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If you manage this site and have a question about why the site is not available, please contact us directly. Most women will have a vaginal infection, characterized by discharge, itching, or odor, during their lifetime.
Meningitis is an inflammation of the meninges which can be associated with modification of the cerebrospinal fluid which is contained between this membranes.
A gardenella vaginalis infection is a vaginal condition or vaginopathy that is triggered by an overgrowth of the gardenella bacteria resulting in a reduction of the good lactobacillus bacteria.
Some typical gardenella symptoms are vaginal irritation and itching as well as strong smelling grey or white vaginal discharge. Gardenella vaginitis is usually not a dangerous health threat but should be treated with a natural gardenella treatment in order to provide relief and avoidence of gardenella vaginosis conditions. This bacterial infection is often causing foul vaginal odors and unpleasant vaginal discharge. It is advisable to treat a gardnerella vaginal infection with natural remedies for gardnerella. Since gardnerella can cause bacterial vaginosis it is crucial to apply home remedies for gardnerella at an early stage of the infection.
Good natural remedies for gardnerella should be able to help bring the pH level in the vagina back into balance. Sometimes gardnerella vaginalis is treated orally but you can also find a gentle but effective homeopathic gardnerella home remedy.
It is recommended to seek a natural cure for gardnerella before one is dealing with a bacterial vaginosis condition. Traditionally natural cures for gardnerella were based on oral methods but there are also herb based and homeopathic methods available that are being used as a natural treatment for gardnerealla.
If you suffer from bacterial vaginosis it might seem like nothing is ever going to take away the unbearable itching or the uncomfortable burning sensation that plagues you almost night and day.
There’s no need to despair however as there are many other bacterial vaginosis cure methods available for you to try, outside of the prescription and medication rounds. That said, this particular bacterial vaginosis cure is very popular and used by many women to help rid themselves of their bacterial vaginosis. Apart from the use of yogurt as a bacterial vaginosis cure you also have the option of using garlic as a natural home remedy. If you can’t stand the smell of garlic then I suggest you get out of the kitchen, but many swear by this method as a great bacterial vaginosis cure. Again there are many ways that you do this but the most popular method involves peeling, and wrapping the garlic clove in a piece of gauze and tying it off with unwaxed dental floss. You then insert this suppository into your vagina leaving a length of the dental floss dangling to be able to pull it out when you need to. And if you don’t fancy trying out either of these natural remedies you always have the option of turning to other alternative natural remedies. Bacterial Vaginosis can occurs when women use clothing that traps moisture and creates a natural environment for anaerobic bacteria to grow. Bacterial Vaginosis often develops from an overgrowth of harmful, anaerobic bacteria – Gardnerella – that naturally exist in the vagina in minor quantities.  Lactobacilli – the good bacteria predominantly can outnumber the harmful colonies and avoid excessive growth. The symptoms of bacterial vaginosis are very similar to other infections like sexually transmitted diseases, such as trichomoniasis.
Good home remedies for bacterial vaginosis should be able to restore the normal pH level in the vagina. The bacterial overgrowth is what a successful home remedy for bacterial vaginosis should be targeted at. Other home remedies for bacteria vaginosis would be wearing cotton underpants and avoiding tight clothes. The best home remedies to get rid of bacterial vaginosis are those that also make sure the condition doesn’t reoccur. Herbal remedies for bacterial vaginosis are more advisable than drugs with possible side effects.
Since the main goal is to establish the natural vaginal bacteria balance, one can apply a bacterial vaginosis herbal remedy specifically formulated to achieve the healthy pH level that is needed in the vaginal flora. A homeopathic remedy for bacterial vaginosis is a very gentle and effective way of dealing with the condition without having to worry about possible harmful side effects that can occur when using prescription drugs. Good homeopathic remedies for bacterial vaginosis are targetting the natural balance of the vaginal flora. In addition to applying natural remedies for bacterial vaginosis it is also important to adjust lifestyle behaviours accordingly.
