From the Guidelines
For non-fungal vulvovaginitis treatment, metronidazole 500mg orally twice daily for 7 days is the most effective approach, as evidenced by a cure rate of 95% in the 7-day regimen 1. The approach to treating non-fungal vulvovaginitis depends on the specific cause, with bacterial vaginosis being a common cause.
- For bacterial vaginosis, metronidazole 500mg orally twice daily for 7 days or metronidazole gel 0.75% intravaginally once daily for 5 days is recommended, with the 7-day regimen being more efficacious 1.
- Alternatively, clindamycin cream 2% intravaginally at bedtime for 7 days is effective, although it appears less efficacious than the metronidazole regimens 1.
- For trichomoniasis, a single 2g oral dose of metronidazole or tinidazole is the treatment of choice, with sexual partners requiring treatment as well.
- For non-infectious causes like allergic or irritant vulvovaginitis, removing the offending agent (soaps, douches, perfumed products) and using mild, unscented cleansers is essential, along with topical steroids like hydrocortisone 1% cream to reduce inflammation.
- For atrophic vaginitis, topical estrogen cream or vaginal moisturizers provide relief. Good hygiene practices are important for all types: wearing cotton underwear, avoiding tight clothing, and wiping front to back after using the bathroom, as these practices help prevent the development of non-fungal vulvovaginitis 1. The principal goal of therapy is to relieve vaginal symptoms and signs, and only women with symptomatic disease require treatment 1.
From the FDA Drug Label
Other pathogens commonly associated with vulvovaginitis such as Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans and Herpes simplex virus should be ruled out. The treatment for non-fungal vulvovaginitis is not explicitly stated in the provided drug labels, but it is mentioned that Tinidazole is indicated for the treatment of bacterial vaginosis and trichomoniasis, which are types of vulvovaginitis.
- Bacterial vaginosis can be treated with tinidazole oral tablets given as either 2 g once daily for 2 days or 1 g once daily for 5 days.
- Trichomoniasis can be treated with a single oral 2 g tinidazole dose. However, the FDA drug label does not provide information on the treatment of non-fungal vulvovaginitis in general, only for specific types of infections. 2, 2, 2
From the Research
Treatment for Non-Fungal Vulvovaginitis
The treatment for non-fungal vulvovaginitis, which includes bacterial vaginosis and trichomoniasis, is as follows:
- Bacterial vaginosis is treated with oral metronidazole, intravaginal metronidazole, or intravaginal clindamycin 3, 4, 5, 6, 7
- Trichomoniasis is treated with oral metronidazole or tinidazole, and patients' sex partners should be treated as well 3, 4, 5, 6
- Noninfectious vaginitis, such as atrophic vaginitis, is treated with hormonal and nonhormonal therapies, and inflammatory vaginitis may improve with topical clindamycin and steroid application 3
Treatment Options
Some specific treatment options include:
- Oral metronidazole 500 mg twice daily for 7 days for bacterial vaginosis 5, 7
- Metronidazole vaginal gel 5 g twice daily for 5 days for bacterial vaginosis 7
- Clindamycin vaginal cream 5 g once daily for 7 days for bacterial vaginosis 7
- Oral fluconazole for vulvovaginal candidiasis, although only topical azoles are recommended during pregnancy 3, 5
Considerations
It's worth noting that:
- The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for the diagnosis of trichomoniasis in symptomatic or high-risk women 3
- Treatment of noninfectious vaginitis should be directed at the underlying cause 3
- Patients with recurrent vulvovaginal candidiasis may require longer courses of therapy to be resolved 5