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. This article looks at 8 home remedies, including…. How is bacterial vaginosis different from a yeast infection? Medically reviewed by Carolyn Kay, M.
Differences Diagnosis Treatment Prevention Summary Bacterial vaginosis BV and vaginal yeast infections have similar symptoms but different causes and treatments. Share on Pinterest Inflammation of the vagina is an effect of both BV and yeast infections. Latest news Scientists identify new cause of vascular injury in type 2 diabetes.
Adolescent depression: Could school screening help? Related Coverage. Causes, symptoms, and treatment of vaginitis. Medically reviewed by University of Illinois. Causes of heavy vaginal discharge. Home remedies for bacterial vaginosis. Medically reviewed by Debra Rose Wilson, Ph. Common infectious forms of vaginitis include bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Vaginitis also can occur because of atrophic changes. Bacterial vaginosis is caused by proliferation of Gardnerella vaginalis, Mycoplasma hominis , and anaerobes.
The diagnosis is based primarily on the Amsel criteria milky discharge, pH greater than 4. The standard treatment is oral metronidazole in a dosage of mg twice daily for seven days. Vulvovaginal candidiasis can be difficult to diagnose because characteristic signs and symptoms thick, white discharge, dysuria, vulvovaginal pruritus and swelling are not specific for the infection. Diagnosis should rely on microscopic examination of a sample from the lateral vaginal wall 10 to 20 percent potassium hydroxide preparation.
Cultures are helpful in women with recurrent or complicated vulvovaginal candidiasis, because species other than Candida albicans e. Topical azole and oral fluconazole are equally efficacious in the management of uncomplicated vulvovaginal candidiasis, but a more extensive regimen may be required for complicated infections. Trichomoniasis may cause a foul-smelling, frothy discharge and, in most affected women, vaginal inflammatory changes.
Culture and DNA probe testing are useful in diagnosing the infection; examinations of wet-mount preparations have a high false-negative rate. The standard treatment for trichomoniasis is a single 2-g oral dose of metronidazole. Atrophic vaginitis results from estrogen deficiency. Treatment with topical estrogen is effective.
Treating bacterial vaginosis in pregnancy reduces preterm birth and late miscarriage. Complicated vulvovaginal candidiasis should be treated with topical antifungal agents for 10 to 14 days. Culture and sensitivity results should be used to guide therapy in women with recurrent vulvovaginal candidiasis i. Vaginitis is among the most common conditions for which women seek medical care, with vaginal discharge accounting for approximately 10 million office visits each year.
Although these infections generally respond to treatment, misdiagnosis and, rarely, pharmacologic resistance may occur. Candida albicans, Candida glabrata, Candida tropicalis. Gardnerella vaginalis, Mycoplasma hominis , Mobiluncus species, Bacteroides species other than Bacteroides fragilis.
Flat, hyperkeratotic lesions that are pruritic or painful; associated vulvar and oral lesions. Sperm, douching, hygiene products tampons, sanitary napkins, latex condoms or diaphragms , dyes, inhaled allergens, occupational exposures. In almost all patients with vaginitis, it is important to perform a thorough assessment that includes speculum examination, pH testing, wet-mount and potassium hydroxide KOH preparations, and cultures when indicated.
This article reviews the diagnosis and management of bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, and vaginal atrophy. Bacterial vaginosis often is identified based on the vaginal pH and the presence of clue cells on light microscopy two of the Amsel criteria 4. A recent analysis 3 found that examination of wet-mount preparations is neither highly sensitive nor specific for vulvovaginal candidiasis.
Culture of the vagina is costly, but may be the only way to ensure diagnosis of vulvovaginal candidiasis in equivocal cases. A reasonable alternative is to use a wet-mount and KOH preparation or Gram stain of the vagina in conjunction with the findings of the physical examination, and to reserve culture for cases of treatment failure.
Finally, a recent study 6 showed that in adolescents, vaginal swabs for wet-mount and KOH preparations may be performed reliably without speculum examination. Bacterial vaginosis accounts for 10 to 30 percent of the cases of infectious vaginitis in women of childbearing age. The Amsel criteria are considered to be the standard diagnostic approach to bacterial vaginosis and continue to be generally reliable.
The presence of small gram-negative rods or gram-variable rods and the absence of longer lactobacilli on a Gram stain of the vaginal discharge also is highly predictive of bacterial vaginosis.
Because G. According to guidelines from the Centers for Disease Control and Prevention CDC , 10 treatment of bacterial vaginosis is indicated to reduce symptoms and prevent infectious complications associated with pregnancy termination and hysterectomy. Treatment also may reduce the risk of human immunodeficiency virus HIV transmission.
The standard treatment for bacterial vaginosis is metronidazole Flagyl in a dosage of mg orally twice daily for seven days Table 2. These agents include 0. Less effective alternatives include metronidazole in a single 2-g oral dose, oral clindamycin, and intra-vaginal clindamycin ovules. Metronidazole tablets Flagyl.
Metronidazole tablets. Bacterial vaginosis has been shown to be a risk factor for premature labor and perinatal infection. A Cochrane review 21 concluded that no evidence supports screening all pregnant women for bacterial vaginosis.
Guidelines from the American College of Obstetricians and Gynecologists 22 and the Agency for Healthcare Research and Quality 23 do not recommend screening in low-risk patients i. However, family physicians should be aware that one recent study 24 demonstrated a significant reduction in spontaneous preterm birth and late miscarriage after treatment with oral clindamycin, mg twice daily for five days, in women with asymptomatic bacterial vaginosis who were at 12 to 20 weeks of gestation.
Therefore, the current recommendations against screening and treating asymptomatic pregnant women may be reevaluated. Because of concerns about teratogenicity, many physicians hesitate to use oral metronidazole in women who are in the first trimester of pregnancy. However, one meta-analysis 25 showed no increased risk of birth defect in infants exposed to metronidazole in utero.
Vaginal clindamycin does not reduce the risk of preterm birth or peripartum infection. Recurrent bacterial vaginosis is common and requires longer treatment 10 to 14 days with any of the recommended or alternative therapies 9 Table 2. 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. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases.
If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur.
Using alcohol or tobacco with certain medicines may also cause interactions to occur. Using this medicine with any of the following is not recommended. Your doctor may decide not to treat you with this medication, change some of the other medicines you take, or give you special instructions about the use of food, alcohol, or tobacco.
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:. Use this medicine exactly as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.
This medicine is to be used only in the vagina. Use it at bedtime, unless your doctor tells you otherwise. Do not get it into your eyes, nose, mouth, or skin. If this medicine does get into your eyes, wash them out right away with large amounts of cool tap water. If your eyes still burn or are painful, check with your doctor. This medicine comes with a patient information leaflet and patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.
The applicator is open at one end where you will insert the plunger and has a pink cap on the other end where the medicine will come out. You will use an applicator to put the gel into your vagina. The applicator has a plastic tube called a barrel that is open at one end and has a plunger another piece of plastic that can move inside the barrel at the other end.
To help clear up your infection completely, it is very important that you keep using this medicine for the full time of treatment, even if your symptoms begin to clear up after a few days. If you stop using this medicine too soon, your symptoms may return. Do not miss any doses. Also, continue using this medicine even if your menstrual period starts during the time of treatment. The dose of this medicine will be different for different patients.
Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
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