A good natural remedy for bacterial vaginosis should also be formulated to avoid the condition from recurring. Restoring a healthy bacterial balance is one of the most important goals of most natural bacterial vaginosis remedies. Gentle and effective holistic bacterial vaginosis remedies always go beyond just dealing with the symptoms. A good holistic bacterial vaginosis remedy focuses on the balance of the natural vaginal bacteria. If you don’t like the idea of using antibiotics which kill not only the bad bacterial overgrowth but also the beneficial vaginal bacteria you should consider a natural bacterial vaginosis remedy.
Acidophilus and lactobacillus bacteria from yoghurt or as supplement tablets or capsules are very popular bacterial vaginosis remedies that might work for some women to some degree. Besides herbal remedies for bacterial vaginosis there are also methods like mixing hydrogen peroxide with water or diluting grapefruit seed extract. Finding home remedies to cure bacterial vaginosis requires to understand the root cause of the problem. A possible home cure for bacterial vaginosis has to address the vaginal bacteria imbalance and how to restore it to the normal pH levels. All natural home cures for bacterial vaginosis should be formulated to prevent the condition from reccuring.
It is advisable to use natural cures for bacterial vaginosis rather than drugs with possible side effects. One should try to cure bacterial vaginosis naturally rather than just masking the symptoms for quick relief. Trying home remedies as a possible bacterial vaginosis natural cure should go along with the appropriate lifestyle behaviour as the ideal method how to cure bacterial vaginosis naturally. If you don’t want to have to worry about any potential side effects when treating BV you will be on the safe side with herbal cures for bacterial vaginosis. Those remedies often contain healthy bacteria for natural vaginal floral support to restore a balanced pH level. Holistic cures for bacterial vaginosis try to approach the problem gentle but effective without the hassle of potential side effects. The main goal for any holistic cure for bacterial vaginosis is to restore a healthy vaginal bacteria balance while preventing the condition from reoccuring. Natural cures for Gardnerella should be able to increase the good bacteria and help stop the overgrowth of bad bacteria in the vagina. The main goal a successful bacterial vaginitis treatment tries to achieve is to avoid bacterial overgrowth.
Once the natural vaginal flora is in balance the treatment for bacterial vaginitis has served it’s purpose. Treating bacterial vaginitis at an early stage is crucial in order to avoid yeast infections or other bacterial manifestations. In general it is advisable to use a natural treatment for bacterial vaginitis rather than a drug with possible side effects. Home remedies for bacterial vaginitis are usually formulated to target vaginal bacterial overgrowth. Restoring the normal pH level in the vagina is the goal of a good natural remedy for bacterial vaginitis. Easy to implement bacterial vaginitis home remedies are cotton underpants and avoidance of tight clothes. A successful bacterial vaginitis home remedy should also make sure the condition doesn’t reoccur. When seeking natural cures for bacterial vaginitis it is important to focus on a natural balanced vaginal flora.
There are good home remedies available that could work as a natural cure for bacterial vaginitis since they are formulated to target this specific goal. How to cure bacterial vaginitis naturally is a common question since one doesn’t want to deal with potential side effects in such a sensitive area. Getting rid of recurring bacterial vaginosis infections requires to keep the pH level in the vagina balanced. In order to avoid recurring bacterial vaginitis one needs to make sure to implement certain lifestyle changes along with using a recurring bacteria vaginosis treatment.
When dealing with recurrent bacterial infections you should start treating the problem at the root cause level. Recurring bacterial infections are often connected with recurrent vaginal odor which is caused by an imbalance of the vaginal flora. It is advisable to consider treating reocurring bacterial vaginosis with home remedies for bacterial vaginosis infections.
Reoccuring bacterial vaginosis is a problem that requires to get to the root of the causes and not only to mask the symptoms for short term relief. A holistic or natural approach for recurrent bacterial vaginitis is more advisable than symptom suppressing drugs.


