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Treatment of vulvovaginitis
Last reviewed: 04.07.2025
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Treatment of vulvovaginitis in girls must begin with the elimination of the main source of infection (chronic diseases of the oropharynx, pyelonephritis, helminthiasis, carious teeth, etc.).
Treatment of vulvovaginitis should include:
- installation of the vagina with antiseptic solutions;
- antibacterial effect taking into account the sensitivity of the isolated microflora to antimicrobial drugs;
- use of antifungal drugs;
- use of eubiotics;
- desensitizing treatment;
- immunomodulatory treatment (as indicated);
- prescription of adaptogens;
- vitamin and mineral complex.
Goals of treatment for vulvovaginitis vulvovaginitis in girls
Elimination of the inflammatory process, absence of clinical symptoms of the disease and normalization of the vaginal microbiocenosis.
Drug 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 the foreign body. Then the vagina is washed with antiseptic solutions.
Treatment of vulvovaginitis caused by enterobiasis should be started with antihelminthic (anthelmintic) treatment. The vagina is washed with antiseptic solutions.
The most difficult to treat is non-specific vulvovaginitis, which usually occurs chronically. Its exacerbations usually occur after acute respiratory infections, flu or any other infection, as well as during exacerbation of chronic tonsillitis or chronic infection of another localization.
Local treatment of vulvovaginitis in girls
Local treatment of vulvovaginitis in girls - washing the vagina with antiseptic solutions: [nitrofural (furacilin), octenisept for mucous membranes, hydroxymethylquinoxyline dioxide (dioxidine), benzyldimethyl-myristoylamino-propylammonium (miramistin), lidocaine + chlorhexidine (instillagel), colargol, albucid, malavit, tantum rose] through a catheter or the introduction of chlorhexidine (hexicon D) 1 vaginal suppository 2 times a day for 10 days, as well as applications to the external genitalia of gels, creams or ointments with the following properties: antiseptic [chlorhexidine gel (hexicon)], anesthetic [lidocaine + prilocaine (emla), kathejel], astringent [zinc-bismuth ointment) and desensitizing [mometasone (elocom), methylprednisolone aceponate (advantan), clobetasol (dermovate) and others]. Antibiotic sticks in the vagina should be used strictly according to indications if the listed drugs are ineffective, taking into account the type and number of microbial agents detected.
In combination with antibiotics, it is necessary to prescribe antifungal, antihistamine drugs, eubiotics or probiotics.
Immunomodulators are also used: Viferon-1 or Kipferon suppositories once a day in the vagina or rectum for 20 days. UV irradiation or light therapy of the vulva area is possible.
General treatment of vulvovaginitis in girls
General treatment of vulvovaginitis in girls includes sanitation of foci of chronic infection (ENT organs, gastrointestinal tract, urinary system), treatment of skin diseases, hardening measures, and training in personal hygiene rules.
In 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 candidal vulvovaginitis, antiprotozoal drugs or antibiotics are combined with antimycotic drugs.
Metronidazole (Trichopolum, Flagyl) 250 mg 2 times a day orally and 500 mg/day intravaginally for 5 days and/or clindamycin (clindacin) 2% cream 5 mg intravaginally for 3 days.
Fluconazole (Diflucan, Mycosyst) for children under 12 years of age - 3-12 mg/kg per day, for children over 12 years of age - 50-150 mg once on the second and last day of taking metronidazole or clindamycin. It is possible to use natamycin (Pimafucin) for children under 12 years of age - 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 in 1 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 antifungal 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 of age - 50-150 mg once or 50 mg/day for 3 days. Natamycin may be used for children under 12 years of age - 0.1 g 2 times a day, over 12 years of age - 4 times a day in combination with natamycin in the form of vaginal suppositories (0.1 g in 1 suppository per day) for 5-10 days or itraconazole at a dose of 200 mg/day for 3 days or ketoconazole (nizoral) no more than 400 mg/day for 5 days.
In chronic recurrent and systemic candidiasis, a combination of oral medications with intravaginal antifungal agents is used: clotrimazole, 1 suppository in the vagina for 7 days, or butoconazole (Gynofort), 1 dose per day once, or natamycin, 1 suppository at night for 6 days, or econazole (Ginopevaril), 1 suppository (50 or 150 mg) for 3 days, or sertaconazole (Zalain), 1 suppository at night (300 mg) once. To achieve complete recovery, two courses are usually carried out with a 7-day interval.
