Family physicians also must remember that vaginal yeast infections may be caused by species other than C. Infections with these species are less common than C. Patients with vulvovaginal candidiasis usually report one or more of the following: vulvovaginal pruritus 50 percent , vulvovaginal swelling 24 percent , and dysuria 33 percent. Because these symptoms are not specific for vulvovaginal candidiasis, family physicians also should consider other causes.
In one study, 30 the presence of vulvovaginal candidiasis was confirmed in only Therefore, the diagnosis of vulvovaginal candidiasis should rely heavily on microscopic examination of a sample taken from the lateral vaginal wall 10 to 20 percent KOH preparation.
Although vaginal culture is not routinely necessary for diagnosis, it can be helpful in women with recurrent symptoms or women with typical symptoms and a negative KOH preparation. All standard treatment regimens for uncomplicated vulvovaginal candidiasis are equally efficacious, resulting in a clinical cure rate of approximately 80 percent 7 Table 3.
However, many women may prefer the simplicity of a single mg oral dose of fluconazole Diflucan. In women with candidal vaginitis, treatment with oral fluconazole has been shown to be safe and as effective as seven days of treatment with intravaginal clotrimazole.
In some patients, fluconazole may cause gastrointestinal upset, headache, dizziness, and rash, although these side effects typically are mild. One tablet intravaginally per day for 7 days or. Two tablets intravaginally per day for 3 days. Information from references 10 and When therapy for vulvovaginal candidiasis is considered, it is helpful to classify the infection as uncomplicated or complicated Table 4.
For example, in complicated vulvovaginal candidiasis, topical therapy has been shown to be more effective than single-dose oral therapy, 28 but treatment should be extended to 10 to 14 days. Infection with Candida species other than C. Woman with uncontrolled diabetes mellitus, immunosuppression, or debilitation; pregnant woman. Adapted from Sexually transmitted diseases treatment guideline If oral therapy is preferred for severe vulvovaginal candidiasis, two sequential mg doses of fluconazole, given three days apart, have been shown to be superior to a single mg dose.
In patients with severe discomfort secondary to vulvitis, the combination of a low-potency steroid cream and a topical antifungal cream may be beneficial. Recurrent vulvovaginal candidiasis is defined as four or more yeast infections in one year. The possibility of uncontrolled diabetes mellitus or immunodeficiency should be considered in women with recurrent vulvovaginal candidiasis.
When it is certain that no reversible causes are present e. Information from reference Culture and sensitivity results should be used to guide therapy, because non— C.
Trichomonas vaginalis infection causes a foul-smelling, frothy discharge that usually is accompanied by vaginal irritation. Although the presence of motile trichomonads in a wet-mount preparation is diagnostic, the examination can be negative in up to 50 percent of women with culture-confirmed infection. Unlike women with asymptomatic G. Occasionally, T. Detection by this method is reported to be 57 percent sensitive and 97 percent specific for trichomoniasis.
When trichomoniasis is found during routine Pap testing, management should be based on the pretest probability of infection in the patient, which is determined by the prevalence of T. For example, if the pretest probability of T. Alternatively, the patient can be offered the options of treatment or confirmatory culture followed by treatment if the culture is positive. Because metronidazole is the only agent that is used to treat T.
A desensitization protocol is available for the management of documented trichomoniasis and frank allergy to metronidazole. Although evidence indicates that resistance of T. If tolerance is a problem, the CDC 10 recommends repeating the 2-g dose of metronidazole orally and if the patient still is infected, giving oral metronidazole in a dosage of 2 g per day for three to five days.
Several alternative regimens for trichomoniasis have been shown to be efficacious. Tinidazole marketed as Fasigyn is widely used in Europe and developing countries. This agent is effective and generally well tolerated, 42 but has not been approved by the U. Food and Drug Administration and, therefore, is not available in this country.
Another treatment option is paromomycin Humatin in a dosage of 5 g intravaginally per day for 14 days. This treatment is reported to be effective in 58 percent of patients. As previously noted, however, the risk of teratogenicity appears to be overstated.
The CDC 10 advises treatment of symptomatic pregnant women with a single 2-g oral dose of metronidazole but does not recommend treatment of asymptomatic pregnant women.
The decrease in estrogen levels during perimenopause and after menopause can cause vaginal atrophy. One important physiologic change is thinning of the vaginal epithelium; another is loss of glycogen, which leads to changes in the vaginal pH and flora.
Many women with these vaginal changes are minimally symptomatic and require only explanation and reassurance.
In women with more severe changes, vaginal irritation, dyspareunia, and fragility may become problems. Atrophy is diagnosed by the presence of a thin, clear or bloody discharge, a vaginal pH of 5 to 7, loss of vaginal rugae, and the finding of parabasal epithelial cells on microscopic examination of a wet-mount preparation. Treatment with topical estrogen cream, tablet, or ring usually provides complete relief of symptoms within weeks. In the interim, patients may obtain relief through use of vaginal lubricants and moisturizers e.
