Treatment

This is dependent on the organism involved.

Women who have bacterial vaginosis or trichomoniasis, and who are also HIV-positive, should receive the same treatment regimen as those who are HIV-negative (1).

In non-pregnant women with bacterial vaginosis, oral or topical metronidazole or topical clindamycin are the treatments of choice.

Pregnant women can be safely treated with metronidazole and clindamycin is an effective alternative (1).

Metronidazole single-dose oral therapy has the lowest efficacy for bacterial vaginosis and is no longer recommended (2).

Non-pregnant women with trichomoniasis can be treated with multi-dose therapy with oral metronidazole or a single dose of tinidazole.

Pregnant women with trichomoniasis should be treated with multi-dose therapy with oral metronidazole, but tinidazole should be avoided (3).

For uncomplicated candidiasis infection, treatment with oral or topical azole antifungal agents should be started:

• pregnant women are treated only with topical azoles, for no longer than 7 days (1)

If atrophic vaginitis is the cause, topical oestrogen in women wishing to avoid hormonal treatment, or concomitant use of a lubricant in women on HRT may be adequate in controlling symptoms. (4)

In non-infective or allergic contact vaginitis, preventive measures are the mainstay of treatment (5).

References

1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.
2. Menard JP. Antibacterial treatment of bacterial vaginosis: current and emerging therapies. Int J Womens Health. 2011;3:295-305.
3. Schumann J. Trichomoniasis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.2023 Jun 12.
4. Sturdee DW, Panay N; International Menopause Society Writing Group. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010 Dec;13(6):509-22.
5. Hainer BL, Gibson MV. Vaginitis: diagnosis and treatment. Am Fam Physician. 2011 Apr 1;83(7):807-15.