1. Women randomized to receive Vitamin D following treatment for bacterial vaginosis were more likely to have higher serum 25(OH)D levels.
2. Women randomized to receive Vitamin D following treatment with metronidazole had a similar prevalence of bacterial vaginosis at 24 weeks when compared to the placebo group.
Evidence Rating Level: 2 (Good)
Study Rundown: Bacterial vaginosis (BV) is one of the most common vaginal infections. Non-white race has been associated with both BV and vitamin D deficiency. Given the regulatory role of vitamin D in the immune response, it is posited that vitamin D deficiency might have a causative role in the pathogenesis of BV. Previous work exploring this relationship has yielded mixed results. The present work is the first to explore the role of high dose vitamin D supplementation for non-pregnant women immediately following treatment for primary occurrence of BV with metronidazole. The authors found that while vitamin D supplementation raised serum 25(OH)D levels, it was not associated with a decreased incidence of recurrent BV.
Limitations of the study include selection bias, small sample size and limited generalizability. It is unknown whether patients who declined to participate in the study were different from participants in a way that might have influenced the observed results, though biological plausibility for such a difference is lacking. Small sample size limited power and a predominantly black sample population limits generalizability to other ethnicities. Additionally, since test of cure was not performed, it is unknown what proportion of patients with BV were experiencing prolonged primary occurrence or recurrence. Future work might include larger, population-based studies that factor in baseline 25(OH)D levels and degree of improvement into the analysis.
In-Depth [randomized controlled trial]: This double blinded, randomized controlled trial assessed recurrence of BV after standard treatment with metronidazole in women receiving vitamin D supplementation (n=59) and women receiving a placebo (n=59) for 24 weeks. Outcomes of interest were prevalence of BV, other infections, and BV-free survival time.
The prevalence of vitamin deficiency among women randomized to receive Vitamin D was 16% compared with 57% of women receiving placebo. Women in the vitamin D group were no more likely to have recurrent BV than the placebo group (HR 1.11, CI 0.68-1.81).
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