# Vaginitis (Non-specific / Atrophic) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Estriol — 0.5 mg — vaginal - Metronidazole — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Clindamycin — 100 mg — vaginal ## Complete treatment card ```text VAGINITIS (NON-SPECIFIC / ATROPHIC) 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://dailyme d.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 Review status: REVIEWED against 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/d ailymed/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) (2026-08) 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 Source StatPearls "Vaginitis" - disease-level clinical article Status traced to the source above Rx: Atrophic vaginitis | Bacterial vaginosis | Main treatment ATROPHIC VAGINITIS 1. ESTRIOL [1st line] Adult 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 Peds No clinical trials to support use in children. 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. Caution 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. Egypt OVESTIN 1 MG 20 TAB SEDICO > SCHE... 11.10 EGP (0.55/unit) -> ? strength differs, ? different route - not vaginal BACTERIAL VAGINOSIS 2. METRONIDAZOLE [1st line] Adult 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) Peds Paediatric dosing for bacterial vaginosis is not addressed in this BASHH adult guideline; specialist paediatric evaluation is required. 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. Caution 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. Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 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... 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 MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT - choose one 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution RED FLAG - Bacterial vaginosis and trichomoniasis in pregnancy carry risks of preterm labor, low birth weight, and chorioamnionitis. 4. CLINDAMYCIN [2nd line] Adult 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 Peds Safety and efficacy in paediatric patients have not been established. 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. Caution 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. Egypt CHENAROMITA 100MG 3 VAGINAL OVULES SEDICO > PEOPLE PHARMA 14.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)