TOC  | ID |  STD 

Sexually Transmitted Diseases Treatment Guidelines 2002  MMWR May 10, 2002/Vol. 51/No.RR-6

Vaginitis

Yeast Candidiasis Vaginitis (Candida albicans)
DX: KOH or wet smear for fungus monilia, hyphae/spores; positive cultures for Candida fungus      
RX:

• 1-day regimens:
• Diflucan/ Fluconazole 150 mg 1 tab PO 1x only
• Sporanox/ Itraconazole 200 mg tab PO bid x 1 day
• Mycelex-G 500 mg vag. tab 1 tab hs x 1 day
• Vagistat-1/Tioconazole OTC vag. 6/5% ointment one dose Rx.
• 3-day regimens:
• Sporanox/ Itraconazole 200 mg tab PO daily x 3 day
• Femsta 3/ Butoconazole nitrate 2% vag. cream 5 g hs x 3 days
• Gyne-Lotrimin 100 mg vag. tab 1 tab hs x 1 week, or 2 tab hs x 3 days.
• Monistat 3 (miconazole) 200 mg supp. hs x 3 days
• Terazol 3/ Tarconazole 0.8% vag. cream x 3 days, 80 mg vag supp. x 3 days.
• 5-day regimen:
• Nizoral/ Ketoconazole 400 mg PO bid x 5 days
• 7-day regimens:
• Monistat 7  or Femizol-M (miconazole) 2% cream 5 gm hs x 1 week
  Monistat 3 (miconazole) 100 mg vag. supp. x 1 week
• Gyne-Lotrimin/Mycelex-7 (Clotrimazole) 1% vag. cream  or 100 mg vag. tab hs x 1 week
• Terazol/Tarconazole 0.4% vag. cream x 1 week
• 14-day regimens:
• Mycostatin/Nystatin vag. tab 1 hs x 2 weeks

Trichomonas Vaginitis
DX: motile trichomonas on smear
RX:  Flagyl (metronidazole) 500 mg 4 tab x1 or 2 tab bid x 1 day only  (same Rx for partner also)
            or 500 mg bid x 7 days

Bacterial vaginosis
Gardnerella vaginitis, Corynebacterium vaginitis, Anaerobic vaginosis, Hemophilus vaginitis, non-specific vaginosis
DX:  Clue cells on saline slide, fishy odor, white to gray thin, homogeneous exudate discharge; vaginal pH >4.5.
RX:

• Flagyl (metronidazole) PO 500 mg bid  or 250 mg tid x 1 week or 2 g in single dose or  
• Clindamycin PO 300 mg bid x 1 week.
• MetroGel-Vaginal metronidazole 0.75% gel 1 applicatorful bid x 5 days, or
• Vaginal clindamycin 2% vaginal cream intravaginally  hs for 7 days

Organisms: Polymicrobial in nature: anaerobes, Mobiluncus species, G.vaginalis, Bacteroides species, peptostreptococci, & Mycoplasma hominis.

REF:

Postgrad Med April 2000;107: 63 - Andrew Coco

REF:  vaginitis2006.pdf  (NEJM Sep 21, 2006)

2006