Oral or vaginal metronidazole (Flagyl) and vaginal clindamycin (Cleocin) are the recommended regimens for creating bacterial vaginosis. Single-dose metronidazole ard clindamycin are less effective but can be used if compliance is a problem.
Many topical and systemic therapies are now available for yeast infections. The efficacy of oral and topical therapies is equivalent, although side effects are more common with systemic therapy. Treatment with topical azoles results in cure in 80% to 90% of patients. The efficiency of oral regimens, especially single-dose fluconazole, has made them very popular among patients. Unless an infection is complicated, it is reasonable to treat according to patient preference.
In complicated cases (e.g., recurrence, diabetes), treatment should be with a topical agent for 14 days. In most cases, sexual partners need not be treated. However, Candida can be transmitted sexually, and partner treatment should be considered in recurrent or resistant cases.
Systemic therapy with metronidazole (Flagyl) is the treatment of choice in cases of trichomoniasis, and the 2 g single-dose oral regimen is very effective. An alternative is 500 mg orally twice daily for 7 days. Topical preparations of metronidazole do not penetrate the urethra or periurethral glands, which can serve as reservoirs for infection and relapse. Sexual partners should be treated simultaneously. Male partners of women with trichomoniasis have detectable infection about one third of the time.