What is the recommended treatment for a Staphylococcus vaginal infection?

Treatment of Staphylococcus Vaginal Infection

For Staphylococcus vaginal infection, the recommended treatment is clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days. 1

Diagnosis and Assessment

• Before initiating treatment, proper diagnosis should be confirmed through:
  • Clinical examination showing signs of vaginitis (pruritus, erythema, discharge) 1
  • Culture or other tests yielding a positive result for Staphylococcus species 1
  • Wet preparation or Gram stain of vaginal discharge to rule out other common causes of vaginitis 1

Treatment Options

First-line Treatment:

• Topical therapy:
  • Clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days 1
  • Note: Clindamycin cream is oil-based and might weaken latex condoms and diaphragms 1

Alternative Options:

• For methicillin-susceptible Staphylococcus aureus (MSSA):

  • Oral clindamycin 300mg twice daily for 7 days 1, 2
  • First-generation cephalosporins (cephalexin) for less serious infections 2

• For methicillin-resistant Staphylococcus aureus (MRSA):

  • Trimethoprim-sulfamethoxazole (TMP-SMX) 1
  • Clindamycin 600mg orally three times daily 1
  • Doxycycline or minocycline (not for children <8 years) 1

Special Considerations

Severe or Complicated Infections

• For severe infections with systemic symptoms or extensive involvement:
  • Hospitalization may be required 1
  • Intravenous vancomycin is recommended for serious MRSA infections 1
  • Linezolid 600mg PO/IV twice daily is an alternative 1

Pregnancy

• Clindamycin cream should be used with caution during pregnancy due to potential increase in adverse events (prematurity and neonatal infections) 1
• Consult with an obstetrician for appropriate management during pregnancy 1

Recurrent Infections

• For recurrent Staphylococcus vaginal infections, consider:
  • Decolonization strategies if recurrent infection occurs despite optimizing hygiene measures 1
  • Nasal decolonization with mupirocin twice daily for 5-10 days 1
  • Topical body decolonization with chlorhexidine skin antiseptic solution for 5-14 days 1
  • Dilute bleach baths (1 teaspoon per gallon of water for 15 minutes twice weekly) 1

Prevention and Follow-up

• Maintain good personal hygiene with regular bathing and hand washing 1
• Keep any draining wounds covered with clean, dry bandages 1
• Focus cleaning on high-touch surfaces that may contact bare skin 1
• Follow-up visits are unnecessary if symptoms resolve 1
• Patients should return for additional therapy if symptoms recur 1

Common Pitfalls and Caveats

• Routine treatment of sex partners is not recommended based on clinical trials showing that a woman's response to therapy and likelihood of relapse are not affected by partner treatment 1
• Do not use rifampin as a single agent for treatment of Staphylococcal infections as resistance develops rapidly 1, 3
• Cultures should be obtained in patients who do not respond to initial treatment to guide antibiotic selection 1
• Identifying Staphylococcus by culture in the absence of symptoms should not lead to treatment, as colonization without infection is common 1