Treatment of Acute Vaginitis

Vulvovaginal Candidiasis (Most Common Acute Vaginitis)

The Centers for Disease Control and Prevention recommends fluconazole 150 mg as a single oral dose or short-course topical azole therapy for the treatment of uncomplicated vulvovaginal candidiasis in women of reproductive age, with 80-90% cure rates 1, 2
Topical azole therapies, such as clotrimazole 1% cream or miconazole 2% cream, are effective treatment options for vulvovaginal candidiasis, with cure rates ranging from 80-90% 1, 3
The American College of Obstetricians and Gynecologists recommends that topical azoles be preferred over nystatin for the treatment of vulvovaginal candidiasis 3, 4

The Centers for Disease Control and Prevention recommends metronidazole 500 mg orally twice daily for 7 days as the first-line treatment for bacterial vaginosis, achieving 95% cure rates 5
Alternative regimens, such as metronidazole 2g orally as a single dose or clindamycin cream 2% intravaginally, may be used for the treatment of bacterial vaginosis, with cure rates ranging from 84-95% 5

The American College of Obstetricians and Gynecologists recommends that only topical azole therapies be used during pregnancy, as oral fluconazole is contraindicated 2
Patients with recurrent vulvovaginal candidiasis (≥4 episodes/year) require longer initial therapy followed by a maintenance regimen, and should be evaluated for predisposing conditions such as diabetes or immunosuppression 2

Oil-based creams and suppositories may weaken latex condoms and diaphragms, and patients should be advised to use alternative forms of contraception 1, 2
Patients should avoid alcohol during metronidazole treatment and for 24 hours after, as it may cause adverse reactions 5