TABLE 80.3 TREATMENT OF INFECTIOUS CAUSES OF VAGINITIS AND VAGINAL DISCHARGE Recommended regimens for the treatment of candidal vulvovaginitis Over-the-counter intravaginal: Clotrimazole 1% cream g intravaginally for 7–14 days Clotrimazole 2% cream g intravaginally for days Miconazole 2% cream g intravaginally for days Miconazole 4% cream g intravaginally for days Miconazole 100 mg vaginal suppository, one suppository for days Miconazole 200 mg vaginal suppository, one suppository for days Miconazole 1,200 mg vaginal suppository, one suppository for day Tioconazole 6.5% ointment g intravaginally in a single application Prescription intravaginal: Butoconazole 2% cream (single-dose bioadhesive product), g intravaginally for day Terconazole 0.4% cream g intravaginally for days Terconazole 0.8% cream g intravaginally for days Terconazole 80 mg vaginal suppository, one suppository for days Prescription oral: Fluconazole 150 mg oral tablet, one tablet in a single dose Recommended regimens for the treatment of bacterial vaginosis Prescription oral: Metronidazole 500 mg orally twice a day for days a Prescription intravaginal: Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for days Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for days b Recommended regimens for the treatment of Trichomonas vaginalis Metronidazole g orally in a single dose Tinidazole g orally in a single dose Recommended regimens for the treatment of Chlamydia trachomatis Azithromycin g orally in a single dose Doxycycline 100 mg orally twice a day for days Recommended regimens for the treatment of Neisseria gonorrhoeae Ceftriaxone 250 mg IM in a single dose PLUS Azithromycin g orally in a single dose OR Doxycycline 100 mg orally twice a day for days Recommended regimen for OUTPATIENT treatment of pelvic inflammatory disease Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days WITH or WITHOUT Metronidazole 500 mg orally twice a day for 14 days Recommended regimen for INPATIENT treatment of pelvic inflammatory disease Regimen 1: Cefotetan g IV every 12 hours OR Cefoxitin g IV every hours PLUS Doxycycline 100 mg orally or IV every 12 hours ADD Metronidazole 500 mg IV every 12 hours if TOA present Regimen 2: Clindamycin 900 mg IV every hours PLUS Gentamycin loading dose IV or IM (2 mg/kg) followed by a maintenance dose (1.5 mg/kg) every hours a Consuming b Might alcohol should be avoided during treatment and for 24 hours thereafter weaken latex condoms and diaphragms for days after use TABLE 80.4 CRITERIA FOR ADMISSION TO THE HOSPITAL FOR PELVIC INFLAMMATORY DISEASE • Surgical emergency cannot be excluded • Pregnancy • Failed clinical improvement on appropriate PO antibiotics • Poor compliance or inability to tolerate PO outpatient regimen • Presence of severe illness, nausea and vomiting, or high fever • Suspected/confirmed tubo-ovarian abscess Suggested Readings and Key References American Academy of Pediatrics Policy statement: Use of chaperones during the physical examination of the pediatric patient Pediatrics 2011;127(5):991–993 Amsel R, Totten PA, Spiegel CA, et al Nonspecific vaginitis: diagnostic criteria and microbial and epidemiologic associations Am J Med 1983;74(1):14–22 Bazella C, Greenfield M Vaginal discharge and odor In: Adams Hillard P, ed Practical Pediatric and Adolescent Gynecology 1st ed Cleveland, OH: John Wiley & Sons Ltd; 2013:14–17 Beyitler I, Kavukcu S Clinical Presentation, diagnosis and treatment of vulvovaginitis in girls: a current approach and review of the literature World J Pediatr 2017;13(2):101–105 Cemek F, Odabas D, Senel U, et al Personal hygiene and vulvovaginitis in prepubertal children J Pediatr Adolesc Gynecol 2016;29:223–227 Centers for Disease Control and Prevention Sexually Transmitted Diseases (STDs), 2015 STD Guidelines Available at https://www.cdc.gov/std/tg2015/pid.htm Accessed March 2020 Emans SJ Vulvovaginal problems in the prepubertal child In: Emans SJ, Laufer MR, Goldstein DP, eds Pediatric and Adolescent Gynecology 6th ed Philadelphia, PA: Lippincott Williams & Wilkins; 2012:42–59 Emans SJ, Woods ER Vulvovaginal complaints in the adolescent In: Emans SJ, Laufer MR, Goldstein DP, eds Pediatric and Adolescent ... Readings and Key References American Academy of Pediatrics Policy statement: Use of chaperones during the physical examination of the pediatric patient Pediatrics 2011;127(5):991–993 Amsel R, Totten... use TABLE 80.4 CRITERIA FOR ADMISSION TO THE HOSPITAL FOR PELVIC INFLAMMATORY DISEASE • Surgical emergency cannot be excluded • Pregnancy • Failed clinical improvement on appropriate PO antibiotics... 1983;74(1):14–22 Bazella C, Greenfield M Vaginal discharge and odor In: Adams Hillard P, ed Practical Pediatric and Adolescent Gynecology 1st ed Cleveland, OH: John Wiley & Sons Ltd; 2013:14–17 Beyitler