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This condition is considered to be a polymicrobial disease that is not sexually transmitted An overgrowth of Gardnerella and other anaerobes is often associated with increased malodorous discharge without obvious vulvitis or vaginitis The discharge is grayish and sometimes frothy, with a pH of 50 55 An amine-like ( fishy ) odor is present if a drop of discharge is alkalinized with 10% potassium hydroxide On wet mount in saline, epithelial cells are covered with bacteria to such an extent that cell borders are obscured (clue cells) Vaginal cultures are generally not useful in diagnosis
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Treatment of both partners simultaneously is recommended; metronidazole, 2 g orally as a single dose or 500 mg orally twice a day for 7 days, is usually used In the case of treatment failure in the absence of reexposure, the patient should be re-treated with metronidazole, 500 mg orally twice a day for 7 days If treatment failure occurs again, give metronidazole, 2 g orally once daily for 3 5 days If this is not effective in eradicating the organisms, metronidazole susceptibility testing can be arranged with the CDC at 770-488-4115
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Warty growths on the vulva, perianal area, vaginal walls, or cervix are caused by various types of the human papillomavirus (HPV) They are sexually transmitted Pregnancy and immunosuppression favor growth Vulvar lesions may be obviously wart-like or may be diagnosed only after application of 4% acetic acid (vinegar) and colposcopy, when they appear whitish, with prominent papillae Fissures may be present at the fourchette Vaginal lesions may show diffuse hypertrophy or a cobblestone appearance Cervical lesions may be visible only by colposcopy after pretreatment with 4% acetic acid These lesions may be related to
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The recommended regimens are metronidazole, 500 mg orally twice daily for 7 days, clindamycin vaginal cream (2%, 5 g), once daily for 7 days, or metronidazole gel (075%, 5 g), twice daily for 5 days Alternative regimens include metronidazole, 2 g orally as a single dose, clindamycin, 300 mg orally twice daily for 7 days, or clindamycin ovules, 100 g intravaginally at bedtime for 3 days
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Recommended treatments for vulvar warts include podophyllum resin 10 25% in tincture of benzoin (do not use during pregnancy or on bleeding lesions) or 80 90% trichloroacetic or bichloroacetic acid, carefully applied to avoid the surrounding skin The pain of bichloroacetic or trichloroacetic acid application can be lessened by a sodium bicarbonate paste applied immediately after treatment Podophyllum resin must be washed off after 2 4 hours Freezing with liquid nitrogen or a cryoprobe and electrocautery are also effective Patient-applied regimens include podofilox 05% solution or gel and imiquimod 5% cream Vaginal warts may be treated with cryotherapy with liquid nitrogen, trichloroacetic acid, or podophyllum resin Extensive warts may require treatment with CO2 laser under local or general anesthesia Interferon is not recommended for routine use because it is very expensive, associated with systemic side effects, and no more effective than other therapies Routine examination of sex partners is not necessary for the management of genital warts since the risk of reinfection is probably minimal and curative therapy to prevent transmission is not available However, partners may wish to be examined for detection and treatment of genital warts and other sexually transmitted diseases While condom use does not appear to prevent HPV transmission, it may result in accelerated regression of associated lesions, including untreated cervical intraepithelial neoplasia (CIN) and in accelerated clearance of genital HPV infection in women
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ACOG Committee on Practice Bulletins Gynecology ACOG Practice Bulletin Clinical management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis Obstet Gynecol 2006 May;107(5):1195 1206 [PMID: 16648432] Sexually transmitted disease treatment guidelines 2006 Centers for Disease Control and Prevention MMWR Recomm Rep 2006 Aug 4;55(RR-11):1 94 [PMID: 16888612]
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