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Treatment of vulvovaginitis
Last reviewed: 23.04.2024
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Treatment of vulvovaginitis in girls should begin with the elimination of the main focus of infection (chronic diseases of the rotosynopharynx, pyelonephritis, helminthiosis, carious teeth, etc.).
Treatment of vulvovaginitis should include:
- installation of the vagina with solutions of antiseptics;
- antibacterial effects, taking into account the sensitivity of the isolated microflora to antimicrobial agents;
- use of antifungal drugs;
- use of eubiotics;
- desensitizing treatment;
- immunomodulating treatment (according to indications);
- administration of adaptagens;
- vitamin and mineral complex.
Objectives of treatment of vulvovaginitis vulvovaginitis in girls
Elimination of the inflammatory process, absence of clinical symptoms of the disease and normalization of the vaginal microbiocenosis.
Medicamentous treatment of vulvovaginitis in girls
Treatment of vulvovaginitis in girls depends on the cause of vulvovaginitis.
Treatment of vulvovaginitis, caused by the presence of a foreign body in the vagina, begins with the removal of a foreign body. Then, the vagina is washed with antiseptic solutions.
Treatment of vulvovaginitis caused by enterobiosis, it is advisable to start with anthelmintic (anthelminthic) effect. The vagina is washed with antiseptic solutions.
The most difficult to treat nonspecific vulvovaginitis, usually chronically. Its exacerbation usually occurs after acute respiratory infections, influenza or any other infection, as well as with exacerbation of chronic tonsillitis or chronic infection of other localization.
Local treatment of vulvovaginitis in girls
The local treatment of vulvovaginitis in girls is the washing of the vagina with antiseptic solutions: [nitrofural (furacilin), octenesis for mucous membranes, hydroxymethyl-chinoxylindioxide (dioxydin), benzyldimethyl-myristoylamino-propylammonium (miramistin), lidocaine + chlorhexidine (instillagel), collargol, albucid, malavit, tantum rosea ] on the catheter or the administration of the drug chlorhexidine (hexicon D) for 1 vaginal suppository 2 times a day for 10 days, as well as applications to the external genital organs of gels, creams or ointments with the properties: antis pticheskimi [chlorhexidine gel (Hexicon)], anesthetics [lidocaine, prilocaine + (Emla) katedzhel] astringent [zinc-bismuth ointment) and desensitizing [mometasone (Elokim). Methylprednisolone aceponate (advantan), clobetasol (dermovit) and others]. Sticks with antibiotics in the vagina should be used strictly according to indications when the listed drugs are ineffective considering the type and amount of microbial agents detected.
In combination with antibiotics, the use of antimycotic, antihistamines, eubiotics or probiotics is mandatory.
Immunomodulators are also used: a suppository of viferon-1 or kipferon once a day in the vagina or rectum for 20 days. Maybe UV or phototherapy of the vulva area.
General treatment of vulvovaginitis in girls
The general treatment of vulvovaginitis in girls includes the sanation of foci of chronic infection (ENT organs, gastrointestinal tract, urinary system), treatment of skin diseases, hardening measures, training in personal hygiene.
With bacterial vaginosis, the dose and duration of treatment are selected taking into account the age and body weight of the child. In the treatment for the prevention of vulvovaginal candidiasis, antiprotozoal drugs or antibiotics with antimycotics are combined.
Metronidazole (trichopolum, flagyl) 250 mg twice a day inwards and 500 mg / day intravaginally for 5 days and / or clindamycin (clindacin) 2% cream 5 mg intravaginally 3 days.
Fluconazole (diflucan, mycosyst) for children under 12 years of age - 3-12 mg / kg per day, for children over 12 years - 50-150 mg once a day on the second and last day of metronidazole or clindamycin. It is possible to use natamycin (pimafucin) for children under the age of 12 years - 0.1 g 2 times a day, over 12 years - 4 times a day in combination with natamycin in the form of vaginal suppositories (0.1 g per suppository per day) for 5-10 days or itraconazole (orungal) at a dose of 200 mg / day for 3 days.
The basis of treatment of mycotic vulvovaginitis is antimycotic drugs. The duration of treatment depends on the clinical effect.
Fluconazole for children under 12 years of age - 3-12 mg / kg per day, for children over 12 years - 50-150 mg once or 50 mg / day for 3 days. It is possible to use natamycin for children under 12 years old - 0.1 g 2 times a day, over 12 years - 4 times a day in combination with natamycin in the form of vaginal suppositories (0.1 g per suppository per day) for 5 -10 days or itraconazole at a dose of 200 mg / day for 3 days or ketoconazole (Nizoral) not more than 400 mg / day for 5 days.
