Treatment for Vulval Itching

Diagnostic Approach

The American College of Family Physicians recommends determining the underlying cause of vulval itching, with vulvovaginal candidiasis (VVC) characterized by pruritus, erythema in the vulvovaginal area, and possibly white discharge, with a normal pH (≤4.5) 1, 2, 3
Trichomoniasis presents with diffuse, malodorous, yellow-green discharge with vulvar irritation, according to the American Family Physician 1
Bacterial vaginosis is characterized by vaginal discharge with a fishy odor, particularly after applying KOH, as reported by the MMWR Recommendations and Reports 4

The Centers for Disease Control and Prevention (CDC) recommends first-line treatment for uncomplicated VVC with topical azole antifungals, such as clotrimazole 1% cream 5g intravaginally for 7-14 days, or fluconazole 150mg oral tablet, single dose 2
For trichomoniasis, the American Family Physician recommends oral metronidazole with a cure rate of 90-95%, and treatment of sex partners to prevent reinfection 1
The American Family Physician suggests oral metronidazole or clindamycin for bacterial vaginosis, with follow-up evaluation one month after treatment completion 3, 4

The American College of Family Physicians recommends only seven-day topical azole therapies for pregnant women with VVC, and notes that fluconazole during pregnancy may be associated with spontaneous abortion and birth defects 3, 5
For women with HIV, the American Family Physician and Clinical Infectious Diseases recommend treatment for VVC that does not differ from those without HIV, and note that lower CD4+ T-cell counts are associated with increased rates of VVC 3, 5

The MMWR Recommendations and Reports advises that self-medication with over-the-counter preparations should only be advised for women previously diagnosed with VVC who experience recurrence of the same symptoms, and that any woman whose symptoms persist after using OTC preparations or who experiences recurrence within 2 months should seek medical care 2, 6
The CDC recommends considering obtaining vaginal cultures to identify unusual species, particularly non-albicans Candida, for persistent or recurrent symptoms 2, 7

The MMWR Recommendations and Reports recommends patients return for follow-up only if symptoms persist or recur within 2 months, and that for complicated VVC, follow-up evaluation is recommended to ensure treatment effectiveness 2, 7