What is the treatment for vulvovaginitis?

From the Guidelines

Vulvovaginitis treatment should be guided by the underlying cause, with bacterial vaginosis treated with metronidazole 500mg orally twice daily for 7 days or metronidazole gel 0.75% intravaginally once daily for 5 days, as recommended by the 2002 CDC guidelines 1. For yeast infections, the most recent evidence from 2022 suggests that fluconazole 150mg as a single oral dose or topical antifungals like clotrimazole 1% cream applied intravaginally for 7-14 days are effective treatments 2. Some key points to consider in treatment include:

• Avoiding alcohol consumption during metronidazole treatment and for 24 hours thereafter 1
• Being aware that clindamycin cream and ovules are oil-based and may weaken latex condoms and diaphragms 1
• Considering the use of molecular testing for vulvovaginal candidiasis diagnosis, which has been shown to have high clinical accuracy 2
• Treating sexual partners for bacterial vaginosis and trichomoniasis to prevent reinfection
• Monitoring for symptoms that persist after treatment, recur frequently, or are accompanied by fever or pelvic pain, which may indicate a more serious condition. It is essential to note that the treatment of vulvovaginitis depends on the specific cause, and a proper diagnosis is crucial for effective management. The 2022 review of vulvovaginal candidiasis treatment guidelines 2 provides the most recent and highest quality evidence for the treatment of yeast infections, while the 2002 CDC guidelines 1 remain relevant for the treatment of bacterial vaginosis.

From the FDA Drug Label

Fluconazole tablets are a prescription medicine used to treat vaginal yeast infections caused by a yeast called Candida. Fluconazole tablet helps stop too much yeast from growing in the vagina so the yeast infection goes away

The treatment for vulvovaginitis caused by a yeast infection is fluconazole tablets. This medication is taken by mouth and helps to stop the growth of yeast in the vagina, allowing the infection to clear up.

• The symptoms of a vaginal yeast infection that may be treated with fluconazole include: + Itching + A burning feeling when urinating + Redness + Soreness + A thick white vaginal discharge that looks like cottage cheese 3

From the Research

Vulvovaginitis Treatment Options

• The treatment of vulvovaginitis depends on the underlying cause, which can be infectious (bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis) or non-infectious (atrophic vaginitis) 4, 5.
• For bacterial vaginosis, the standard treatment is oral metronidazole (500 mg twice daily for 7 days) or intravaginal metronidazole gel 4, 6, 7.
• Vulvovaginal candidiasis can be treated with topical azole or oral fluconazole, with the choice of treatment depending on the severity of the infection and the presence of complications 4, 5, 8.
• Trichomoniasis is typically treated with a single 2-g oral dose of metronidazole or tinidazole, with treatment of sex partners also recommended 4, 5, 8.
• Atrophic vaginitis is treated with topical estrogen or non-hormonal therapies, with the goal of relieving symptoms and improving quality of life 4, 5.

Treatment Efficacy and Safety

• The efficacy of treatment for vulvovaginitis varies depending on the underlying cause and the treatment chosen, with cure rates ranging from 75% to 90% for bacterial vaginosis and vulvovaginal candidiasis 4, 5, 6.
• The safety of treatment for vulvovaginitis is generally good, with common side effects including nausea, vomiting, and vaginal discharge 4, 6, 7.
• The choice of treatment should be based on the severity of the infection, the presence of complications, and the patient's medical history and preferences 5, 8, 7.

Special Considerations

• Pregnant women with symptomatic bacterial vaginosis or trichomoniasis should be treated to prevent adverse outcomes of pregnancy, with metronidazole (250 mg orally three times a day for 7 days) recommended for pregnant women 5, 7.
• Women with recurrent or complicated vulvovaginitis may require longer courses of treatment or alternative therapies, with the goal of relieving symptoms and preventing future episodes 5, 8.