eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Vaginitis: Follow-up

Author: Hetal B Gor, MD, FACOG, Consulting Staff, Private Practice, Bergen County, New Jersey
Contributor Information and Disclosures

Updated: Dec 17, 2009

Follow-up

Further Inpatient Care

  • Inpatient care usually is not indicated for vaginitis, unless serious pelvic infections arise or evidence of systemic infection in an immunocompromised host is present.

Further Outpatient Care

  • Follow-up care is not indicated if patients are asymptomatic. However, in women who are pregnant or those with recurrent infections, a follow-up evaluation should be performed 1 month after completion of treatment.
  • Consider treatment of partners in case of trichomoniasis;
  • If chronic or recurrent infections occur, consider treatment of partners in case of bacterial vaginosis.
  • Yeast culture, glucose intolerance test, and HIV test should be offered in case of recurrent or resistant vaginal candidiasis.

Inpatient & Outpatient Medications

  • All regimens are administered on an outpatient basis (see Medication).

Deterrence/Prevention

  • Although not extensively studied, safe sexual practices may play a role in decreasing bacterial vaginosis (BV) and T vaginalis infections.
  • Good hygiene also may play a role in preventing candidal infections.
  • No studies show any benefit to douching as a treatment or prevention for vaginitis; douching may actually exacerbate symptoms.
  • Tampon use does not seem to be associated with vaginitis.

Complications

  • Bacterial vaginosis has been associated with pelvic inflammatory disease (PID), endometritis, and vaginal cuff cellulitis when invasive procedures have been performed. Such procedures include endometrial biopsies, cesarean section, uterine curettage, and intrauterine device (IUD) placement.
  • During pregnancy, bacterial vaginosis and trichomoniasis are associated with an increased risk of premature rupture of membranes, preterm labor,5 low birth weight, and preterm delivery.

Prognosis

  • The prognosis is very good because most of those infected are cured.

Patient Education

Miscellaneous

Special Concerns

  • Patients who are immunocompromised, such as those with HIV, should be treated with the same regimens.
  • Pregnancy should not delay treatment.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Phuong H Nguyen, MD and Susanne Ching, MD to the development and writing of this article.



More on Vaginitis

Overview: Vaginitis
Differential Diagnoses & Workup: Vaginitis
Treatment & Medication: Vaginitis
Follow-up: Vaginitis
Multimedia: Vaginitis
References
[ CLOSE WINDOW ]

References

  1. Vaginitis. NHIOnDemand. Available at http://content.nhiondemand.com/psv/HC2.asp?objID=100638&cType=hc. Accessed 12/8/08.

  2. CDC. Tracking the Hidden Epidemics 2000: Trends in STDs in the United States. Centers for Disease Control and Prevention, Sexually Transmitted Diseases. Available at www.cdc.gov/std/Trends2000/trichomoniasis.htm. Accessed 12/8/2008.

  3. Donati L, Di Vico A, Nucci M, et al. Vaginal microbial flora and outcome of pregnancy. Arch Gynecol Obstet. Dec 5 2009;[Medline].

  4. [Guideline] American College of Obstetricians and Gynecologists (ACOG). Vaginitis. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2006 May. 12 p. (ACOG practice bulletin; no. 72). [Full Text].

  5. Islam A, Safdar A, Malik A. Bacterial vaginosis. J Pak Med Assoc. Sep 2009;59(9):601-4. [Medline].

  6. [Guideline] ACOG Committee on Practice Bulletins--Gynecology. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis. Obstet Gynecol. May 2006;107(5):1195-1206. [Medline].

  7. American Academy of Family Practice. Vaginitis. ACOG Technical Bulletin. 2000;[Full Text].

  8. Association of Professors of Gynecology and Obstetrics. Diagnosis of vaginitis. In: APGO Educational Series in Women's Health Issues. 1996;1-9.

  9. Bornstein J, Zarfati D. A universal combination treatment for vaginitis. Gynecol Obstet Invest. 2008;65(3):195-200. [Medline].

  10. CDC. 1998 Guidelines for Treatment of Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 1998;47(RR-1):70-79. [Medline].

  11. Davis JD, Connor EE, Clark P, et al. Correlation between cervical cytologic results and Gram stain as diagnostic tests for bacterial vaginosis. Am J Obstet Gynecol. Sep 1997;177(3):532-5. [Medline].

  12. DeCherney AH, Pernoll ML, eds. Obstetric and Gynecologic Diagnosis and Treatment. 8th ed. Stamford, Conn: Appleton & Lange; 1996:689-712.

  13. Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician. Sep 1 2000;62(5):1095-104. [Medline].

  14. Eschenbach DA, Hillier S, Critchlow C, et al. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol. Apr 1988;158(4):819-28. [Medline].

  15. Force R. Management of Vulvovaginal Candidiasis: safe, effective and appropriate therapy -- A Pharmacology Perspective. Vulvovaginal Candidiasis: A contemporary approach to recognition and management. 1997:10-4.

  16. Gjerdingen D, Fontaine P, Bixby M, et al. The impact of regular vaginal pH screening on the diagnosis of bacterial vaginosis in pregnancy. J Fam Pract. Jan 2000;49(1):39-43. [Medline].

  17. Holmes KK, Sparling PF, Mardh P. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill Text; 1999:563-639.

  18. Katzung BG, ed. Basic and Clinical Pharmacology. 6th ed. New York, NY: McGraw-Hill Professional Publishing; 1995:723-9, 741-2, 799-803.

  19. Mishell DR, Stenchever MA, Droegemueller W. Comprehensive Gynecology. 3rd ed. St Louis, Mo: Mosby-Year Book; 1997:625-635.

  20. Siberry GK, Iannone R. The Harriet Lane Handbook. 15th ed. St Louis, Mo: Mosby-Year Book; 2000:615-892.

  21. Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. Aug 1 1985;152(7 Pt 2):924-35. [Medline].

  22. Summers PR. Diagnosis of Vulvovaginal Candidiasis: considering conditions that mimic or mask. Vulvovaginal Candidiasis: A contemporary approach to recognition and management. 1997:6-9.

  23. Sweet RL. Importance of differential diagnosis in acute vaginitis. Am J Obstet Gynecol. Aug 1 1985;152(7 Pt 2):921-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

vaginitis, vaginal infection, Trichomonas vaginalis, vaginal candidiasis, Candida infection, bacterial vaginosis, BV, pelvic inflammatory disease, PID, yeast infection, vaginal pH, treatment, diagnosis, symptoms

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Hetal B Gor, MD, FACOG, Consulting Staff, Private Practice, Bergen County, New Jersey
Hetal B Gor, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Bruce A Meyer, MD, MBA, Vice President for Medical Affairs, Associate Dean for Health System Affairs and Director of the Faculty Practice Plan, Professor, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School
Bruce A Meyer, MD, MBA is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Physician Executives, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Medical Group Management Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Antonio V Sison, MD, Medical Director, Ob/Gyn Group, Robert Wood Johnson University Hospital at Hamilton
Antonio V Sison, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Association of Professors of Gynecology and Obstetrics
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.