![]() Vaginal creams work internally and, like pessaries, are inserted into the vagina using an applicator. There are two types of creams used to treat thrush: vaginal and vulval. ![]() They need to be pushed high into your vagina with your finger or an applicator. Pessaries are bullet-shaped tablets that can be either hard or waxy. Pessaries and creams work directly at the site of infection - in the vagina and on the outer lips of the vagina. Treatments can be bought over the counter at a chemist, but they may be cheaper (or free) if you get them by prescription. Creams to be put on the vulva and/or into the vagina.Pessaries to be inserted into the vagina.Thrush is caused by a fungus (candida), and is therefore treated with antifungal drugs. Terconazole 0.Follow VAGINAL THRUSH PRODUCTS Antifungal drugs Terconazole 0.4 percent vaginal cream (Terazol 7) Tioconazole 6.5 percent ointment (Vagistat-1)* One tablet intravaginally per day for 14 days ![]() One suppository intravaginally per day for 3 days Miconazole 200-mg vaginal suppository (Monistat 3)* One suppository intravaginally per day for 7 days Miconazole 100-mg vaginal suppository (Monistat 7)* Miconazole 2 percent vaginal cream (Monistat)* Two tablets intravaginally per day for 3 daysĬlotrimazole 500-mg vaginal tablet (Mycelex-G) One tablet intravaginally per day for 7 days Finally, a recent study 6 showed that in adolescents, vaginal swabs for wet-mount and KOH preparations may be performed reliably without speculum examination.īutoconazole 2 percent vaginal cream (Mycelex-3)*īutoconazole 2 percent vaginal cream, sustained release (Gynezole-1)Ĭlotrimazole 1 percent vaginal cream (Mycelex-7)*ĥ g intravaginally per day for 7 to 14 daysĬlotrimazole 100-mg vaginal tablet (Gyne-Lotrimin, Mycelex-7) 5 DNA-based diagnostic tools with varying degrees of sensitivity and specificity also are available. A reasonable alternative is to use a wet-mount and KOH preparation or Gram stain of the vagina in conjunction with the findings of the physical examination, and to reserve culture for cases of treatment failure. Culture of the vagina is costly, but may be the only way to ensure diagnosis of vulvovaginal candidiasis in equivocal cases. A recent analysis 3 found that examination of wet-mount preparations is neither highly sensitive nor specific for vulvovaginal candidiasis. Bacterial vaginosis often is identified based on the vaginal pH and the presence of clue cells on light microscopy (two of the Amsel criteria 4). Treatment with topical estrogen is effective.Īlthough it is tempting to treat vaginal complaints empirically based on the patient’s history alone, studies 2, 3 have demonstrated poor correlation between symptoms and the final diagnosis. Atrophic vaginitis results from estrogen deficiency. The standard treatment for trichomoniasis is a single 2-g oral dose of metronidazole. Culture and DNA probe testing are useful in diagnosing the infection examinations of wet-mount preparations have a high false-negative rate. Trichomoniasis may cause a foul-smelling, frothy discharge and, in most affected women, vaginal inflammatory changes. Topical azole and oral fluconazole are equally efficacious in the management of uncomplicated vulvovaginal candidiasis, but a more extensive regimen may be required for complicated infections. ![]() ![]() Cultures are helpful in women with recurrent or complicated vulvovaginal candidiasis, because species other than Candida albicans (e.g., Candida glabrata, Candida tropicalis) may be present. Diagnosis should rely on microscopic examination of a sample from the lateral vaginal wall (10 to 20 percent potassium hydroxide preparation). Vulvovaginal candidiasis can be difficult to diagnose because characteristic signs and symptoms (thick, white discharge, dysuria, vulvovaginal pruritus and swelling) are not specific for the infection. The standard treatment is oral metronidazole in a dosage of 500 mg twice daily for seven days. The diagnosis is based primarily on the Amsel criteria (milky discharge, pH greater than 4.5, positive whiff test, clue cells in a wet-mount preparation). Bacterial vaginosis is caused by proliferation of Gardnerella vaginalis, Mycoplasma hominis, and anaerobes. Vaginitis also can occur because of atrophic changes. Common infectious forms of vaginitis include bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. ![]()
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