Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1508 Vaginitis

General Measures

■Perform full pelvic examination to assess for vaginitis, cervicitis, PID

■Obtain fresh samples for vaginal pH testing, microscopic evaluation

of vaginal specimens by wet mount and KOH, cervical gram-stain

■Consider pregnancy testing and evaluation for chlamydia, gonor-

rhea, syphilis, and HIV

■Counsel regarding modifiable risk factors

■Advise patient to abstain from sexual activity during treatment

■Empirically treat all sexual partners of patients with trichomoniasis;

BV and VVC do not typically require treatment of partner

specific therapy

Indications

■BV: diagnosis requires 3 of the following 4 criteria: homogenous

gray-white vaginal discharge; pH > 4.5, amine odor, clue cells on

wet mount; treat all symptomatic patients

■VVC: fungal elements on KOH or wet mount; compatible clinical

syndrome

■Trichomoniasis: motile trichomonads on wet mount; sexual contact

to patient with trichomoniasis

Treatment Options

■BV

➣Metronidazole for 7 days OR Metronidazole 0.75% gel intravagi-

nally twice a day for 5 days OR Clindamycin 2% cream intravagi-

nally each night for 7 days

➣Alternatives: Clindamycin for 7 days OR Metronidazole orally

once (less effective than 7 day course)

➣In pregnancy: Clindamycin for 7 days OR Metronidazole for 7

days (after 1st trimester)

■WC

➣Fluconazole orally once OR intravaginal Butoconazole, Clotri-

mazole, Miconazole, Nystatin, Terconazole, Tioconazole (cre-

ams, tablets, suppositories) for 1–7 days

➣Alternatives: Itraconazole orally once; OR Nystatin vaginal tablets

for 14 days (less effective)

➣Consider longer courses (14 days of topical treatment or Flucona-

zole for 4 days) for complicated infections

➣In pregnancy: topical agents only, treat for 7 days

■Trichomoniasis

➣Metronidazole orally once OR for 7 days