Vaginitis is the presenting symptom at millions of office visits each year in the United States. Although treatment of sporadic cases is often straightforward, recurrent cases present both diagnostic and treatment challenges. Molecular diagnostic tests are likely superior to in-office microscopy for most clinicians and most cases. In both recurrent bacterial vaginosis and recurrent vulvovaginal candidiasis, national treatment guidelines recommend an extended treatment duration with one of the first-line agents. In cases in which such treatment is not successful, vaginal boric acid is likely the cheapest and easiest alternative option. New antifungal medications offer additional but limited treatment options. Probiotics are not recommended for prevention of vulvovaginal candidiasis; however, vaginal products containing Lactobacillus crispatus may have promise for recurrent bacterial vaginosis. Trichomoniasis should be treated with a 1-week course of metronidazole; this is the only sexually transmitted infection for which treatment recommendations vary by sex. In cases in which patients do not respond to initial treatment, the diagnosis should be reconsidered, and other potential causes such as desquamative inflammatory vaginitis, genitourinary syndrome of menopause, or vulvodynia should be considered.

中文翻译：

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阴道炎的评估和治疗。


阴道炎是美国每年数百万次就诊的首发症状。虽然散发病例的治疗通常很简单，但复发病例同时存在诊断和治疗挑战。对于大多数临床医生和大多数病例，分子诊断测试可能优于诊室显微镜检查。对于复发性细菌性阴道病和复发性外阴阴道念珠菌病，国家治疗指南建议使用其中一种一线药物延长治疗持续时间。在这种治疗不成功的情况下，阴道硼酸可能是最便宜和最简单的替代选择。新的抗真菌药物提供了额外但有限的治疗选择。不建议使用益生菌来预防外阴阴道念珠菌病;然而，含有 Lactobacillus crispatus 的阴道产品可能对复发性细菌性阴道病有希望。滴虫病应使用 1 周疗程的甲硝唑治疗;这是唯一一种治疗建议因性别而异的性传播感染。如果患者对初始治疗无反应，则应重新考虑诊断，并应考虑其他潜在原因，例如脱屑性炎症性阴道炎、绝经期泌尿生殖系统综合征或外阴痛。