Management of Recurrent Bacterial Vaginosis and Vaginal Candidiasis

Evaluation and Diagnosis

Before initiating treatment, confirm the diagnosis with appropriate testing to identify the specific pathogens and rule out other causes of vaginitis, as recommended by the Centers for Disease Control and Prevention 1
For recurrent BV, vaginal cultures should be obtained to confirm the clinical diagnosis, according to the Centers for Disease Control and Prevention 2, 3
For recurrent VVC, cultures should be obtained to identify non-albicans species, particularly Candida glabrata, which may require different treatment approaches, as suggested by the Centers for Disease Control and Prevention 2, 3

For complicated VVC, consider 7-14 days of topical therapy or fluconazole 150 mg oral dose, repeated after 3 days, as recommended by the Centers for Disease Control and Prevention 2, 4
Evaluate for predisposing conditions that may contribute to recurrence, including diabetes, immunosuppression, and antibiotic use, as advised by the Centers for Disease Control and Prevention 2, 5

For BV, consider treatment of male partners in women with recurrent infection, though evidence for this approach is limited, according to the Centers for Disease Control and Prevention 3, 4
For VVC, partner treatment is generally not recommended as VVC is not usually sexually transmitted, as stated by the Centers for Disease Control and Prevention 6, 3

Schedule follow-up visits to assess treatment response and adjust therapy as needed, as recommended by the Centers for Disease Control and Prevention 2, 3
Patients should be instructed to return if symptoms persist or recur after completing the extended and maintenance treatment regimens, according to the Centers for Disease Control and Prevention 2, 4

Failure to identify non-albicans Candida species, which may be present in 10-20% of RVVC cases and require different treatment approaches, as noted by the Centers for Disease Control and Prevention 2, 4
Neglecting to evaluate for underlying conditions that may contribute to recurrent infections, as advised by the Centers for Disease Control and Prevention 2, 5