A good treatment for recurrent bacterial vaginosis is usually designed to balance the vaginal pH level. Using alternative methods that are gentle is the recommended way of treating recurrent bacterial vaginosis.
Bacterial vaginosis (BV) is usually caused by a bacterial flora imbalance and can lead to vaginal infections if not addressed early with a BV treatment. When good bacteria like lactobacillus are being reduced by antibiotics or other causes they allow other microorganisms to multiply and produce toxins while competing with the healthy bacteria that contribute to a balanced vaginal ph level. Other causes for BV are tight clothing like wearing thongs and being sexually very active, although no direct sexual transmission evidence has been found. It is also possible that a BV infection goes unnoticed and goes away on its own without even expressing any of the unpleasant BV symptoms.
Symptoms of BV often get also confused with yeast infections or trichomoniasis which are both not triggered by bacteria.
If you suspect signs of BV it is advisable to get a proper diagnosis before drawing the wrong conclusions. It is not unusual for women that undergo an antibiotic BV treatment to suffer from recurrent BV.
When a BV infection stays untreated there is a risk of developing chronic BV which is why it is important to take measures once diagnosed with BV.
After the BV diagnosis most women will want to instantly get rid of BV which should not be approached with antibiotics as they are mainly suppressing the BV symptoms but not necessarily the actual BV causes.
Some women try tea tree oil or yoghurt to get rid of BV and re-balance the normal pH of the vaginal flora.
From our perspective the most senseful way how to get rid of BV permanently is to investigate natural BV treatments that address not only the symptoms but actually eliminiate the BV causes and provide you with long-lasting protection against recurring BV. There are different BV home treatment options one can come across like oxygen therapies, nutritional supplements or homeopathic and over the counter BV treatments. So we highly recommend to study reports about natural BV home remedies to find out which natural BV remedy you want to consider. Most of the time, doctors prescribe metronidazole and clindamycin which can be taken as pill or be used as cream. With the availability of complementary and alternative therapies and over-the-counter medications for candidiasis, many symptomatic women seek these products before or in addition to an evaluation by a medical provider.Obtaining a medical history alone has been shown to be insufficient for accurate diagnosis of vaginitis and can lead to the inappropriate administration of medication. Many diseases, like cancer or connective tissue diseases, like lupus erythematosus or sarcoidosis may be accompanied by an inflammatory reaction of the meninges. Meningitis can occur due to allergies to medicines, some cancers and autoimmune diseases such as lupus. Since gardnerella can also cause meningitis it is important to apply a gardnerella treatment early on. You’ve tried just about every bacterial vaginosis cure available on the market and nothing has worked to date. The first method requires you to literally paint the walls of the vagina with the yogurt, and since this can be a fairly messy affair before and afterwards, you might also want to wear a pad while the yogurt is within you to avoid spillages! Simply coat the tampon in the unsweetened yogurt and insert into the vagina, replacing every few hours or as needed. The yogurt is available as lactobacillus acidophilus tablets, and the garlic is also available in tablet or powdered form. Bacterial vaginosis cure methods can run the gamut from apple cider vinegar baths to garlic suppositories to yogurt coated tampons.
It often develops when the normal balance of bacteria naturally found in the vagina becomes disrupted.
If this fine balance is disturbed and harmful bacteria flourishes, it often triggers the problem of unpleasant, fishy discharge and burning sensations. Some medical professionals believe that one cause is sexual intercourse, but there is no evidence to conclude that this is the case. The best method to identify a bacterial vaginosis infection is to have a doctor conduct an examination. Therefore one should apply a remedy that is specifically formulated to gently help re-establish the vaginal flora balance and avoid reoccuring bacteria vaginosis by stopping bacterial overgrowth in its tracks. In some cases iching and burning sensations are experienced as BV symptoms although not every female with a BV infection necessarily deals with those sensations. Oftentimes the BV symptoms dissappear during the time of the treatment only to come back shortly after the pills are finished. As we’ve already stated using antibiotics is not really a way how to cure BV permanently and it is also questionable if eating yoghurt can cure BV naturally.
