infectious

Vaginitis (Non-specific / Atrophic)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources9 sources

BASHH National Guideline for the Management of Vulvovaginal Candidiasis & Vaginitis 2019 · BASHH UK National Guideline for the Management of Bacterial Vaginosis 2012 · Dalacin Cream 2% (clindamycin vaginal) SmPC sections 4.2 and 4.4 (eMC product 1080) · Estriol 1 mg/g cream SmPC sections 4.2 and 4.4 (eMC product 5384) · NAMS Position Statement: Management of genitourinary syndrome of menopause 2020 · NICE Guideline NG23: Menopause: diagnosis and management 2015 · Dalacin Cream 2% (clindamycin vaginal) SmPC sections 4.1 & 4.2, https://www.medicines.org.uk/emc/product/1080/smpc · DailyMed CLEOCIN (clindamycin phosphate) vaginal ovule label, SetID 3db26227-208d-4fdd-8426-1d9be5cda9b4, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3db26227-208d-4fdd-8426-1d9be5cda9b4 · SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/5384/smpc

Verified against5 documents

BASHH UK National Guideline for the Management of Bacterial Vaginosis 2012
Dalacin Cream 2% (clindamycin vaginal) SmPC sections 4.1 & 4.2, https://www.medicines.org.uk/emc/product/1080/smpc
DailyMed CLEOCIN (clindamycin phosphate) vaginal ovule label, SetID 3db26227-208d-4fdd-8426-1d9be5cda9b4, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3db26227-208d-4fdd-8426-1d9be5cda9b4
SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/5384/smpc
Vaginitis - disease-level clinical article (vaginitis-nonspecific-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

Abnormal discharge, itching, irritation, odor, dysuria, and painful intercourse are what bring patients in for evaluation [burning on passing urine · itching · painful intercourse]
Discharge that turns abundant, clear, and stretchy around ovulation is a normal cyclical pattern, not vaginitis
Itching or burning is never normal for vaginal discharge; a marked shift in color, texture, or smell suggests infection [itching]
Mixed vaginitis produces a variable picture - a change in discharge plus genital itching and burning [genital itching]

Signs — what you find (3)

Yellow-green, frothy discharge above pH 4.5 with a strawberry-looking cervix points to trichomoniasis
Vulvar redness, fissures, ulcers, or swelling on inspection suggest a specific infectious or dermatologic cause [redness]
Atrophic vaginitis shows a pale, thin vaginal lining with loss of the normal rugal folds, occasional petechiae, and sometimes purulent discharge [atrophy · pallor · petechiae · pus]

Tests (6)

Normal vaginal pH sits between 3.8 and 4.5; a rise above that points toward infection or inflammation
Clue cells covering more than a fifth of the squamous cells signal bacterial vaginosis
White cells outnumbering epithelial cells by more than 3-to-1 point to candidiasis, atrophic vaginitis, or an STI
A fishy odor released when KOH is added to the slide is a positive whiff test
Desquamative inflammatory vaginitis shows parabasal cells with heavy white cells, few lactobacilli, high pH, and a negative amine test
Nucleic acid amplification is the gold-standard test for Trichomonas vaginalis

If not this — what else fits (5)

Chlamydia and gonorrhea can produce discharge and irritation that resemble vaginitis
Genital herpes can cause pain, itching, and blisters mistaken for vaginitis
A urinary tract infection can cause burning and urgency that overlap with vaginitis symptoms
Pelvic inflammatory disease adds lower abdominal pain and fever on top of the abnormal discharge, setting it apart from plain vaginitis
A retained tampon or other foreign object can cause discharge, odor, and irritation that mimics vaginitis

SourceStatPearls "Vaginitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Atrophic vaginitis | Bacterial vaginosis | Main treatment

ATROPHIC VAGINITIS

ESTRIOL

Atrophic vaginitis

1st line

Strength0.5 mg

Formvaginal

Adult dose and duration

1 applicator-dose (0.5 g cream = 0.5 mg estriol) intravaginally daily for first 4 weeks, then taper to maintenance 1 applicator-dose twice weekly. - Initial 2-3 weeks daily, then ongoing twice weekly maintenance

Paediatric dose

No clinical trials to support use in children.

Dose source

SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/5384/smpc

Why

Topical vaginal estriol cream/pessaries are not registered in Egypt; oral estriol tablets (Ovestin 1 mg) exist but differ in systemic absorption and route.

