Infectious vaginitis. Selecting therapy and preventing recurrence

Vaginal candidiasis, trichomoniasis, and bacterial vaginosis can be difficult to manage because of predisposing factors and frequent recurrence. Thus, in addition to drug therapy, management should include attempts to minimize factors that contribute to recurrence. Both topical and oral agents are available for vaginal candidiasis and bacterial vaginosis, and both routes of administration appear equally safe and effective. Topical therapy may be used for these conditions in pregnant women. Only oral therapy is optimal for trichomoniasis. However, during pregnancy, the infection may be managed with topical clotrimazole. Currently, treatment of a woman's sexual partner is recommended in the management of trichomoniasis and is optional in cases of bacterial vaginosis. Sexual activity may also contribute to the recurrence of vaginal candidiasis; however, more studies are needed to evaluate the impact on recurrence rates of treating the male partner.