Vaginitis Bundle (BV · candidiasis · trichomoniasis)
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
Discharge, odour, itch and dysuria overlap between bacterial vaginosis, candidiasis, trichomoniasis and noninfective causes. Identify the syndrome before choosing a regimen, and separate pregnancy from nonpregnancy prescribing.
Assessment & interpretation
- Record discharge characteristics, vulval inflammation, vaginal pH and microscopy or NAAT where appropriate. Pelvic pain, fever or cervical tenderness needs assessment beyond simple vaginitis.
- Use culture or further assessment for persistent or complicated candidiasis rather than repeatedly prescribing empirical treatment.
Decisions that change management
- Symptomatic bacterial vaginosis in pregnancy should be treated. One CDC regimen is metronidazole 500 mg orally twice daily for 7 days.
- For vulvovaginal candidiasis in pregnancy, use a topical azole course for 7 days; avoid oral fluconazole. An example is clotrimazole 1% cream, 5 g intravaginally once daily for 7 days.
- For trichomoniasis in women, use metronidazole 500 mg orally twice daily for 7 days. Symptomatic pregnant patients should be tested and treated.
Follow-up & safety-netting
- Trichomoniasis needs partner treatment, abstinence until treatment is completed and symptoms resolve, and repeat testing at approximately 3 months.
- Persistent symptoms require reassessment of the diagnosis, adherence, exposure and possible resistance.
Clinical pitfalls
- Do not apply trichomoniasis partner-management instructions indiscriminately to candidiasis or bacterial vaginosis.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Fever, severe pelvic/abdominal pain, systemic illness, pregnancy fluid-loss concern or inability to tolerate treatment needs assessment for another/complicated condition.
When clinic, day care or home care may be suitable
- Uncomplicated BV, candidiasis or trichomoniasis does not normally require admission. Identify the cause rather than treating every discharge with every drug.
Before going home
- The diagnosis, pregnancy-appropriate treatment and return advice are clear; follow-up is arranged for persistent/recurrent or uncertain symptoms.
Discharge medicines and treatment changes
- Use the regimen for the confirmed/likely organism. In pregnancy use the selected topical azole course for candidiasis; do not substitute routine oral fluconazole.
- Partner treatment/retesting is relevant to trichomoniasis, not automatically to every cause of vaginitis.
Tests, pending results and their reviewer
- Assign microbiology/STI results and arrange review if tests or symptoms do not fit the presumed diagnosis.
Home care and counselling
- Discuss treatment completion, avoiding irritants and relevant partner/STI advice.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
If symptoms persist or recur | Reassess the diagnosis and treatment rather than repeatedly self-treating. |
About 3 months after trichomoniasis treatment | Retest sexually active women for reinfection under the CDC pathway. |
Return urgently
- Fever, severe pain, fainting, bleeding or suspected membrane rupture requires prompt assessment.
Treatment
① Immediate stabilization — first minutes
③ First-line treatment & drug regimens
Establish whether symptoms are due to BV, Candida, trichomoniasis or another cause before selecting a course. The cards below separate treatment choices; they are not a combination to give every patient.
④ Drug treatment detail (4 agents)
- Indication: Symptomatic BV, including pregnancy where treatment is indicated
- CDC does not require routine alcohol abstinence on evidence of a disulfiram-like interaction; product leaflets may give different advice. Follow the dispensed product instructions and discuss the difference.
- Symptoms and tolerance; recurrent symptoms need reassessment, not indefinite repeat courses
- Indication: Symptomatic bacterial vaginosis when an oral alternative is appropriate
- Do not shorten this CDC pregnancy BV course to five days.
- Symptom response, intolerance and severe/persistent diarrhoea suggestive of C. difficile
- Indication: Trichomoniasis, including symptomatic pregnant women
- Treat partner(s), avoid sex until both treatment courses complete and symptoms resolve, and retest women at about 3 months
- Indication: Symptomatic confirmed/suspected vulvovaginal candidiasis; reconsider other diagnoses with persistent symptoms
- CDC recommends topical azoles for seven days during pregnancy. Check product effects on latex contraception.
- Symptom response, local irritation and recurrence; culture/speciation when complicated or refractory
Monitoring
- Symptom resolution review; recurrent candida: glucose screen + longer maintenance topical
Post-treatment care
- Avoid douching practices; hygiene counselling
Diagnosis & assessment
- Haemodynamic instability -> sepsis pathway
Initial assessment
See treatment table for testing and regimens.
Principles & follow-up
Management principles
Sources (10)
2021-07 · updated 2025-12-22 (page review; guidance itself unchanged) · checked 2026-08-23 · verified-live
Open source ↗
CDC pages + wall chart: uncomplicated gonorrhoea cervix/urethra/rectum → ceftriaxone 500 mg IM single dose (<150 kg; 1 g if ≥150 kg); pharyngeal same; conjunctivitis 1 g IM; DGI 1 g IV/IM q24h; PID outpatient → ceftriaxone 500 mg IM ×1 + doxycycline 100 BD ×14 d + metronidazole 500 BD ×14 d; chlamyd…
· checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for vaginitis. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge check …
· checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for vaginitis. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge check …
· checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for vaginitis. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge check …
· checked 2026-10-17 · verified-live
Open source ↗
1% clotrimazole vaginal cream 5 g/day and pregnancy-specific seven-day topical azole recommendation; avoid oral fluconazole in pregnancy and evaluate persistent symptoms.
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.