Vaginal Infections
CURRENT GUIDANCE UPDATE
Bacterial Vaginosis
Bacterial vaginosis is the most common vaginal infection in women of reproductive age, and oral or vaginal metronidazole remains the recommended first-line treatment.
Vulvovaginal Candidiasis
A single oral dose of fluconazole provides treatment outcomes equivalent to topical azole therapies for uncomplicated vulvovaginal candidiasis.
Trichomoniasis Management
Trichomoniasis is the most common non-viral sexually transmitted infection worldwide, requiring metronidazole therapy together with treatment of sexual partners.
Accurate Diagnosis
Early assessment, appropriate laboratory testing and targeted treatment help relieve symptoms, prevent recurrence and reduce transmission of vaginal infections.
Introduction
Common Vaginal Infections
Vaginal infections are among the most common reasons for gynaecological consultation. Accurate diagnosis is essential because bacterial vaginosis, vulvovaginal candidiasis and trichomoniasis have different causes, treatments and recurrence patterns.
Most Common Vaginal Infection
Bacterial vaginosis affects around 30% of women and results from replacement of normal Lactobacillus flora by anaerobic bacteria. It typically presents with a thin grey-white discharge and a characteristic odour, especially after intercourse.
- Oral metronidazole 400 mg twice daily for 5–7 days
- Vaginal metronidazole gel or clindamycin cream
- Recurrent cases may benefit from maintenance metronidazole gel and probiotics
- Metronidazole is safe during the second and third trimester of pregnancy
Thrush
Approximately 75% of women experience thrush at least once in their lifetime, most commonly caused by Candida albicans. Symptoms include thick white discharge, itching, burning and vulval soreness.
- Fluconazole 150 mg oral single dose
- Topical azole creams are equally effective
- Recurrent infection requires maintenance fluconazole for 6 months
- Non-albicans Candida may require boric acid suppositories or alternative therapy
Protozoal STI
Trichomoniasis is the most common non-viral sexually transmitted infection worldwide. Symptomatic women may present with yellow-green frothy discharge, itching and dysuria, although many remain asymptomatic.
- Metronidazole 2 g single dose or 400–500 mg twice daily for 5–7 days
- Partner notification and treatment are essential
- Diagnosis by microscopy, NAAT or rapid antigen testing
- Metronidazole is considered safe in all trimesters of pregnancy
Other Important Causes
- Aerobic vaginitis caused by organisms such as E. coli
- Cervicitis due to chlamydia or gonorrhoea with minimal vaginal symptoms
- Vulval dermatoses such as lichen sclerosus causing chronic itching
- Clinical examination and appropriate laboratory testing help distinguish these conditions
Frequently Asked Questions
Can I use over-the-counter thrush treatment without seeing a doctor?
For a first episode with classic symptoms, over-the-counter treatment is acceptable. However, persistent, recurrent, or atypical symptoms should be clinically assessed, as self-diagnosis is incorrect up to 50 percent of the time.
Is bacterial vaginosis sexually transmitted?
BV is not classified as an STI, but it is associated with sexual activity, including between female partners, and can recur after treatment.
Conclusion
Vaginal infections are common, uncomfortable, and very treatable, but accurate diagnosis is the essential first step. Specialist assessment ensures the right treatment is given the first time, preventing recurrence and complications.
Sources & References
This article draws on guidance current at the time of writing from the following bodies and publications:
RCOG/BASHH
2023 GuidelinesACOG
2021, updated 2023WHO
STI Guidelines (2021)⚠ IMPORTANT DISCLAIMER
This article is provided for general knowledge and reference purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. No medication, treatment, or change to your healthcare should be undertaken based on this content without first consulting a qualified doctor. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
Consult Dr. Ruby Rashmi
Specialist Obstetrician & Gynecologist, Dubai
