3) Treatment options for genital infections not normally considered sexually transmitted

Warning

a. Vulvovaginal candidiasis

Young person 13 to 15 years old (inclusive)

Vaginal candidiasis is rare in girls before puberty, but can occur in adolescents. Candida vulvitis can be treated locally with cream (clotrimazole cream 1% topical application 2 to 3 times daily), but is almost invariably associated with vaginal infection, which should also be treated with antifungal pessaries or cream inserted high into the vagina (including during menstruation). However, these are not recommended for pre-pubertal girls and treatment with external cream alone may be more appropriate. Intravaginal preparations (particularly those that require the use of an applicator) should also be avoided in young women who have not been sexually active and have no experience of using tampons, unless there is no alternative. The safety and efficacy of oral triazoles (for example fluconazole) has not been established in girls under 16 years but, treatment with single dose oral fluconazole 150mg may be considered for girls post puberty1.

b. Bacterial vaginosis

Young person 13 to 15 years old (inclusive)

Preferred treatment

metronidazole 2g orally in a single dose 11

 

Alternative treatments

metronidazole 400 mg orally twice daily for 7 days1

 

Metronidazole gel 0.5% and clindamycin cream 2% are not licensed for use in children. In addition, intravaginal preparations (particularly those that require the use of an applicator) should be avoided in young girls who are not sexually active and have no experience of using tampons, unless there is no alternative.

Editorial Information

Last reviewed: 09/07/2024

Next review date: 16/09/2026

Author(s): West of Scotland Managed Clinical Network in Sexual Health Clinical Guidelines Group .

Version: 7.1

Approved By: West of Scotland Managed Clinical Network in Sexual Health