In chronic recurrent and systemic candidiasis, a combination of oral drugs with intravaginal antimycotics is used: clotrimazole for 1 suppository in the vagina for 7 days or butoconazole (gynofort) 1 dose per day once, or natamycin for 1 suppository at night for 6 days, or econazole (ginopevaril) for 1 suppository (50 or 150 mg) for 3 days, or sertaconazole (zalain) - 1 suppository at night (300 mg) once. To achieve full recovery, usually two courses with a 7-day interval.
In the treatment of infectious-mycotic vulvovaginitis combined terzinan is used, which includes terinidazole, neomycin sulfate, nystatin and a microdose of prednisolone. Also used are nifuratel (makmiror) containing 500 mg of nifuratel and 200,000 units of nystatin, or metronidazole + miconazole (clion-D 100), consisting of 100 mg of metronidazole and 100 mg of miconazole nitrate, or poly-Nina, which includes neomycin, polymyxin B , nystatin and dimethylpolysiloxane gel. The drugs are administered once intravaginally at night for 10 days.
When a specific infection (chlamydia, mycoplasma, ureaplasma, gonorrhea, trichomoniasis) is detected, treatment is carried out with antibacterial drugs to which these microorganisms are sensitive. In this case, it is necessary to examine for these types of infections and treatment of other family members of the sick girl.
Treatment of trichomonas vulvovaginitis
Apply antiprotozoal agents of general and local action.
Metronidazole tablets inside take in a dose taking into account the age of the child (at the age of 1-5 years - 80 mg 2-3 times a day, 6-10 years - 125 mg 2-3 times a day, 11-14 years - 250 mg 2-3 times a day) for 10 days. Adolescent girls take metronidazole according to the regimens adopted for the treatment of trichomoniasis in adults.
Simultaneously with the ingestion of antiprotozoal drugs, the toilet of the vagina is made weakly disinfectant, vaginal preparations containing metronidazole, nifuratel and other anti-trichomonadic agents are prescribed.
With prolonged recurrent trichomoniasis it is advisable to use vaccine therapy: solkotrihovak 0.5 ml intramuscularly, 3 injections at intervals of 2 weeks, then one year later 0.5 ml intramuscularly once.
The lack of clinical manifestations and the negative results of microscopic and cultural studies made 7-10 days after the end of treatment are considered criteria for cure.
Treatment of gonorrheic vulvovaginitis
Treatment of vulvovaginitis of gonorrheal nature should be performed by a dermatovenereologist.
All pre-school girls who visit children's institutions after the end of treatment for gonorrhea stay in the hospital for 1 month to establish cure. During this time, 3 provocations and 3 crops are done (once every 10 days). The criterion for curing gonorrhea in children is a normal clinical picture and negative results of repeated laboratory tests after 3 provocations.
Antibiotics of choice - preparations of the penicillin group (benzylpenicillin, ampicillin, ampicillin + oxacillin (ampiox), oxacillin). It is also possible to use macrolides, aminoglycosides, tetracyclines.
Sulfanilamide preparations are prescribed for intolerance or ineffectiveness of antibiotics from the calculation of 25 mg / kg on the first day of admission and at 12.5 mg / kg on subsequent days, with a course of treatment of 5-7 days.
Immunotherapy is used with a "fresh" torpid, chronic form of gonorrhea, with relapses of the disease, as well as with ineffectiveness of antibiotic treatment. Children under 3 years of immunotherapy gonovaktsinoy not spend.
Treatment of vulvovaginitis chlamydia and mycoplasma
Treatment of urogenital chlamydia should be complex with the use in accordance with the detected immune pathologies of antibacterial and antifungal agents, interferons, immunocorrectors.
Antibiotics: azithromycin (sumamed) for children weighing up to 50 kg - 20 mg / kg on the first day of admission and 10 mg / kg per day for 2-5 days; girls with a body weight of more than 50 kg - on the first day of 1.0 g, 2-5 days to 0.5 g / day; or roxithromycin (rolid) for children under 12 years of age - 5-8 mg / kg per day, for children over 12 years - 150 mg twice a day for 7-12 days, or clarithromycin (klatsid) for children under the age of 12 12 years - 7.5 mg / kg, for children over 12 years - 125-250 mg twice a day for 7-12 days, or josamycin (vilprafen) for girls aged 3 months to 1 year - for 7.5- 15,0 ml / day of the suspension inside, at the age of 1-6 years - 15-30 ml / day, at the age of 6-14 years - 30-45 ml / day, over the age of 14 years - 1-2 grams or 30-50 ml / kg per day 7-14 days, or midekamycin (macropen) for children under 12 years of age - 20-40 mg / kg 2 times a day, de pits over the age of 12 years - 400 mg 3 times daily 7-14 days, or doxycycline (JUnidoks soljutab) - Only children over the age of 8 years. For girls from 8 to 12 years - 4 mg / kg in the first day, 2 mg / kg 2 times a day for 2-7 days, for girls over the age of 12 years 200 mg orally in the first dose, then 100 mg 2 times a day day 2-7 days.
