What is the treatment for vaginal inflammation evident by the presence of pus cells in a vaginal swab result, indicating a mild to moderate inflammatory response?

From the Guidelines

Vaginal inflammation with pus cells in a vaginal swab result is typically treated with antifungal agents, as it is often caused by a fungal infection such as candidiasis.

Treatment Options

• For uncomplicated cases, single-dose fluconazole or short-course fluconazole for 3 days can be effective, achieving a >90% response rate 1.
• Topical antifungal agents can also be used, with no one agent superior to another, as recommended by the Infectious Diseases Society of America 1.

Important Considerations

• Before starting treatment, a wet-mount preparation with saline and 10% potassium hydroxide should be used to confirm the diagnosis and demonstrate the presence of yeast or hyphae 1.
• Vaginal cultures for Candida should be obtained if the initial findings are negative 1.
• Complicated cases, such as those caused by non-albicans species or in abnormal hosts, may require longer treatment courses or alternative agents 1.

From the Research

Treatment for Vaginal Inflammation

The presence of pus cells in a vaginal swab result indicates a mild to moderate inflammatory response. The treatment for vaginal inflammation depends on the underlying cause of the infection.

• For aerobic vaginitis (AV), treatment may include a combined local treatment with:
  • Antibiotics (infectious component) 2
  • Steroids (inflammatory component) 2
  • Estrogen (atrophy component) 2
• In cases with Candida present, antifungals must be tried first 2
• Vaginal rinsing with povidone iodine can provide rapid relief of symptoms, but does not provide long-term reduction of bacterial loads 2
• Local antibiotics, such as kanamycin, may be used to treat AV 2
• Oral therapy with amoxyclav or moxifloxacin can be used to achieve rapid and short-term improvement of severe symptoms, especially in deep dermal vulvitis and colpitis infections with group B streptococci or (methicillin resistant) Staphylococcus aureus 2
• For desquamative inflammatory vaginitis (DIV), treatment may include:
  • Local vaginal clindamycin 3, 4
  • Vaginal corticosteroids 3
  • Maintenance treatment should be considered as relapse is common 3

Important Considerations

• Treatment should be based on microscopy findings, rather than just vaginal culture results 2
• The diagnosis of AV is per exclusionem, and other causes of vaginal discharge should be excluded 2
• DIV is a diagnosis of exclusion, and other causes of purulent vaginitis should be excluded 3, 4