Therapeutic target
Restoration of normal mucosal flora and thus prevention of complications.
Therapy recommendations
- Antibiosis (antibiotics: oral, vaginal tablets, vaginal gel) for bacterial vaginosis.
- Antifungal drugs for candidamycosis of the vagina (vagina).
- Active substances for special infection (see below).
- Notes on skin diseases (see below).
- See also under “Further therapy“.
Agents (main indication) of bacterial vaginosis (Gardnerella vaginalis, Bacteroides, Mycoplasma, Peptococcus)
Antibiotics
| Active ingredient groups | Active ingredients |
| Nitromidazoles | Metronidazole |
| MetronidazoleVaginal Gel | |
| Lincosamide | Clindamycin |
Vaginal antiseptic
| Active ingredient group | Active ingredients |
| Quaternary amonium compounds | Dequalinium |
Active substances (main indication) of candidamycosis of the vagina
Antifungal agents – local therapy
| Drug group | Active ingredients |
| Imidazole | Clotrimazole |
| Econazole | |
| Miconazole |
- Vaginal use of clotrimazole and miconazole in the first trimester (third trimester of pregnancy) does not appear to increase the risk of spontaneous abortion (miscarriage from natural causes).
Antifungals – Systemic therapy for recurrent chronic vaginitis.
| Drug group | Active ingredients |
| Triazoles | Fluconazole |
| Itraconazole |
- Pregnancy warning: fluconazole (antifungal agent belonging to the triazole derivatives group), oral; reproductive toxicity (48% ↑).
Active substances in special indications
Trichomonads
| Active ingredient group | Active ingredients |
| Nitromidazoles | Metronidazole |
Colpitis plasmacellularis
It is a disease,anamnestic with chronic fluorine (discharge) and many different treatment attempts with antibiotics and antifungals (drugs used to treat fungal infections (mycoses)). It also often resembles trichomonad colpitis. It is likely that the causes are different. There is no detectable causative agent as yet. Therefore, the diagnosis is made solely by therapeutic success (about 90%) with clindamycin, which is indicated when suspected. Also, there is no typical histologic finding.
| Drug group | Active ingredients |
| Lincosamide | ClindamycinVaginal Gel |
Staphylococcus aureus
Colonization (“colonization”) of the vagina with Staphylococcus aureus is usually clinically unproblematic, but can lead to massive wound healing problems in the event of surgery or other injury. Since most staphylococci produce beta-lactamase, antibiotics that are pencillinase-resistant must be used. Agents of choice are dicloxacillin, flucloxacillin, oxacillin, cephalosporins, erythromycin and clindamycin. The very rare special form, toxic shock syndrome (TSS; synonym: tampon disease), which leads to circulatory collapse and potentially death due to toxins (“poisons”), will not be discussed in this context.
| Drug group | Active ingredients |
| Staphylococcal penicillins(penicillinase-resistant β-lactam antibiotic). | Dicloxacillin |
| Flucloxacillin | |
| Oxacillin | |
| Cephalosporins | Cefazolin |
| Cefadroxil | |
| Cefotiam | |
| Cefotaxime | |
| Ceftriaxone | |
| Ceftazidime | |
| Cefuroxime | |
| Macrolides | Erythromycin |
| Lincosamide | Clindamycin |
Streptococcal colpitis
Streptococci are also among the most dangerous bacteria in the genital area, with septic clinical pictures and toxic shock syndrome (TSS).Therefore, antibiotic therapy must be administered even if the patient is free of symptoms.
