Treatment of Coinfections with Gardnerella vaginalis and Candida species

Bacterial Vaginosis (Gardnerella vaginalis) Treatment

The Centers for Disease Control and Prevention recommends oral metronidazole 500 mg twice daily for 7 days as the first-line treatment for bacterial vaginosis, with a cure rate of 86-97% 1, 2
Patients should avoid alcohol during treatment with metronidazole and for 24 hours afterward, as recommended by the Centers for Disease Control and Prevention 2
For treatment failure, the Centers for Disease Control and Prevention recommends retreating with metronidazole 500 mg twice daily for 7 days 3
For repeated treatment failures, consider metronidazole 2 g once daily for 3-5 days, as suggested by the Centers for Disease Control and Prevention 3

The Infectious Diseases Society of America recommends fluconazole 150 mg oral tablet as a single dose for the treatment of vulvovaginal candidiasis, with therapeutic cure rates of approximately 55% 4
Topical azole treatments, such as clotrimazole 1% cream 5 g intravaginally for 7-14 days, are alternative options for the treatment of vulvovaginal candidiasis, as recommended by the Infectious Diseases Society of America and the Centers for Disease Control and Prevention 4, 5
Miconazole 2% cream 5 g intravaginally for 7 days is another alternative treatment option for vulvovaginal candidiasis, as recommended by the Infectious Diseases Society of America and the Centers for Disease Control and Prevention 4, 5
Terconazole 0.4% cream 5 g intravaginally for 7 days is also an alternative treatment option for vulvovaginal candidiasis, as recommended by the Infectious Diseases Society of America 4
Butoconazole 2% cream 5 g intravaginally for 3 days is an alternative treatment option for vulvovaginal candidiasis, as recommended by the Centers for Disease Control and Prevention 5

For bacterial vaginosis in pregnancy, the Centers for Disease Control and Prevention recommends metronidazole 2 g in a single dose after the first trimester 5
For vulvovaginal candidiasis in pregnancy, the Infectious Diseases Society of America recommends topical azole treatments 7
Patients with HIV should receive the same treatment regimens as those without HIV, as recommended by the Centers for Disease Control and Prevention 3
Treatment of male sex partners for bacterial vaginosis has not been shown to reduce recurrence rates and is not recommended by the Centers for Disease Control and Prevention 2

Self-diagnosis of yeast vaginitis is unreliable and can lead to inappropriate treatment, as noted by the Infectious Diseases Society of America 6
Oil-based creams and suppositories may weaken latex condoms and diaphragms, as warned by the Centers for Disease Control and Prevention 5
Approximately 10-20% of women normally harbor Candida species in the vagina without symptoms, so treatment should be based on both symptoms and laboratory findings, as recommended by the Centers for Disease Control and Prevention 5

Follow-up is recommended if symptoms persist after completing treatment, as recommended by the Infectious Diseases Society of America 4
For recurrent vulvovaginal candidiasis (≥4 episodes/year), consider maintenance therapy with fluconazole 150 mg weekly for 6 months after initial induction therapy, as recommended by the Infectious Diseases Society of America 7, 6