Vaginitis Treatment

  • Treatment

    While uncomfortable, vaginitis does not require emergency care. Contact a gynecologist or a family physician if symptoms occur.

    Several medications are available over-the-counter to treat vaginal yeast infections; however, because symptoms may be caused by other organisms or by an allergic reaction, it's best to consult a physician before using these medications. Over-the-counter products with butoconazole, miconazole, clotrimazole, and tioconazole fight yeast infections. Other products may contain antihistamines or topical pain relievers that mask the symptoms, but do not cure the infection.

    If the infection is caused by an organism other than yeast, self-medicating with one of these products can delay proper treatment and increase the risk of complications. Most women cannot accurately diagnose a yeast infection.

    A baking soda sitz bath, with only the genitals and buttocks resting in lukewarm water and baking soda, may relieve the external itching of a yeast infection. A sitz bath will only relieve symptoms, however, and will not resolve the problem.

    Avoid sexual intercourse until therapy is completed and you and your partner are free of symptoms.

    Your doctor is the best source of information on the drug treatment choices available to you.

    The doctor will ask questions about your general health, medication use, and sexual activity to determine factors that may contribute to vaginitis. The doctor may order tests to learn if you have other diseases such as sexually transmitted infections or a chronic condition.

    For allergic vaginitis, the doctor will try to determine what agents or products may be producing your symptoms, and may order a topical cream to relieve symptoms. You may have to change brands or eliminate some products one at a time until you learn what is triggering your symptoms.

    Some women use herbal remedies to treat the infection and the symptoms; however, the effectiveness of these treatments is unknown. Some patients have tried yogurt douches, inserting boric acid suppositories into the vagina, or taking acidophilus by mouth in hopes of treating or preventing vaginal infections by restoring the normal balance in the vagina. However, oral or vaginal remedies with lactobacillus may not contain strains that produce hydrogen peroxide and adhere to the vaginal lining, which doctors believe may be important for successful colonization. Herbal remedies, such as tree oil or goldenseal, may help soothe inflamed tissue.

    A number of herbal remedies exist that are thought to relieve symptoms of vaginitis.

    Table 2.  Alternative Treatments for Vaginitisa

    Condition Alternative treatment
    Vaginal candidiasis Acidophilus oral pills, intravaginal suppositories
    Yogurt (plain): oral or intravaginal
    Boric acid; intravaginal suppository
    Echinacea; oral tincture
    Goldenseal; oral tincture
    Tea-tree oil; intravaginal suppositories, douche
    Trichomoniasis Echinacea; oral tincture
    Goldenseal; oral tincture
    Tea-tree oil; intravaginal suppositories, douche
    Bacterial vaginosis Tea-tree oil; intravaginal suppositories, douche

    a Proven medical treatments exist for all the listed conditions

    Bacterial vaginosis and trichomoniasis can increase a woman's risk for delivering a premature or low-birth-weight baby. If you are pregnant, seek medical care to treat the infection as soon as symptoms appear. Even without symptoms the infections should be treated to decrease the risk to the baby.

    Treatment regimens differ for pregnant women. Some antimicrobial agents cannot be safely administered during pregnancy. Metronidazole should not be taken during the first three months of pregnancy, but is considered safe after that. Because bacterial vaginosis frequently recurs, pregnant women should be rechecked one month after completing treatment. Pregnant women who have previously delivered prematurely should be checked for a bacterial infection.

    If the causative agent is transmitted through sexual contact, the woman's partner should be treated Table 03.

    Table 3.  Guidelines for Screening Sexual Partners

    Condition Screening and treatment recommendations
    Bacterial vaginosis Not routinely recommended
    Vulvovaginal candidiasis Not routinely recommended, but should be considered for partners of women with recurrent infections
    Trichomoniasis Sexual partners should be examined and treated with same regimen as patient
    Mucopurulent cervicitis Sexual partners should be examined and treated for STD identified or suspected in patient
    Gonorrhea (uncomplicated) Sexual partner should be examined and treated
    Chlamydia Sexual partner should be examined and treated if last sexual contact was within 60 days prior to symptoms onset
    HSV-2 Sexual partner should be examined and, if symptomatic, treated

    Most vaginitis clears up with prescribed treatment within a two-week period, but chronic or recurrent infections may require therapy for extended periods. Up to 30% of women with bacterial vaginosis will experience a second episode within one month. Administering antibiotics to the woman's sex partner does not decrease the risk of a recurrent bacterial infection. Recurrent yeast infections may require long-term therapy. Women with HIV infections may suffer from yeast infections that do not respond well to treatment.

    Recurrent infections require treatment for longer periods Table 04.

    Table 4.  Treatment of Recurrent Vaginitis

    Vaginitis type Suggested regimen(s)
    Bacterial vaginosis Clindamycin, 300 mg orally twice daily for 7 daysMetronidazole, 500 mg orally twice daily for 7 days prior to menstruation, followed by 500 mg orally twice daily for 3-5 days after menstruation
    Trichomoniasis After first failure: Metronidazole, 500 mg twice daily for 7 daysFor repeated failures: Metronidazole, 2 g in a single dose daily for 3-5 daysIf infection continues: consider metronidazole susceptibility testing
    Vulvovaginal candidiasis Intensive initial regimen for 10 to 14 days, followed by up to 6 months treatment with:Ketoconazole, 100 mg orally once dailyItraconazole, 50 to 100 mg orally once dailyFluconazole, 100 mg orally once weeklyClotrimazole tablet, 500 mg intravaginally once weeklySubsequent relapse justifies treatment for at least 12 monthsIf symptoms persist during treatment, consider culture and sensitivity testing to identify resistant species of Candida other than C. albicans

    Contact your doctor if symptoms recur. Patients with recurrent yeast and bacterial infections should be monitored to determine if treatments have been successful.

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