To avoid the development of candidiasis, antimycotic agents are used.
To correct the immune disorders appoint kipferon or viferon-1 to 1 suppository once a day rectally or intravaginally for 10 days.
To normalize the intestinal microflora after taking antibiotics, you can designate bactisubtil, lactobacillus acidophilus + kefir (acipol) fungi, hilak-forte, normoflorin B or normoflorin D \ linex, evitaly, etc.
Systemic enzyme therapy: vobenzim for children under 1 year - 1 dragee for 6 kg of body weight per day, girls over 12 years - 3 tablets 3 times a day for 3-6 weeks.
The criterion for cure is the absence of antigen in the smear taken no earlier than 21 days after antibiotic use, and the positive dynamics of antibody titers.
Treatment of vulvovaginitis with herpesvirus infection
At the heart of the treatment is systemic exposure to antiviral drugs: acyclovir, 200 mg 5 times a day, or valaciclovir 500 mg twice a day for 5 days.
Locally used antiviral ointments (acyclovir and others) for 5-10 days.
Treatment of atopic vulvovaginitis
Atopic vulvovaginitis, the leading components of a successful therapeutic effect are the elimination of contact with the allergen, compliance with a hypoallergenic diet, the performance of allergist prescriptions. It is necessary to regulate the nutrition of the child, to exclude products containing obligate allergens (for example, fish, eggs, citrus fruits, chocolate, honey, strawberries and others), histamine-liberators (meat and fish broths, fried, smoked and spicy dishes, cheese, eggs, beans, , wet, marinated products, chocolate) and histamine-like substances (tomatoes, walnuts).
Antihistamines are applied with the course of treatment up to 2 weeks: cetirizine (zirtek) from 6 months to 6 years - 5 mg or 5 ml solution per day, over 6 years - 10 mg once a day; desloratadine (erius) for children aged 2-5 years at 1.25 mg / day in the form of a syrup, from 6 to 11 years - 2.5 mg / day, 12 years and older - 5 mg / day: fexofenadine (telphase \ gyphast ) children aged 6 to 12 years - 30 mg twice a day, from 12 years - 120-180 mg / day.
Should be treated intestinal dysbiosis, which increases the manifestations of allergy due to increased absorption of allergens inflamed mucous membrane of the intestine, a violation of the transformation of products, increased formation of histamine from the histidine of the food substrate under the influence of opportunistic flora and the like.
If a complication occurs in the form of pyoderma, an antibacterial effect is necessary. The choice of the drug is determined by the sensitivity of the microflora.
In the chronic stage of the disease, local treatment is carried out with agents that improve metabolism and microcirculation in the lesions (1% tannin solution, decoction of the oak cortex, celostoderm 0.1% ointment, cream 1-2 times a day), epithelizing and keratoplastic agents [Actovegin 5% ointment. Solkoseril, dexpanthenol (belanten), ointments with vitamin A].
Surgical treatment of vulvovaginitis
It is shown in exceptional cases when a combination of vulvitis or vulvovaginitis with complete infection of the sexual fissure and inability to complete spontaneous urination. Separate fusion (synechia) of the posterior adhesion and small labia with subsequent processing of the fusion zone and the Boulevard ring in the morning and in the afternoon with a mixture of cream traumeel C and contractubex, for the night with cream estriol (ovestin) for 10-14 days.
Approximate terms of incapacity for work
From 7 to 14 days.
[Further management of vulvovaginitis in girls
In the process of treatment, the examination and collection of the contents of the vagina is carried out on the 3rd and 7th days. After curing the bacterial nonspecific vulvovaginitis, a control examination is performed 30, 60 and 90 days after the end of treatment. Preventive examination is done once a year. Then - in the decreed time.
Brief recommendations for those who have vulvovaginitis
In order to prevent recurrence of vulvovaginitis, careful observance of the rules of intimate hygiene is necessary, especially in public places. It is not recommended to wash the external genitals with soap, since the bacteriostatic effect of soap can cause damage to the protective properties of the vulva and perineal skin and lead to dermatitis and recurrence of vulvitis. In the vagina of girls, the indigenous flora is bifidobacteria, so it is not safe to prescribe local treatment with drugs containing lactobacilli. Girls are not recommended to wear synthetic underwear and panties that do not fully cover the crotch and gluteal folds (for example, thong panties or panties in the form of sports trunks with cuts in the side seams). It is necessary timely treatment and sanitation of foci of infection (chronic diseases of the rotosynopharynx, pyelonephritis, carious teeth, and so on) and helminthic invasion, avoidance of unreasonable use of antiseptic, antibacterial drugs and glucocorticoids, hardening (sports, water procedures).