Vaginitis in Nonpregnant Patients
Publication Date: December 31, 2019
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:
- visualization of spores, pseudohyphae, or hyphae on wet-mount microscopy or
- vaginal fungal culture or commercial diagnostic test results positive for Candida species.
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
American College of Obstetricians and Gynecologists
Publication Month/Year
December 31, 2019
Last Updated Month/Year
April 1, 2024
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