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Vaginitis is an altered vaginal discharge in women of reproductive age that may be secondary
to non-sexually transmitted infections (STIs) (eg bacterial vaginosis
[BV], vulvovaginal candidiasis [VVC]), STIs (eg Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis,
herpes simplex virus), or non-infective causes (eg foreign bodies,
cervical polyps or ectopy, genital tract malignancy, fistula, allergies).
Trichomoniasis is caused by a flagellated protozoan, Trichomonas vaginalis. It is always sexually transmitted.
Bacterial vaginosis is the most common cause of vaginitis, vaginal discharge or malodor. Its prevalence is similar in both pregnant and non-pregnant women.Vulvovaginal candidiasis is caused by overgrowth of yeasts where 70-90% of cases are secondary to Candida albicans. It most commonly occurs when the vagina is exposed to estrogen (ie, reproductive years, pregnancy) and may be precipitated by antibiotic or corticosteroid use. Immunocompromised and diabetic women are also at risk.
Syndromic or empiric therapy may be given if patient is low risk for STIs or without symptoms of upper genital tract infection.
Nitroimidazoles are the only class of drugs that are used for the oral or parenteral treatment of trichomoniasis.
In bacterial vaginosis, seven-day regimen of oral Metronidazole, 5-day regimen of intravaginal
Metronidazole gel, or 7-day regimen of intravaginal Clindamycin cream
may be advised.
In non-pregnant women with uncomplicated vulvovaginal candidiasis, topical/intravaginal and oral antifungal azoles have similar efficacy. Asymptomatic candidiasis should only be treated during pregnancy due to perinatal transmission. Longer therapy may be required in infection with yeasts other than C albicans. Uncomplicated vulvovaginal candidiasis is effectively and safely managed with oral and short-course topical regimens.