There are herbal remedies for BV as well as vitamin or homeopathic remedies for BV you could try as well. Therefore, a careful history, examination, and laboratory testing to determine the etiology of vaginal complaints are warranted. Meningitis is a very serious disease and requires urgent diagnosis and initiation of treatment.
A group of viruses known as the enteroviruses, causing stomach problems, are responsible for approximately 90% of recorded viral meningitis. In the absence of treatment, the infection will spread to the brain (meningo-encephalitis) and can lead to coma, behavioral disorders, paralysis and convulsions.
Infants and children treated for meningitis should always be monitored after they healed and should be checked to prevent long-term complications such as hearing loss.
An overgrowth of certain strains of bacteria can cause bacterial vaginosis symptoms and is especially harmful to pregnant women which is why it is important to seek natural cures for bacterial vaginosis. A good holistic cure for Bacterial Vaginosis is to not create an environment where those bacteria can grow. In fact, women who are not sexually active, and even virgins, can develop Bacterial Vaginosis and want to find out how to cure bacterial vaginosis.
Often this is done by analyzing a sample of vaginal discharge under a microscope before seeking a natural cure for bacterial vaginosis. Information on sexual behaviors and practices, gender of sex partners, menses, vaginal hygiene practices (such as douching), and other medications should be elicited.
Although vulvovaginal candidiasis (VVC) usually is not transmitted sexually, it is included in this section because it is frequently diagnosed in women who have vaginal complaints or who are being evaluated for STDs.Various diagnostic methods are available to identify the etiology of an abnormal vaginal discharge. Clinical laboratory testing can identify the cause of vaginitis in most women and is discussed in detail in the sections of this report dedicated to each condition. In the clinician’s office, the cause of vaginal symptoms might be determined by pH, a potassium hydroxide (KOH) test, and microscopic examination of fresh samples of the discharge. Because pH testing is not highly specific, discharge should be further examined microscopically by first diluting one sample in one to two drops of 0.9% normal saline solution on one slide and a second sample in 10% KOH solution (samples that emit an amine odor immediately upon application of KOH suggest BV or trichomoniasis infection). Cover slips are then placed on the slides, and they are examined under a microscope at low and high power.The saline-solution specimen might yield motile T. The KOH specimen typically is used to identify the yeast or pseudohyphae of Candida species.
However, the absence of trichomonads or pseudohyphae in KOH samples does not rule out these infections, because the sensitivity of microscropy is approximately 50% compared with NAAT (trichomoniasis) or culture (yeast).In settings where pH paper, KOH, and microscopy are not available, alternative commercially available point-of-care tests or clinical laboratory testing can be used to diagnose vaginitis. The presence of objective signs of vulvar inflammation in the absence of vaginal pathogens after laboratory testing, along with a minimal amount of discharge, suggests the possibility of mechanical, chemical, allergic, or other noninfectious irritation of the vulva.Bacterial VaginosisBV is a polymicrobial clinical syndrome resulting from replacement of the normal hydrogen peroxide producing Lactobacillus sp. Some women experience transient vaginal microbial changes, whereas others experience them for a longer intervals of time. The cause of the microbial alteration that characterizes BV is not fully understood, nor is whether BV results from acquisition of a sexually transmitted pathogen.
Although a card test is available for the detection of elevated pH and trimethylamine, it has low sensitivity and specificity and therefore is not recommended. PCR also has been used in research settings for the detection of a variety of organisms associated with BV, but evaluation of its clinical utility is uncertain. Detection of one organism or group of organisms might be predictive of BV by Gram stain (321). Cervical Pap tests have no clinical utility for the diagnosis of BV because of their low sensitivity.TreatmentTreatment is recommended for women with symptoms.
