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Gegevens

Gepubliceerd op donderdag 02 oktober 2008 18:17

published in Huisarts Nu 2002; 31(2):58-77

 

DIAGNOSIS

• Symptoms of itching and irritation combined with clinical signs of thick white discharge are not sufficiently predictive for the diagnosis of Candida albicans vaginitis (level 2).
• Microscopic examination of the vaginal discharge is the most reliable test to confirm the diagnosis of vaginosis and vaginal candidiasis (level 1).
• Measurement of vaginal pH is a simple test to carry out to exclude bacterial vaginosis or Trichomonas infection (level 1).

TREATMENT

Candida infections

• Topical treatment of Candida vaginitis with clotrimazole or miconazole is just as effective as oral treatment with itraconazole or fluconazole. Single-day therapy is preferable (level 1).
• If inadequate results are obtained, in the case of severe symptoms or if there is a history of recurrent Candida vaginitis, more prolonged treatment is recommended (level 3).
• Treatment with topical imidazole derivatives for one week is recommended during pregnancy (level 1).
• There is no optimum treatment in the case of recurrent Candida infections. Prophylactic topical treatment can be instituted with clotrimazole or miconazole on day five of the menstrual cycle, for six months (level 3).
  Recurrences can then be prevented during the course of treatment (level 1).

Bacterial vaginosis

• Metronidazole 2 x 500 mg daily for seven days is recommended as reference treatment. Alternatives are topical treatment with clindamycin or metronidazole gel (level 1).
• In the case of pregnant women without a history of premature birth, treatment is only indicated in the case of symptoms, with oral metranidazole 250 mg three times daily, for seven days (alternative: oral clindamycin 300 mg twice daily for seven days) (level 1).
• In pregnant women with a history of premature birth, bacterial vaginosis is actively detected and treated positively with the same regimen (level 2). Treatment at the start of the second trimester of pregnancy should be chosen (level 3).

Trichomonas vaginalis

• In the case of non-pregnant women with Trichomonas infection, metronidazole in a single dose of 2 g is given to the patient and her partner(s) (level 1).
• In the case of pregnant women, treatment can be considered if symptoms occur; a single oral dose of 2 g metronidazole is given (level 3).