Evaluation of vulvovaginal symptoms includes a pelvic examination (with a speculum examination) and simple rapid diagnostic tests.
- Abnormal vaginal discharge is assessed for pH, a fishy odor after mixing with 10% KOH (BV), evidence on microscopy of motile trichomonads and/or clue cells of BV (vaginal epithelial cells coated with coccobacillary organisms) when the specimen is mixed with saline, or hyphae or pseudohyphae on microscopy when 10% KOH is added (vaginal candidiasis).
- A DNA probe test (the Affirm test) can detect T. vaginalis, C. albicans, and increased concentrations of G. vaginalis. A NAAT for T. vaginalis is available.
Treatment: Vulvovaginal Infections - Vulvovaginal candidiasis:Miconazole (a single 1200-mg vaginal suppository), clotrimazole (two 100-mg vaginal tablets daily for 3 days), or fluconazole (150 mg PO once) are all effective.
- Trichomoniasis:Metronidazole (2 g PO once) or tinidazole is effective. Treatment of sexual partners with the same regimen reduces the risk of reinfection and is the standard of care.
- BV: Metronidazole (500 mg PO bid for 7 days), 2% clindamycin cream (one full applicator vaginally each night for 7 days), or 0.75% metronidazole gel (one full applicator vaginally bid for 5 days) is effective, but recurrence is common regardless of the regimen used.
|