From the Guidelines
For excess vaginal discharge in adolescents, the most effective treatment option is to first determine if the discharge is normal or abnormal, and if abnormal, to treat the underlying cause with either metronidazole (500 mg twice daily for 7 days) or clindamycin cream (2% applied intravaginally at bedtime for 7 days) for bacterial vaginosis, or over-the-counter antifungal treatments like miconazole or clotrimazole vaginal creams or suppositories used for 1-7 days for yeast infections, as recommended by the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections treatment guidelines 1.
Normal Vaginal Discharge
Normal discharge is typically clear or white, non-irritating, and may increase during certain times of the menstrual cycle. Daily hygiene measures can help, including:
- Wearing cotton underwear
- Avoiding tight clothing
- Using unscented soaps for washing the external genital area
- Avoiding douches or feminine sprays which can disrupt vaginal pH
Abnormal Vaginal Discharge
Abnormal discharge is yellow/green, foul-smelling, or accompanied by itching, pain, or redness. The adolescent should see a healthcare provider for proper diagnosis and treatment. The healthcare provider may prescribe:
- Metronidazole (500 mg twice daily for 7 days) or clindamycin cream (2% applied intravaginally at bedtime for 7 days) for bacterial vaginosis, as recommended by the Centers for Disease Control and Prevention 1
- Over-the-counter antifungal treatments like miconazole or clotrimazole vaginal creams or suppositories used for 1-7 days for yeast infections, as recommended by the Infectious Diseases Society of America 1
Diagnosis
Diagnosis of the underlying cause of abnormal discharge can be made through:
- Clinical examination
- Wet mount preparation with use of saline and 10% potassium hydroxide to demonstrate the presence of yeast or hyphae
- Vaginal cultures for Candida
- pH testing to determine if the vaginal pH is elevated, which can indicate bacterial vaginosis or trichomoniasis 1
From the FDA Drug Label
Vaginal candidiasis: Two adequate and well-controlled studies were conducted in the U. S. using the 150 mg tablet. The therapeutic cure rate, defined as a complete resolution of signs and symptoms of vaginal candidiasis (clinical cure), along with a negative KOH examination and negative culture for Candida (microbiologic eradication), was 55% in both the fluconazole group and the vaginal products group Fluconazole PO 150 mg tablet Vaginal Product qhs x 7 days Enrolled 448 422 Evaluable at Late Follow-up 347 (77%) 327 (77%) Clinical cure 239/347 (69%) 235/327 (72%) Mycologic eradication 213/347 (61%) 196/327 (60%) Therapeutic cure 190/347 (55%) 179/327 (55%)
The treatment options available for an adolescent with excessive vaginal discharge include:
- Fluconazole (PO): a 150 mg tablet, with a therapeutic cure rate of 55% 2
- Vaginal products: such as clotrimazole or miconazole, with a therapeutic cure rate of 55% 2 Key points:
- The treatment options are for vaginal candidiasis, which may be the cause of excessive vaginal discharge
- The efficacy of fluconazole and vaginal products is comparable, with a therapeutic cure rate of 55% 2
From the Research
Treatment Options for Excessive Vaginal Discharge in Adolescents
The treatment options for excessive vaginal discharge in adolescents depend on the underlying cause of the discharge. According to 3, treatment is based on historical events and a physical examination that includes cultures of the discharge, with the goal of effectively treating the underlying cause.
Common Causes and Treatments
- Bacterial vaginosis, vulvovaginal candidiasis, and trichomonas are common microbial etiologies of vaginitis, and their diagnosis and treatment in adolescents are discussed in 4.
- For recurrent bacterial vaginosis, recommended treatment consists of an extended course of metronidazole treatment, and if ineffective, metronidazole vaginal gel or alternative treatments such as secnidazole may be used, as stated in 5.
- In some cases, vaginal discharge may be caused by a foreign body lodgement, which can be diagnosed and treated by removal of the foreign object, as described in 6.
Importance of Proper Diagnosis and Treatment
- Proper diagnosis and treatment of vaginal discharge are crucial to prevent complications and recurrence, as highlighted in 4 and 5.
- Adolescents with vaginal discharge should seek medical attention to determine the underlying cause and receive appropriate treatment, as emphasized in 7.
Factors Associated with Knowledge and Practice
- Higher age, marriage, late menarche, and seeking medical care for complaints of vaginal discharge are factors associated with a high knowledge level about vaginal discharge, as found in 7.