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The treatment of vaginal infections depends on the cause of the infection, ie: whether it is bacterial, viral, parasitic or fungal. Treatment is described per condition below:
Bacterial Vaginosis
Bacterial Vaginosis (BV) is an infection of bacteria in the vagina. Symptoms include an off-white or grey discharge and a fishy or musty smell. BV can be treated with over the counter topical (vaginal) or oral antibiotics such as metronidazole or clindamycin. On occasion however, it may require long-term or repeat treatments. Many doctors believe metronidazole shouldn't be used during the first three months of pregnancy as its safety has not been established.
During the treatment cycle, it is recommended that you refrain from having sex. In general, it is not necessary to treat male sex partners. BV may occur between women who have sex with other women, in which case both partners need to be treated.
Note: When using metronidazol you should not use alcohol. This can cause very severe nausea and vomiting.
Vulvovaginal candidiasis (Yeast infection or Thrush)
Vulvovaginal candidiasis (VVC), also known as thrush, is a fungal infection of the vagina. The main symptom of thrush is a white vaginal discharge that resembles cottage cheese.
VVC may be spread by sexual contact. Some anti-fungal creams (miconazole and clotrimazole) are available over the counter to treat this condition. Other non-prescription products contain antihistamines or topical anaesthetics that mask symptoms and do not treat the underlying problem. Note: some anti-fungal medicines are oil based and may weaken condoms and diaphragms. Newer types of treatment include a single oral dose of fluconazole or itraconazole.
It is advisable to treat sexual partners with an anti-fungal cream which is applied twice daily for one week on the male genitals. Infection in males may be asymptomatic.
Trichomoniasis
Trichomoniasis is a sexually transmitted infection caused by parasites
Given that the disease is sexually transmitted, it is preferable for both partners to receive treatment to eliminate the parasite.
Generally, the treatment for trichomoniasis is metronidazole, which is usually prescribed in one large oral dose or several smaller doses taken over three to seven days. Note: drinking alcohol while taking this drug can cause nausea and vomiting.
Post-menopausal vaginal discharge
Postmenopausal (atrophic) vaginal discharge is an infection or inflammation of the vagina caused by lowered oestrogen levels that upset the vagina's normal balance. Treatment consists of oestrogen replacement therapy either topically, transdermally or orally, and treatment of the secondary infection if present. A water-soluble lubricant may be used if oestrogen cannot be taken.
Reviewed by Dr. Owen Wiese, April 2015.
