Vaginitis (cont.)

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How is vaginitis diagnosed?

The diagnosis of vaginitis is suggested by the characteristic signs and symptoms, when present. A careful history and physical exam are the first steps in diagnosis. The physical examination will include a pelvic examination and possibly the removal of samples of vaginal discharge. A wet prep is an examination of vaginal discharge under the microscope. This test may be used to identify Trichomonas or yeast organisms. In other cases, a culture of vaginal secretions or from the area of the cervix may be sent to the laboratory to precisely identify the organism responsible for the vaginitis.

What is the treatment for vaginitis?

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The treatment for vaginitis depends upon the exact cause.

Bacterial infections are commonly treated with injections of antibiotics or oral antibiotics. The cephalosporin drugs, such as ceftriaxone or cefixime (Suprax), are typically used to treat gonorrhea. Treatment for gonorrhea should always include medication that will treat Chlamydia (for example, azithromycin [Zithromax, Zmax] or doxycycline [Vibramycin, Oracea, Adoxa, Atridox and others]) as well as gonorrhea, because gonorrhea and Chlamydia frequently exist together in the same person. Guidelines for treatment of STDs are constantly being adjusted based on the resistance of the infections to antibiotics.

Bacterial vaginosis is usually treated by metronidazole (Flagyl) taken either by mouth or applied as a vaginal gel or by vaginal clindamycin cream (Cleocin).

The treatment for trichomoniasis vaginitis is usually a single oral dose of metronidazole or tinidazole.

Yeast vaginitis is usually treated with topical anti-fungal medications including butoconazole (Femstat 3), clotrimazole (Lotrimin), miconazole (Monistat), and terconazole (Terazol 3). Other antifungal drugs are available as vaginal tablets such as clotrimazole (Lotrimin, Mycelex), miconazole, (Monistat; Micatin), terconazole (Terazol), and nystatin (Mycostatin). Oral medications for yeast vaginitis and vulvitis include fluconazole (Diflucan), but oral antifungal drugs are associated with some unpleasant side effects like headache and nausea.

While there is no cure for atrophic vaginitis that arises in postmenopausal women, systemic or topical estrogen preparations can provide relief. For women who do not choose to take hormone therapy, a number of vaginal lubricant products are available.

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