Rarely, endometrial hyperplasia can be a side effect of vaginal estrogen treatment. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Clenney received his medical degree from the University of South Florida College of Medicine, Tampa, and completed a family medicine residency at the Naval Hospital Jacksonville.
He also completed a faculty development fellowship and a master of public health degree at Emory University. The authors indicate that they do not have any conflicts of interest.
Sources of funding: none reported. Address correspondence to Timothy L. Many women may prefer miconazole for its convenient single-dose option. During pregnancy, terconazole can be absorbed from the vagina and potentially cause adverse effects in an unborn baby. Consult a healthcare provider before using terconazole or miconazole while pregnant.
Since terconazole and miconazole are usually applied topically, they have a low risk of interacting with alcohol. Alcohol may indirectly affect how well the immune system can fight off infections. Terconazole is only effective for vaginal infections caused by a species of yeast called Candida. It is not effective for other infections, such as bacterial vaginosis.
The strongest medicine for a yeast infection is an antifungal agent belonging to the azole class. The usual treatment of choice is a single dose of Diflucan fluconazole.
OTC antifungals like miconazole are also effective for mild, infrequent yeast infections. For more serious yeast infections, an oral antifungal drug may be necessary. Skip to main content Search for a topic or drug. Terconazole vs. By Gerardo Sison, Pharm. Want the best price on terconazole? Want the best price on miconazole? Top Reads in Drug vs. Toujeo vs Lantus: Main Differences and S Dulera vs Advair: Main Differences and S Suboxone vs Methadone: Main Differences Looking for a prescription?
Search now! Type your drug name. Relationship between clinical diagnosis of recurrent vulvovaginal candidiasis and detection of Candida species by culture and polymerase chain reaction. Arch Gynecol Obstet. Vaginal swabs versus lavage for detection of Trichomonas vaginalis and bacterial vaginosis among HIV-positive women.
Charonis G, Larsson PG. Acta Obstet Gynecol Scand. Cost-effectiveness of diagnostic strategies for vaginitis. J Gen Intern Med. Bacterial vaginosis: diagnostic and pathogenetic findings during topical clindamycin therapy.
Bacterial vaginosis and risk of pelvic inflammatory disease. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition.
J Infect Dis. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. Accessed September 12, The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women.
Cochrane Database Syst Rev. Probiotics for the treatment of bacterial vaginosis. Antibiotics for treating bacterial vaginosis in pregnancy. Preventive Services Task Force. Screening for bacterial vaginosis in pregnancy to prevent preterm delivery: U.
Preventive Services Task Force recommendation statement. Ann Intern Med. Six years observation after successful treatment of bacterial vaginosis. Infect Dis Obstet Gynecol. Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. Suppressive antibacterial therapy with 0. A meta-analysis of the Papanicolaou smear and wet mount for the diagnosis of vaginal trichomoniasis. Use of spun urine to enhance detection of Trichomonas vaginalis in adolescent women.
Arch Pediatr Adolesc Med. Rapid antigen testing compares favorably with transcription-mediated amplification assay for the detection of Trichomonas vaginalis in young women. Clin Infect Dis. Detection of Chlamydia trachomatis and Trichomonas vaginalis by polymerase chain reaction in introital specimens from pregnant women. Interventions for treating trichomoniasis in women.
Interventions for trichomoniasis in pregnancy. An epidemiological survey of vulvovaginal candidiasis in Italy. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis thrush. Clinical practice guidelines for the management of candidiasis: update by the Infectious Diseases Society of America. Local oestrogen for vaginal atrophy in postmenopausal women. This content is owned by the AAFP.
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Read the Issue. Sign Up Now. Apr 1, Issue. Vaginitis: Diagnosis and Treatment. A 33 Nitroimidazole drugs e. A 44 Oral and vaginal antifungals are equally effective for the treatment of uncomplicated vulvovaginal candidiasis. A 47 All methods of estrogen delivery relieve the symptoms of atrophic vaginitis. Enlarge Print Table 1. Table 1. Enlarge Print Table 2. Table 2. Enlarge Print Table 3.
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To see the full article, log in or purchase access. BV results from an overgrowth of harmful bacteria in the vagina, while an overgrowth of Candida fungus causes a yeast infection. Both infections cause changes in vaginal discharge. BV causes thin discharge with a fishy odor, while a yeast infection causes discharge that is thick and odorless.
Doctors typically recommend antibiotic medications to treat BV and antifungal medications to treat yeast infections. Also, over-the-counter tablets, creams, ointments, and suppositories are available to treat mild to moderate yeast infections. Vaginitis is an inflammation of the vagina that is typically caused by a fungal or bacterial infection. Symptoms include discharge, itching, burning….
Having a certain amount of vaginal discharge is a normal sign of a healthy reproductive system. This article looks at why people may have excessive….
Bacterial vaginosis is the most common vaginal infection, having affected as many as 1 in 4 women in the U. While antibiotics are usually effective…. Many treatments are available for a yeast infection, some of which a person can administer at home.
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