The established benefits of therapy in nonpregnant women are to relieve vaginal symptoms and signs of infection. Women should be advised to refrain from intercourse or to use condoms consistently and correctly during the treatment regimen. Additional regimens include metronidazole (750-mg extended release tablets once daily for 7 days), or a single dose of clindamycin intravaginal cream, although data on the performance of these alternative regimens are limited.Several studies have evaluated the clinical and microbiologic efficacy of using intravaginal lactobacillus formulations to treat BV and restore normal flora (325-327). Further research efforts to determine the role of these regimens in BV treatment and prevention are ongoing.Follow-UpFollow-up visits are unnecessary if symptoms resolve. Because recurrence of BV is common, women should be advised to return for evaluation if symptoms recur.
Detection of certain BV-associated organisms have been associated with antimicrobial resistance and might determine risk for subsequent treatment failure (328-333).
Limited data are available regarding optimal management strategies for women with early treatment failure. Using a different treatment regimen might be an option in patients who have a recurrence; however, re-treatment with the same topical regimen is another acceptable approach for treating recurrent BV during the early stages of infection (334).
For women with multiple recurrences after completion of a recommended regimen, metronidazole gel twice weekly for 4-6 months has been shown to reduce recurrences, although this benefit might not persist when suppressive therapy is discontinued (335). Limited data suggest that oral nitroimidazole followed by intravaginal boric acid and suppressive metronidazole gel for those women in remission might be an option in women with recurrent BV (336). Therefore, routine treatment of sex partners is not recommended.Special ConsiderationsAllergy or Intolerance to the Recommended TherapyIntravaginal clindamycin cream is preferred in case of allergy or intolerance to metronidazole or tinidazole.


Intravaginal metronidazole gel can be considered for women who do not tolerate systemic metronidazole. Intravaginal metronidazole should not be administered to women allergic to metronidazole.PregnancyTreatment is recommended for all pregnant women with symptoms.
Although BV is associated with adverse pregnancy outcomes, including premature rupture of membranes, preterm labor, preterm birth, intra-amniotic infection, and postpartum endometritis, the only established benefit of therapy for BV in pregnant women is the reduction of symptoms and signs of vaginal infection. Additional potential benefits include reducing the risk for infectious complications associated with BV during pregnancy and reducing the risk for other infections (other STDs or HIV).Several trials have been undertaken to determine the efficacy of BV treatment among pregnant women. Two trials demonstrated that metronidazole was efficacious during pregnancy using the 250-mg regimen (338,339); however, metronidazole administered at 500 mg twice daily can be used. One trial involving a limited number of participants revealed that treatment with oral metronidazole 500 mg twice daily was equally effective as metronidazole gel, with cure rates of 70% using Amsel criteria to define cure (340), and a recent trial demonstrated a cure rate of 85% using Gram stain criteria after 4 weeks with oral clindamycin (341). Multiple studies and meta-analyses have not demonstrated an association between metronidazole use during pregnancy and teratogenic or mutagenic effects in newborns (342,343). Seven trials have evaluated treatment of pregnant women with asymptomatic BV at high risk for preterm delivery; one showed harm (344), two showed no benefit (345,346), and four demonstrated benefit (338,339,347,348) .
Therefore, evidence is insufficient to assess the impact of screening for BV in pregnant women at high risk for preterm delivery (85).Similarly, data are inconsistent regarding whether the treatment of asymptomatic pregnant women with BV who are at low risk for preterm delivery reduces adverse outcomes of pregnancy.
Although USPSTF recommends against screening these women (85), one trial demonstrated a 40% reduction in spontaneous preterm birth among women using oral clindamycin during weeks 13–22 of gestation (348). Providers should be aware that intravaginal clindamycin cream might be associated with adverse outcomes if used in the latter half of pregnancy.HIV InfectionBV appears to recur with higher frequency in HIV-positive women (352). Patients who have BV and also are infected with HIV should receive the same treatment regimen as those who are HIV negative.TrichomoniasisTrichomoniasis is caused by the protozoan T. Some women have symptoms characterized by a diffuse, malodorous, yellow-green vaginal discharge with vulvar irritation. Because of the high prevalence of trichomoniasis in clinical and nonclinical settings (64,92,353,354), testing for T.
