Vaginitis in Nonpregnant Patients

Publication Date: January 1, 2020
Last Updated: March 14, 2022

Recommendations

The use of Amsel clinical criteria or Gram stain with Nugent scoring is recommended for the diagnosis of bacterial vaginosis. (A)
574
Oral or intravaginal metronidazole or intravaginal clindamycin is recommended for the treatment of bacterial vaginosis. Alternative treatments include oral secnidazole, oral tinidazole, or oral clindamycin. (A)
574
Nucleic acid amplification testing is recommended for the diagnosis of trichomoniasis. (A)
574
Oral nitroimidazoles are recommended for the treatment of trichomoniasis. (A)
574
In a symptomatic patient, diagnosis of vulvovaginal candidiasis requires one of the following two findings:
  1. visualization of spores, pseudohyphae, or hyphae on wet-mount microscopy or
  2. vaginal fungal culture or commercial diagnostic test results positive for Candida species.
( A )
574
Extended antifungal treatment is recommended for patients with recurrent vulvovaginal candidiasis to reduce the likelihood of persistent symptoms. (A)
574
Patients should be retested within 3 months after treatment for T. vaginalis because of the high rates of infection recurrence. (B)
574
Pap tests are not reliable for the diagnosis of vaginitis. Diagnostic confirmation is recommended for incidental findings of vulvovaginal candidiasis, bacterial vaginosis, or trichomoniasis on a Pap test. (B)
574
A complete medical history, physical examination of the vulva and vagina, and clinical testing of vaginal discharge (ie, pH testing, a potassium hydroxide [KOH] “whiff test,” and microscopy) are recommended for the initial evaluation of patients with vaginitis symptoms. (C)
574
Intravaginal azole therapy or oral fluconazole is recommended for the treatment of uncomplicated vulvovaginal candidiasis. (C)
574
Self-diagnosis of common vaginitis is not recommended because of its limited accuracy and the nonspecific nature of vulvovaginal symptoms. (C)
574
Probiotics (vaginal or oral) and nonmedical therapies are not recommended for the treatment or prevention of vaginitis. (C)
574
Whenever trichomoniasis is confirmed, current sex partners should be referred for presumptive therapy and counseled to refrain from sexual activity until they have completed therapy and are asymptomatic. (C)
574

Recommendation Grading

Overview

Title

Vaginitis in Nonpregnant Patients

Authoring Organization

Publication Month/Year

January 1, 2020

Last Updated Month/Year

January 9, 2023

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Physician, nurse nurse midwife, nurse certified nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D014627 - Vaginitis, D059268 - Atrophic Vaginitis

Keywords

vulvovaginitis, Vaginitis, vaginal infection