| Drug group | Active ingredients |
| Benzylpenicillin | Penicillin G |
| Aminopenicillins | Amoxicillin |
| Cephalosporins | Cefuroxime |
- In case of colonization of the vagina with beta-hemolytic streptococci of serogroup B, prophylaxis with penicillin G or ampicillin i. v. should be given to the pregnant woman at the onset of labor or after rupture of the membranes
Herpes vaginalis
| Active ingredient group | Active ingredients |
| Antivirals | Aciclovir |
| Aciclovir |
Condylomata acuminata
A solitary infestation of the vagina (vagina) is certainly extremely rare, since a wound in the vagina is a prerequisite for such a case as a port of entry. However, in the case of a pronounced infestation of the vulva (totality of the external primary sex organs), the vagina and the cervix are also frequently affected.Safe prevention against HPV 6 + 11 is possible through vaccination.The means of choice are topical applications (application of medical agents where they should have a therapeutic effect) before surgical ablation (e.g. with a sharp spoon, electric snare, CO2 laser, cryosurgery/surgery by means of icing). For more, see HPV infection/pharmacotherapy.
Atrophic colpitis
Therapy consists primarily of local rarely of systemic estrogen administration (effect not occurring or not occurring only at the site of absorption (uptake) but at some other site/organ (here: vagina) in the system/body). Only local (“topical”) therapy will be discussed here. The drug of choice is estriol (E3). It has no endometrial (endometrial) effect, unlike estradiol (E2).
| Active ingredient group | Active ingredients |
| Estrogens | |
| Estriol (E3) | Estrogen vaginal cream |
| Estrogen vaginal ovulum/tablet/suppository | |
| Estradiol (E2) | Estradiol vaginal tablet |
Note: Vaginal estrogen therapy did not result in an increased risk of mammary carcinoma(breast cancer), colorectal carcinoma (carcinoma of the colon (intestine) or rectum (rectum)), and endometrial carcinoma (cancer of the uterus) in users with an intact uterus; likewise, the risk of apoplexy (stroke) and pulmonary and deep vein thrombosis was not increased. Irrespective of this, the European Medicines Agency, after reexamining the risks, recommends that high-dose vaginal creams containing estradiol (with 100 micrograms of estradiol per gram of cream (0.01%)) be used only once and for a maximum of 4 weeks. In this regard, the drug agency refers to side effects such as hormone replacement therapy, i.e., endometrial cancer, breast cancer, venous thromboembolism, and stroke.
Skin diseases
For details, see diseases; only brief information follows:
- Behçet’s disease: Treatment is with corticosteroids in the acute stage, and immunosuppressants (azathioprine, ciclosporin (cyclosporin A), chlorambucil, cyclophosphamide) in severe cases and frequent relapses (“recurrence”). If this also does not lead to the desired success, infliximab or thalidomide therapy can be prescribed.
- Lichen ruber/ planus erosivus: therapy: cortisone preparations in the form of ointments, creams or adhesive pastes.
- Psoriasis: Basically, systemic and topical therapy are considered:
- Topical therapy: calcineurin inhibitors, dithranol, glucocorticosteroids, coal tar, tazarotene, vitamin D and analogues.
- Systemic therapy: adalimumab, ciclosporin (cyclosporin A), etanercept, fumaric acid esters, infliximab, methotrexate, retinoids* * , ustekinumab* .
For the vaginal area, glucocorticoids are agents of choice. * Red Hand Letter (11/22/2014) on ustekinumab: occurrence of exfoliative dermatitis (erythroderma) and exfoliation of the skin* * Oral retinoids acitretin, alitretinoin, and isotretinoin should be used in women of childbearing age only with adherence to a pregnancy prevention program.
Supplements (dietary supplements; vital substances)
Suitable dietary supplements for natural defense should contain the following vital substances:
- Vitamins (A, C, E, D3, B1, B2 B3, B5, B6, B12, folic acid, biotin)
- Trace elements (chromium, iron, copper, manganese, molybdenum, selenium, zinc).
- Omega-3 fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)).
- Secondary plant compounds (eg beta-carotene, flavonoids, lycopene, polyphenols).
- Probiotics
Note: The listed vital substances are not a substitute for drug therapy. Food supplements are intended to supplement the general diet in the particular life situation.