Vaginal discharge. Usually three forms:
1) Bacterial Vaginosis. Clinical criteria require three of the following symptoms or signs:
a) a homogeneous, white, noninflammatory discharge that smoothly coats the vaginal walls;
b) the presence of clue cells on microscopic examination; a pH of vaginal fluid > 4.5; and
c) a fishy odor of vaginal discharge before or after addition of 10% KOH (i.e., the whiff test, also used to determine who plays t-ball).
4) Occ. reported is recurrent Grp A streptococci vulvovaginitis/cellulitis, where the 'husband' can be a rectal carrier and source of recurrence.
Three forms, not mutually exclusive:
1) BV: anaerobic microorganisms, mycoplasmas, and Gardnerella vaginalis. Non culture techniques have revealed a host of hither to unknown anaerobes (PubMed). This is more an overgrowth syndrome due to abnormal flora.
b) Candida albicans.
III) T. vaginalis. They can coexist together.
Metronidazole 500 mg po twice a day for 7 days OR metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days OR clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days. Relapse likely.
Alternative Regimens (not as good)
Candida (from the CDC guidelines)
Intravaginal Agents: Butoconazole 2% cream 5 g intravaginally for 3 days. Butoconazole 2% cream 5 g (Butaconazole1-sustained release), single intravaginal application. Clotrimazole 1% cream 5 g intravaginally for 7 to 14 days. Clotrimazole 100 mg vaginal tablet for 7 days. Clotrimazole 100 mg vaginal tablet, two tablets for 3 days. Clotrimazole 500 mg vaginal tablet, one tablet in a single application. Miconazole 2% cream 5 g intravaginally for 7 days. Miconazole 100 mg vaginal suppository, one suppository for 7 days. Miconazole 200 mg vaginal suppository, one suppository for 3 days. Nystatin 100,000-unit vaginal tablet, one tablet for 14 days. Tioconazole 6.5% ointment 5 g intravaginally in a single application. Terconazole 0.4% cream 5 g intravaginally for 7 days. Terconazole 0.8% cream 5 g intravaginally for 3 days. Terconazole 80 mg vaginal suppository, one suppository for 3 days.
The use of probiotics (as compared, I suppose to the amateur biotics) is still not clear, but may have some benefit (PubMed).
Trichomoniasis: A single 2 gm po dose of metronidazole or 500 mg po bid x 7 d or tinidazole 2 gm po one time.
Do not need to treat male partners.