FDA-cleared tests for trichomoniasis in women include OSOM Trichomonas Rapid Test (Genzyme Diagnostics, Cambridge, Massachusetts), an immunochromatographic capillary flow dipstick technology, and the Affirm VP III (Becton Dickenson, San Jose, California), a nucleic acid probe test that evaluates for T.
The results of the OSOM Trichomonas Rapid Test are available in approximately 10 minutes, whereas results of the Affirm VP III are available within 45 minutes. Although these tests tend to be more sensitive than those requiring vaginal wet preparation, false positives might occur, especially in populations with a low prevalence of disease.Culture is another sensitive and highly specific commercially available method of diagnosis. Among women in whom trichomoniasis is suspected but not confirmed by microscopy, vaginal secretions should be cultured for T. An FDA-cleared PCR assay for detection of gonorrhea and chlamydial infection (Amplicor, manufactured by Roche Diagnostic Corp.) has been modified for T. Abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.The nitroimidazoles comprise the only class of drugs useful for the oral or parenteral therapy of trichomoniasis. Of these drugs, metronidazole and tinidazole are available in the United States and are cleared by the FDA for the treatment of trichomoniasis. Randomized controlled trials comparing single 2-g doses of metronidazole and tinidazole suggest that tinidazole is equivalent or superior to metronidazole in achieving parasitologic cure and resolution of symptoms (361).
Low-level metronidazole resistance has been identified in 2%–5% of cases of vaginal trichomoniasis (362,363), but high-level resistance only rarely occurs. Fortunately, infections caused by most of these organisms respond to tinidazole or higher doses of metronidazole.
Tinidazole has a longer serum half-life and reaches higher levels in genitourinary tissues than metronidazole.
For patients failing this regimen, treatment with tinidazole or metronidazole at 2 g orally for 5 days should be considered. If these therapies are not effective, further management should be discussed with a specialist.
Existing data suggest that patient-delivered partner therapy might have a role in partner management for trichomoniasis; however, no one partner management intervention has shown superiority over another in reducing reinfection rates (72,73).
Although no data are available to guide treatment of the male partners of women with nitroimidazole treatment failure, on the basis of expert opinion, male partners should be evaluated and treated with either tinidazole in a single dose of 2 g orally or metronidazole twice a day at 500 mg orally for 7 days.Special ConsiderationsAllergy, Intolerance, and Adverse ReactionsMetronidazole and tinidazole are both nitroimidazoles.
Patients with an immediate-type allergy to a nitroimidazole can be managed by metronidazole desensitization in consultation with a specialist (364-366). Although some trials suggest the possibility of increased prematurity or low birth weight after metronidazole treatment, limitations of the studies prevent definitive conclusions regarding risks for treatment (367,368). Clinicians should counsel patients regarding the potential risks and benefits of treatment and communicate the option of therapy deferral in asymptomatic pregnant women until after 37 weeks’ gestation. All symptomatic pregnant women should not only be considered for treatment regardless of pregnancy stage, but be provided careful counseling regarding condom use and the continued risk of sexual transmission.Women can be treated with 2 g metronidazole in a single dose at any stage of pregnancy.
Multiple studies and meta-analyses have not demonstrated an association between metronidazole use during pregnancy and teratogenic or mutagenic effects in infants (342,343,369).
For women treated with tinidazole, interruption of breastfeeding is recommended during treatment and for 3 days after the last dose.HIV InfectionThere is increasing evidence for epidemiologic and biologic interaction between HIV and T. For sexually active women who are HIV-positive, screening for trichomoniasis at entry into care with subsequent screening performed at least annually is recommended based on the reported prevalence of T.
Rescreening 3 months after completion of therapy should be considered among HIV-positive women with trichomoniasis, a recommendation based on the high proportion of recurrent or persistent infection and the association between HIV and T.
