Table 1.

Management Algorithm and Treatments for Vaginal Symptoms

Control GroupIntervention GroupTreatments
Patient meets 3 or 4 Amsel criteria and is diagnosed with bacterial vaginosisPatients whose chief complaint is odor are diagnosed with presumptive bacterial vaginosisMetronidazole 500 mg bid for 7 days Alternative: Clindamycin 2% cream intravaginal bid for 7 days or Metrogel intravaginal qhs for 5 days
Yeast forms are seen and patient is diagnosed with candidiasisPatients whose chief complaint is itching or irritation are diagnosed with presumptive candidiasisFluconazole 150 mg po once at the time of visit Alternative: Terconazole vaginal cream or suppositories
Trichomonads are seen on microscopy or Trichomonas vaginalis culture is positivePatients treated if culture is positiveMetronidazole 2 g po at the time of visit; partner referred for treatment Alternative: Metronidazole 500 mg po bid for 5 days
If none of the above, provider may either treat as per the intervention arm or not treatAll other patients are treated for both presumptive candidiasis and presumptive bacterial vaginosis