Cautions

First-line low-dose topical estrogen for atrophic vaginitis and genitourinary syndrome of menopause (GSM).
Minimal systemic absorption; endometrial protection with progestogen is NOT required for local low-dose intravaginal estriol.
Exclude endometrial hyperplasia, unexplained vaginal bleeding, and active hormone-dependent malignancies before starting treatment.
Two different products and two different strengths: the cream is 1 mg/g and one applicatorful delivers 0.5 mg, the pessary is 0.03 mg. 0.05 mg is neither of them.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
OVESTIN 1 MG 20 TAB? strength differs? different route - not vaginal	SEDICO > SCHERING PLOUGH	11.10 EGP (0.55/unit)

BACTERIAL VAGINOSIS

METRONIDAZOLE

Bacterial vaginosis

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

400 mg orally twice daily for 7 days (or 0.75% vaginal gel once daily at bedtime for 5 days) for non-specific bacterial vaginitis / bacterial vaginosis x 7 days oral (or 5 days vaginal)

Paediatric dose

Paediatric dosing for bacterial vaginosis is not addressed in this BASHH adult guideline; specialist paediatric evaluation is required.

Dose source

BASHH UK National Guideline for the Management of Bacterial Vaginosis 2012

Why

Nitroimidazole antibiotic active against the anaerobic bacteria, including Gardnerella vaginalis, responsible for bacterial vaginosis, the most common cause of non-specific vaginal discharge; a first-line oral or topical treatment.

Cautions

400 mg twice daily is the BASHH figure for bacterial vaginosis. 500 mg twice daily is the CDC one; both are in use, and the dose given here follows BASHH.
Indicated when non-specific vaginitis presents with foul malodorous discharge, clue cells, or elevated pH (> 4.5) indicative of bacterial vaginosis.
May cause metallic taste, nausea, and gastrointestinal discomfort.
Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DUMOZOL 500MG 20 F.C. TABS.	MINA PHARM > ALPHARMA-DENMARK	7.00 EGP (0.35/unit)
ZOLGUARD 500MG 20 TAB.	UNIPHARMA CO. > UNIPHARMA	9.00 EGP (0.45/unit)
NITROFECTAZOLE 500 MG 20 F.C. TABS.	GYPTO PHARMA	10.50 EGP (0.53/unit)
FLAGICURE FORTE 500 MG 20 F.C. TAB	KAHIRA	23.00 EGP (1.15/unit)
TRICHOGYL 500MG 12 F.C.TAB.	EL NASR	15.00 EGP (1.25/unit)
FLAGELLAT FORTE 500MG 20 F.C.TABS.	MUP	30.00 EGP (1.50/unit)
GEDAZOLE 500MG 20 TAB.	JEDCO INT. CO. FOR PHARMACEUTICALS	34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.	GYPTO PHARMA	34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solid	MINA PHARM > ALPHARMA-DENMARK	5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solid	MEMPHIS	19.50 EGP

MAIN TREATMENT - choose one

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Vaginitis - disease-level clinical article (vaginitis-nonspecific-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Bacterial vaginosis and trichomoniasis in pregnancy carry risks of preterm labor, low birth weight, and chorioamnionitis.

CLINDAMYCIN

2nd line

Strength100 mg

Formvaginal

Adult dose and duration

Cream 2%: 1 applicatorful (5 g = 100 mg clindamycin) intravaginally at bedtime for 7 days (or 3 days). Ovules: 1 ovule (100 mg) intravaginally at bedtime for 3 days. x 3-7 days

Paediatric dose

Safety and efficacy in paediatric patients have not been established.

Dose source

Dalacin Cream 2% SmPC sections 4.1 & 4.2 (eMC product 1080, cream regimen) and DailyMed CLEOCIN clindamycin phosphate vaginal ovule label (ovule regimen), SetID 3db26227-208d-4fdd-8426-1d9be5cda9b4

Why

Lincosamide antibiotic with anaerobic activity, used as a topical alternative to metronidazole for bacterial vaginosis in patients who are allergic to or fail metronidazole therapy.

Cautions

Alternative treatment for non-specific bacterial vaginitis in patients allergic to metronidazole or failing metronidazole.
Clindamycin vaginal cream weakens latex condoms and diaphragms for up to 72 hours after application.
Not in the first trimester - there are no adequate studies. Second and third only where it is clearly needed.
Expect thrush afterwards in a fair number of women: clearing the bacteria lets yeast take the space.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CHENAROMITA 100MG 3 VAGINAL OVULES	SEDICO > PEOPLE PHARMA	14.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.