- Vaginal Infections
 Trichomoniasis
- Primary
drug choice:
- metronidazole (Flagyl) (2
g, oral, 1dose)
- clear
treatment of choice
- for
metronidazole
(Flagyl)-resistant
strains: treat with
metronidazole (Flagyl)
for extended periods and
with higher doses
- Alternative
agent:
- metronidazole
(Flagyl) (lower dosage,
extended treatment)
- Bacterial
vaginosis
- Responsible
organisms:
- Over
growth with Gardnerella
vaginalis, Mycoplasma
hominis, Mobiluncus,
other anaerobes
- Normal Lactobacillus
species replaced by the
above organisms
- Clinical
comments:
- associated
with premature labor
& delivery
complications
- symptomatic
bacterial vaginosis and
pregnancy: treat it
- Primary
drug choice:
- metronidazole (Flagyl)
Or
- metronidazole (Flagyl)
gel (0.75%) Or
- clindamycin (Cleocin) (2%
cream)
- Alternative
agents:
- metronidazole (Flagyl)
lower dosage
- clindamycin (Cleocin),
Laurel
- metronidazole (Flagyl)
(higher dosage: two
grams, oral, 1 dose)
- Vulvovaginal
candidiasis
- Primary
drug choices-- intravaginal
- butoconazole (Femstat),
clotrimazole (Mycelex),
miconazole (Monistat),
terconazole (Terazol),
tioconazole (Vagistat)
- Or oral --fluconazole (Diflucan)
- Alternative
agent:
- nystatin (Mycostatin) --
2 week treatment protocol
- Clinical
comments:
- recurrence: frequent
- with culture-proven
recurrent infection:
- 6-month prophylactic oral
ketoconazole (Nizoral) or
oral fluconazole
(Diflucan) had been shown
effective
- Possible increased risk
of azole-resistant Candida
glabrata caused
vulvovaginal candidiasis
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