In the treatment of infectious and mycotic vulvovaginitis, the combined drug terzhinan is used, which includes ternidazole, neomycin sulfate, nystatin and a microdose of prednisolone. Also used is nifuratel (macmiror), containing 500 mg of nifuratel and 200,000 U of nystatin, or metronidazole + miconazole (klion-D 100), consisting of 100 mg of metronidazole and 100 mg of miconazole nitrate, or polygynax, which includes neomycin, polymyxin B, nystatin and dimethylpolysiloxane gel. The drugs are used intravaginally once at night for 10 days.
If a specific infection is detected (chlamydia, mycoplasma, ureaplasma, gonorrhea, trichomoniasis), treatment is carried out with antibacterial drugs to which these microorganisms are sensitive. In this case, it is necessary to examine other family members of the sick girl for these types of infection and treat them.
Treatment of trichomonas vulvovaginitis
Antiprotozoal agents of general and local action are used.
Metronidazole tablets are taken orally in a dose based on the child's age (1-5 years old - 80 mg 2-3 times a day, 6-10 years old - 125 mg 2-3 times a day, 11-14 years old - 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 oral administration of antiprotozoal drugs, the vagina is cleaned with mild disinfectants, and vaginal preparations containing metronidazole, nifuratel and other antitrichomonal agents are prescribed.
In case of long-term recurrent trichomoniasis, it is advisable to use vaccine therapy: solcotrichovac 0.5 ml intramuscularly, 3 injections with an interval of 2 weeks, then after a year 0.5 ml intramuscularly once.
The criteria for recovery are the absence of clinical manifestations and negative results of microscopic and cultural studies performed 7-10 days after the end of treatment.
Treatment of gonorrheal vulvovaginitis
Treatment of vulvovaginitis of gonorrheal origin should be carried out by a dermatovenerologist.
All preschool-age girls attending child care institutions remain in hospital for 1 month after completion of treatment for gonorrhea to establish cure. During this time, 3 provocations and 3 cultures are performed (once every 10 days). The criterion for cure of gonorrhea in children is a normal clinical picture and negative results of repeated laboratory tests after 3 provocations.
Antibiotics of choice are drugs of the penicillin group (benzylpenicillin, ampicillin, ampicillin + oxacillin (ampiox), oxacillin). It is also possible to use macrolides, aminoglycosides, tetracyclines.
Sulfanilamide drugs are prescribed in case of intolerance or ineffectiveness of antibiotics at a rate of 25 mg/kg on the first day of administration and 12.5 mg/kg on subsequent days, with a course of treatment of 5-7 days.
Immunotherapy is used for "fresh" torpid, chronic forms of gonorrhea, relapses of the disease, and also when antibacterial treatment is ineffective. Children under 3 years of age are not given immunotherapy with gonovaccine.
Treatment of chlamydial and mycoplasmal vulvovaginitis
Treatment of urogenital chlamydia should be comprehensive, using antibacterial and antifungal agents, interferons, and immunocorrectors in accordance with the detected immune pathology.
Antibiotics: azithromycin (sumamed) for children weighing up to 50 kg - 20 mg/kg on the first day of administration and 10 mg/kg per day for 2-5 days; for girls weighing over 50 kg - 1.0 g on the first day, 0.5 g/day for 2-5 days; or roxithromycin (rulid) for children under 12 years of age - 5-8 mg / kg per day, for children over 12 years of age - 150 mg 2 times a day for 7-12 days, or clarithromycin (klacid) for children under 12 years of age - 7.5 mg / kg, for children over 12 years of age - 125-250 mg 2 times a day for 7-12 days, or josamycin (vilprafen) for girls aged 3 months to 1 year - 7.5-15.0 ml / day of suspension orally, at the age of 1-6 years - 15-30 ml / day, at the age of 6-14 years - 30-45 ml / day, over 14 years of age - 1-2 g or 30-50 ml / kg per day for 7-14 days, or midecamycin (macropen) for children in under 12 years of age - 20-40 mg/kg 2 times a day, for children over 12 years of age - 400 mg 3 times a day for 7-14 days, or doxycycline (Unidox Solutab) - only for children over 8 years of age. For girls from 8 to 12 years of age - 4 mg/kg on the first day, 2 mg/kg 2 times a day for 2-7 days, for girls over 12 years of age 200 mg orally the first time, then 100 mg 2 times a day for 2-7 days.
