pilot study with 25 women to evaluate the effectiveness of weekly secnidazole for recurrent BV. While the sample size was small and the study was not a direct comparison with other therapies, results indicated that this once-weekly regimen was at least as effective as the CDC-recommended suppressive treatments. This finding is promising, suggesting a more manageable alternative for long-term treatment.

Beyond medication, Neal stressed the importance of accurate diagnosis. Misdiagnosis is common, and proper evaluation—including detailed patient history, in-office microscopy, and the appropriate use of testing modalities—is critical. Once diagnosed correctly, clinicians should educate and support patients, stressing the importance of adherence to suppressive therapy. Ultimately, a combination of precise diagnosis, patient education, and simpler, more tolerable treatments such as weekly secnidazole could significantly improve the management and outcomes of recurrent BV.

Disclosure: University Grants/Research Support; Self; Lupin Pharmaceuticals.

Reference:

Neal, CM. Once weekly secnidazole granules for the treatment of recurrent bacterial vaginosis. Poster. Presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.