Vulvovaginitis in Emergency Medicine Treatment & Management

  • Author: Mark J Leber, MD, MPH; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 16, 2012
 

Prehospital Care

  • Prehospital care rarely is needed.
  • Some women with recurrent candidal infections opt for treatment with over-the-counter (OTC) medications that generally are highly effective for candidiasis. Preparations for intravaginal administration of butoconazole, clotrimazole, miconazole, and tioconazole are available OTC. Self-medication with OTC preparations should be advised only for women who have been diagnosed previously with vulvovaginal candidiasis and who have a recurrence of the same symptoms. Any woman whose symptoms persist after using an OTC preparation or who has a recurrence of symptoms within 2 months should seek medical care.[23] Unnecessary or inappropriate use of OTC preparations is common and can lead to delay of treatment of other etiologies of vulvovaginitis that could result in adverse clinical outcomes. Studies on women treating themselves for candidiasis revealed a 28% accuracy rate.[3]
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Emergency Department Care

  • No specific ED care is needed.
  • If sexual abuse of a child is suspected, call upon further resources, such as a social work and child welfare agency.
  • Medical treatment should be tailored to the suspected pathogen.
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Consultations

  • Consultations are not necessary for most patients.
  • Suspected child sexual abuse must be reported to the child welfare agency and police. Strongly consider consultation with a clinician experienced in the area of child abuse, if available.
  • A patient with a vaginal foreign body that is difficult to observe or remove may require sedation or referral to a gynecologist for examination under general anesthesia.
  • Patients with infections that are difficult to treat or that are recurrent occasionally require gynecologic consultation.
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Contributor Information and Disclosures
Author

Mark J Leber, MD, MPH  Assistant Professor of Emergency Medicine in Clinical Medicine, Weill Cornell Medical College; Attending Physician, Lincoln Medical and Mental Health Center

Mark J Leber, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Anuritha Tirumani, MD  Research Coordinator, Department of Emergency Medicine, Brooklyn Hospital Center

Disclosure: Nothing to disclose.

Specialty Editor Board

David S Howes, MD  Professor of Medicine and Pediatrics, Emergency Medicine Residency Program Director Emeritus, Head, Phemister Society, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark Zwanger, MD, MBA  Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Reza Keshavarz, MD, to the development and writing of this article.

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The photomicrograph reveals bacteria adhering to vaginal epithelial cells known as clue cells. The presence of clue cells is a sign that the patient has bacterial vaginosis. Source CDC Phil/ M.Rein.
Candida albicans photomicrograph. Source CDC.
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