Typical symptoms of VVC include pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge. An estimated 75% of women will have at least one episode of VVC, and 40%–45% will have two or more episodes within their lifetime.
On the basis of clinical presentation, microbiology, host factors, and response to therapy, VVC can be classified as either uncomplicated or complicated (Box 3). The diagnosis can be made in a woman who has signs and symptoms of vaginitis when either 1) a wet preparation (saline, 10% KOH) or Gram stain of vaginal discharge demonstrates yeasts, hyphae, or pseudohyphae or 2) a culture or other test yields a yeast species. Use of 10% KOH in wet preparations improves the visualization of yeast and mycelia by disrupting cellular material that might obscure the yeast or pseudohyphae. Examination of a wet mount with KOH preparation should be performed for all women with symptoms or signs of VVC, and women with a positive result should receive treatment. For women with negative wet mounts who are symptomatic, vaginal cultures for Candida should be considered. If the wet mount is negative and Candida cultures cannot be done, empiric treatment can be considered for symptomatic women with any sign of VVC on examination. Identifying Candida by culture in the absence of symptoms or signs is not an indication for treatment, because approximately 10%–20% of women harbor Candida sp.
Patients and providers should refer to condom product labeling for further information.Intravaginal preparations of butaconazole, clotrimazole, miconazole, and tioconazole are available over-the-counter (OTC). Women whose condition has previously been diagnosed with VVC are not necessarily more capable of diagnosing themselves; therefore, any woman whose symptoms persist after using an OTC preparation or who has a recurrence of symptoms within 2 months should be evaluated with office-based testing. Unnecessary or inappropriate use of OTC preparations is common and can lead to a delay in the treatment of other vulvovaginitis etiologies, which can result in adverse clinical outcomes.Box 3. A minority of male sex partners might have balanitis, which is characterized by erythematous areas on the glans of the penis in conjunction with pruritus or irritation. These men benefit from treatment with topical antifungal agents to relieve symptoms.Special ConsiderationsAllergy, Intolerance, and Adverse ReactionsTopical agents usually cause no systemic side effects, although local burning or irritation might occur. Therapy with the oral azoles has been associated rarely with abnormal elevations of liver enzymes. The pathogenesis of RVVC is poorly understood, and most women with RVVC have no apparent predisposing or underlying conditions.
Vaginal cultures should be obtained from patients with RVVC to confirm the clinical diagnosis and to identify unusual species (including nonalbicans species), particularly Candida glabrata.
Conventional antimycotic therapies are not as effective against these species as they are against C. If this regimen is not feasible, topical treatments used intermittently as a maintenance regimen can be considered. However, 30%–50% of women will have recurrent disease after maintenance therapy is discontinued. Options include longer duration of therapy (7–14 days) with a nonfluconazole azole drug (oral or topical) as first-line therapy.
If recurrence occurs, 600 mg of boric acid in a gelatin capsule is recommended, administered vaginally once daily for 2 weeks. Only topical azole therapies, applied for 7 days, are recommended for use among pregnant women.HIV InfectionThe incidence of VVC in HIV-infected women is unknown. Vaginal Candida colonization rates among HIV-infected women are higher than among those for seronegative women with similar demographic characteristics and high-risk behaviors, and the colonization rates correlate with increasing severity of immunosuppression. Symptomatic VVC is more frequent in seropositive women and similarly correlates with severity of immunodeficiency.
In addition, among HIV-infected women, systemic azole exposure is associated with the isolation of nonalbicans Candida species from the vagina.On the basis of available data, therapy for VVC in HIV-infected women should not differ from that for seronegative women. Although long-term prophylactic therapy with fluconazole at a dose of 200 mg weekly has been effective in reducing C.
Given the frequency at which RVVC occurs in the immmunocompetent healthy population, the occurrence of RVVC should not be considered an indication for HIV testing among women previously testing HIV negative.



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