Clinician Resources Vulvovaginitis
Given the frequency and often painful presentation of vaginitis, it is important for clinicians to keep up to date with diagnosis and the latest treatments. To support clinicians in their endeavor to provide the best patient care possible, we have included a number of reliable resources for additional information.
Clear steps to clinical proficiency beyond yeast, bacterial vaginosis, and STIs
This site is edited by ©Harvard Vanguard Medical Associates and Elizabeth G Stewart and Ione Bissonnette. Dr Stewart is co- Founder of the Vulvovaginal Service at Harvard Vanguard Medical Associates/Atrius Health in Boston and was the co-investigator in the National Institutes of Health-funded first epidemiological study of vulvovaginal pain. Dr Stewart and her co-contributors and editors of this site are acclaimed specialists in the field of vulvovaginal disorders.
This site provides practicing clinicians, medical educators, and students with evidence-based information for practice in:
- Gynecology, Dermatology, Urogynecology, and Internal Medicine
- Advanced Practice Nursing
- Sex Therapy
- Physical Therapy
- Behavioral Health
Additionally, there are printable patient handouts available in the resources section.
A non-profit organization, The International Society for the Study of Vulvovaginal Disease (ISSVD), composed of health care professionals from different areas, including, gynecologists, dermatologists, general practitioners, physiotherapist, nurse practitioners, etc. – all devoted to the study, investigation, and treatment of vulvovaginal diseases.
The ISSVD regularly publishes guidelines for a range of vulvovaginal diseases, including vaginitis. As a world leader for Vulvovaginal Education and Research, the ISSVD’s Guidelines, Recommendations for the Diagnosis and Treatment of Vaginitis are widely regarded.
The American College of Obstetricians and Gynecologists – This publication is a decision support resource for women’s health care providers—reliable and relevant, grounded in scientific evidence, and developed through a rigorous and inclusive process.
Vaginitis is defined as inflammation or infection of the vagina and is associated with a spectrum of symptoms, including vulvovaginal itching, burning, irritation, dyspareunia, “fishy” vaginal odor, and abnormal vaginal discharge. Vaginal symptoms are some of the most frequent reasons for patient visits to obstetrician–gynecologists and may have important consequences in terms of discomfort and pain, days lost from school or work, sexual functioning, and self-image. Distinguishing vaginal from vulvar symptoms is important to direct evaluation and treatment. The purpose of this document is to provide updated evidence-based guidance for the diagnosis and treatment of the common causes of vaginitis in nonpregnant patients.
Information on the treatment of vaginitis in patients with human immunodeficiency virus (HIV) is covered elsewhere. Guidelines are subject to change. For the most up-to-date information on vaginitis diagnosis and treatment, see the Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases webpage, which is available at https://www.cdc.gov/std/.
This publication is only available to members and subscribers.
UpToDate, the world’s leading evidence-based clinical decision support resource by Wolters Kluwer.
Vaginitis is the general term for disorders of the vagina caused by infection, inflammation, or changes in the normal vaginal flora. Symptoms include vaginal discharge, odor, pruritus, and/or discomfort.
The information in this report updates the 2015 guidelines. These guidelines discuss:
1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis;
2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease;
3) alternative treatment options for bacterial vaginosis;
4) management of Mycoplasma genitalium;
5) human papillomavirus vaccine recommendations and counseling messages;
6) expanded risk factors for syphilis testing among pregnant women;
7) one-time testing for hepatitis C infection;
8) evaluation of men who have sex with men after sexual assault;
9) two-step testing for serologic diagnosis of genital herpes simplex virus.
Physicians and other healthcare providers can use these guidelines to assist in prevention and treatment of STIs.
Four common pathological conditions are associated with vaginal discharge: bacterial vaginosis, aerobic vaginitis, candidosis, and the sexually transmitted infection, trichomoniasis.
Chlamydial or gonococcal cervical infection may result in vaginal discharge. Vaginal discharge may be caused by a range of other physiological and pathological conditions including atrophic vaginitis, desquamative inflammatory vaginitis, cervicitis, and mucoid ectopy. Psychosexual problems may present with recurrent episodes of vaginal discharge and vulval burning. These need to be considered if tests for specific infections are negative. Many of the symptoms and signs are non-specific and a number of women may have other conditions such as vulval dermatoses or allergic and irritant reactions.
International Journal of STD & AIDS. 2018;29(13):1258-1272. doi:10.1177/0956462418785451
This publication is only available to subscribers.
Authors: Sherrard J, Wilson J, Donders G, Mendling W, Jensen JS.
These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11–14, 2019. The information in this report updates the 2015 guidelines.
These guidelines discuss
- updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis;
- addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease
- alternative treatment options for bacterial vaginosis
- management of Mycoplasma genitalium;
- human papillomavirus vaccine recommendations and counseling messages;
- expanded risk factors for syphilis testing among pregnant women;
- one-time testing for hepatitis C infection;
- evaluation of men who have sex with men after sexual assault; and
- two-step testing for serologic diagnosis of genital herpes simplex virus.
Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.
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