Vaginal infections: diagnosis and management.

Three common infections account for most vaginal symptoms. Successful management depends on accurate identification of the etiologic agent and appropriate treatment. Clinical examination and office laboratory tests are usually adequate to diagnose bacterial vaginosis. Diagnosis of Candida vulvovaginitis and vaginitis caused by Trichomonas may require culture. Bacterial vaginosis is usually treated with a one-week course of metronidazole; treatment during pregnancy and the benefit of concomitant treatment of sexual partners remain points of controversy. Intravaginal application of imidazoles is the recommended initial treatment of Candida vulvovaginitis, although several effective alternative treatments are available. Trichomonas vaginitis usually responds to oral metronidazole, and treatment of sexual partners is recommended. Treatment during pregnancy should be limited because of concern about teratogenic effects. Recurrent or persistent vaginal symptoms require exclusion of the possibility of reinfection or the presence of other conditions (particularly cervicitis); symptoms may respond to prolonged or prophylactic regimens.