From the Guidelines
Vaginitis should be treated based on the underlying cause, with metronidazole being the preferred treatment for bacterial vaginosis (BV), as it has been shown to be efficacious in numerous studies, resulting in relief of symptoms and improvement in clinical course and flora disturbances 1. The most common causes of vaginitis are bacterial vaginosis (BV), yeast infections (candidiasis), and trichomoniasis.
- For bacterial vaginosis, treatment typically involves metronidazole 500mg orally twice daily for 7 days, which has been shown to have a cure rate of 95% 1.
- For yeast infections, fluconazole 150mg as a single oral dose or topical antifungals like miconazole or clotrimazole for 1-7 days are effective.
- Trichomoniasis requires metronidazole 2g as a single oral dose or 500mg twice daily for 7 days. Proper diagnosis is essential before treatment, as symptoms can overlap between different types of vaginitis.
- Maintaining good hygiene, avoiding douching, wearing breathable cotton underwear, and practicing safe sex can help prevent recurrence.
- Pregnant women should consult healthcare providers before using any medications.
- Recurrent vaginitis may require longer treatment courses or investigation for underlying conditions like diabetes or immunosuppression. It is also important to note that only women with symptomatic disease require treatment, and treatment of male partners has not been shown to alter either the clinical course of BV in women during treatment or the relapse/reinfection rate 1.
From the FDA Drug Label
1.4 Bacterial Vaginosis Tinidazole is indicated for the treatment of bacterial vaginosis (formerly referred to as vaginitis, vaginitis, nonspecific vaginitis, or anaerobic vaginosis) in adult women Other pathogens commonly associated with vulvovaginitis such as Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans and Herpes simplex virus should be ruled out.
Tinidazole is indicated for the treatment of bacterial vaginosis, which is formerly referred to as vaginitis. Key points to consider:
- The drug is specifically indicated for adult women.
- It is essential to rule out other common pathogens associated with vulvovaginitis before treatment. 2
From the Research
Definition and Causes of Vaginitis
- Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning 3
- The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, accounting for 40-50%, 20-25%, and 15-20% of cases, respectively 3
- Noninfectious causes, including atrophic, irritant, allergic, and inflammatory vaginitis, are less common and account for 5-10% of vaginitis cases 3
Diagnosis of Vaginitis
- Diagnosis is made using a combination of symptoms, physical examination findings, and office-based or laboratory testing 3
- Bacterial vaginosis is traditionally diagnosed with Amsel criteria, although Gram stain is the diagnostic standard 3
- Newer laboratory tests that detect Gardnerella vaginalis DNA or vaginal fluid sialidase activity have similar sensitivity and specificity to Gram stain 3
- The diagnosis of vulvovaginal candidiasis is made using a combination of clinical signs and symptoms with potassium hydroxide microscopy; DNA probe testing is also available 3
- 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 Vaginitis
- Bacterial vaginosis is treated with oral metronidazole, intravaginal metronidazole, or intravaginal clindamycin 3
- Treatment of vulvovaginal candidiasis involves oral fluconazole or topical azoles, although only topical azoles are recommended during pregnancy 3
- Trichomoniasis is treated with oral metronidazole or tinidazole, and patients' sex partners should be treated as well 3
- Treatment of noninfectious vaginitis should be directed at the underlying cause, such as hormonal and nonhormonal therapies for atrophic vaginitis 3
- In cases of recurrent vaginitis, extended treatment duration with one of the first-line agents may be recommended, and alternative options such as vaginal boric acid may be considered 4