Intravaginal Vitamin C for the Treatment and Prevention of Bacterial Vaginosis
Bibliographic record
Abstract
OBJECTIVE: To evaluate the effectiveness of intravaginal vitamin C in the treatment and prevention of bacterial vaginosis compared with control or antibiotics. DATA SOURCES: Electronic databases (MEDLINE, EMBASE, Cumulated Index in Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials), Google Scholar, clinical trial registries, and gray literature were searched for articles in any language from inception to May 2025. METHOD OF STUDY SELECTION: We included randomized trials involving nonpregnant patients and intravaginal vitamin C as treatment for acute bacterial vaginosis or prevention of recurrence. Covidence software was used for study screening. TABULATION, INTEGRATION, AND RESULTS: Risk of bias was assessed with the Cochrane Risk of Bias 2 tool. The primary outcome was clinical or microbiologic cure or recurrence. Results were reported as risk ratios (RRs) with 95% CIs. Certainty in conclusions was reported with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Nine trials (n=1,107) were included. Eight evaluated primary treatment of bacterial vaginosis, with a maximum follow-up of 30 days. Most trials used a vitamin C dose of 250 mg daily for 6 days. Among these trials, four compared vitamin C with control (placebo or no treatment) and four with metronidazole. Only one trial, comparing vitamin C with placebo, assessed prevention of recurrence after antibiotic cure. We found a higher proportion of short-term cure (1-3 weeks) in the vitamin C group compared with control (66% vs 42%, RR 1.57, 95% CI, 1.03-2.39; low-certainty evidence) and metronidazole (62% vs 52%, RR 1.20, 95% CI, 1.03-1.41; very low-certainty evidence). Recurrence of bacterial vaginosis was lower in the vitamin C group compared with the placebo group at 6 months (16% vs 32%, RR 0.50, 95% CI, 0.27-0.93; low-certainty evidence). CONCLUSION: Treatment with intravaginal vitamin C (250 mg daily for at least 6 days) may increase cure for bacterial vaginosis in the short term and may prevent recurrence; however, additional randomized trials are needed, particularly to evaluate recurrence beyond 1 month. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42024611533.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".