The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of the "Major Recommendations" field
The following recommendations are based on good and consistent scientific evidence (Level A):
- Women with complicated vulvovaginal candidiasis should receive more aggressive treatment than women with an uncomplicated episode.
- To prevent reinfection, women with trichomoniasis should avoid intercourse until they and their partner have received treatment.
The following recommendations and conclusions are based on limited or inconsistent scientific evidence (Level B):
- Microscopy is the first line for diagnosing vulvovaginal candidiasis and trichomoniasis. In selected patients, culture for yeast and T vaginalis should be obtained in addition to standard office-based testing.
- Douching is not recommended for the prevention or treatment of vaginitis.
- Self-diagnosis of vaginitis is unreliable.
The following recommendation is based primarily on consensus and expert opinion (Level C):
- Clinical evaluation of women with vaginal symptoms should be encouraged, particularly for women who fail to respond to self-treatment with a nonprescription antifungal.
Definitions:
Grade of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.