To prevent the development of candidiasis, antifungal agents are used.
To correct immune disorders, Kipferon or Viferon-1 is prescribed, 1 suppository 1 time per day rectally or intravaginally for 10 days.
To normalize the intestinal microflora after taking antibiotics, you can prescribe baktisubtil, acidophilic lactobacilli + kefir fungi (atsipol), hilak-forte, normoflorin B or normoflorin D, linex, evitalia, etc.
Systemic enzyme therapy: Wobenzym for children under 1 year old - 1 tablet per 6 kg of body weight per day, for girls over 12 years old - 3 tablets 3 times a day for 3-6 weeks.
The criteria for recovery are the absence of antigen in a smear taken no earlier than 21 days after the use of antibiotics, and positive dynamics of antibody titers.
Treatment of vulvovaginitis in herpesvirus infection
The basis of treatment is systemic use of antiviral drugs: acyclovir 200 mg 5 times a day or valacyclovir 500 mg 2 times a day for 5 days.
Antiviral ointments (acyclovir and others) are applied locally for 5-10 days.
Treatment of atopic vulvovaginitis
In atopic vulvovaginitis, the leading components of successful treatment are eliminating contact with the allergen, following a hypoallergenic diet, and following the allergist's instructions. It is necessary to adjust the child's diet, 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, legumes, fermented, soaked, pickled foods, chocolate), and histamine-like substances (tomatoes, walnuts).
Antihistamines are used in a course of treatment of up to 2 weeks: cetirizine (Zyrtec) from 6 months to 6 years - 5 mg or 5 ml of solution per day, over 6 years - 10 mg 1 time per day; desloratadine (Erius) for children aged 2-5 years 1.25 mg / day in the form of syrup, from 6 to 11 years - 2.5 mg / day, 12 years and older - 5 mg / day: fexofenadine (Telfast Gifast) for children aged 6 to 12 years - 30 mg 2 times a day, from 12 years - 120-180 mg / day.
It is necessary to treat intestinal dysbacteriosis, which increases the manifestations of allergies due to increased absorption of allergens by the inflamed intestinal mucosa, disruption of food conversion, increased formation of histamine from histidine in the food substrate under the influence of opportunistic flora, etc.
If complications such as pyoderma occur, antibacterial action is necessary. The choice of 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 affected areas (1% tannin solution, oak bark decoction (oak bark), celestoderm 0.1% ointment, cream 1-2 times a day), epithelializing and keratoplastic agents [actovegin 5% ointment, solcoseryl, dexpanthenol (bepanten), ointments with vitamin A].
Surgical treatment of vulvovaginitis
It is indicated in exceptional cases of vulvitis or vulvovaginitis combined with complete fusion of the genital slit and the impossibility of full spontaneous urination. Separation of the fusion (synechia) of the posterior commissure and the labia minora is performed, followed by treatment of the fusion zone and the boulevard ring in the morning and during the day with a mixture of traumeel C cream and contractubex, at night - with estriol (ovestin) cream for 10-14 days.
Approximate periods of incapacity for work
From 7 to 14 days.
[ Further management of vulvovaginitis in girls
During treatment, examination and collection of vaginal contents are performed on the 3rd and 7th days. After cure of bacterial non-specific vulvovaginitis, a control examination is performed 30, 60 and 90 days after completion of treatment. Preventive examination is performed once a year, then - at decreed times.
Brief recommendations for those who have vulvovaginitis
In order to prevent recurrent vulvovaginitis, it is necessary to carefully observe the rules of intimate hygiene, especially in public places. It is not recommended to wash the external genitalia with soap, since the bacteriostatic effect of soap can cause a violation of the protective properties of the skin of the vulva and perineum and lead to the development of dermatitis and relapse of vulvitis. In the vagina of girls, the indigenous flora is bifidobacteria, so it is unsafe to prescribe local treatment with drugs containing lactobacilli. Girls are not recommended to wear synthetic underwear and panties that do not completely cover the perineum and gluteal folds (for example, thong panties or panties in the form of sports trunks with slits in the side seams). It is necessary to provide timely treatment and sanitation of foci of infection (chronic diseases of the oropharynx, pyelonephritis, carious teeth, etc.) and helminthic invasion, avoid unjustified use of antiseptic, antibacterial drugs and glucocorticoids, and carry out hardening (sports, water procedures).