A Comparison of Outcomes from Antibiotic Treatment with and without Probiotics in 897 Patients with Lower Urogenital Tract Infections, Including Cystitis, Urethritis, Prostatitis, and Vulvovaginitis.

BACKGROUND Urogenital bacterial infections have a high incidence in humans. The most frequent cause of infections of the urogenital tract is gram-negative bacteria. Antibiotics are very effective in curing infectious diseases but they are accompanied by health complications. Probiotics are live microorganisms that are believed to confer a beneficial effect on human health when consumed in adequate amounts. This study aimed to compare outcomes from antibiotic treatment with and without the use of probiotics in 897 patients with lower urogenital tract infections, including cystitis, urethritis, prostatitis, and vulvovaginitis. MATERIAL AND METHODS A total of 897 patients aged 18 to 55 years were included in this research. Patients were divided into an intervention group including 460 patients (254 women, 206 men) and a comparison group including 437 patients (240 women, 197 men). The probiotics received by patients were capsules of ProBalans®. The diagnosis of cystitis, urethritis, prostatitis, vulvovaginitis, and sexually transmitted infection was done using several tests, and antibiotics were used for treatment. Qualitative data were analyzed using the chi-square or Fisher exact test. RESULTS We found a significant difference regarding patients' impressions of improvement after therapy between patients in the intervention group and the comparison group. CONCLUSIONS Use of probiotics together with antibiotics in the treatment of urogenital tract infection can help to reduce the adverse effects of antibiotics, increase the efficiency of antibiotic therapy, and reduce bacterial resistance to antibiotics. However, further research is needed to confirm these potential health benefits.

Clinical Situation, Species Distribution, and Antibiotic Resistance of Pathogenic Bacteria and Fungi in 626 Cases of Vulvovaginitis in Hangzhou, China.

BACKGROUND: Female vulvovaginitis was one of the most common gynecological diseases. It had a great negative impact on their work and quality of life. This retrospective study evaluated the clinical and laboratory data of patients with vulvovaginitis in Hangzhou, China. To analyze the clinical situation, species distribution and antibiotic resistance of pathogenic fungi and bacteria in 626 cases of vulvovaginitis in Hangzhou. Microorganism culture, identification, and antibiotic susceptibility testing were conducted. The study aimed to provide a theoretical value for an effective treatment of vulvovaginitis. METHODS: In total, 626 outpatients and inpatients diagnosed with vulvovaginitis were selected from January 2018 to January 2023. Data of all the patients were collected from the hospital's electronic medical records. Vaginal secretion was collected for testing and SPSS 25.0 software was used to perform statistical analysis. RESULTS: A total of 626 strains of fungi, Gram-positive, and -negative bacteria were detected. Clinical situations of patients infected with the top five pathogenic fungi and bacteria were analyzed. Pathogenic fungi and bacteria were slightly different in each age group and in each onset time group. The results of antibiotic susceptibility testing showed that the resistance rates of itraconazole and fluconazole were high and Gram- negative and -positive bacteria were multidrug resistant. Gram-negative bacteria were more sensitive to carbenicillins and compound antibiotics, while Gram-positive bacteria were sensitive to rifampicin and daptomycin. MRSA and non vancomycin-resistant strains were detected. CONCLUSIONS: Fungi and bacteria were usually detected as pathogenes in patients with vulvovaginitis in Hangzhou. Some factors, such as age and onset time, often affected the incidence. Pathogenic fungi and bacteria were resistant to some common antibiotics, and clinical treatments should be carried out in a timely and reasonable manner according to the results of antibiotic susceptibility testing.

A Vulvovaginal Yeast Infection Caused by Cryptococcus victoriae in Vietnam: A Rare Case Report.

Cases of vulvovaginitis caused by Cryptococcus genus are exceedingly uncommon, with only a handful of instances having been described for this causative species. This report describes a rare case of vulvovaginitis suspected to be caused by Cryptococcus victoriae in a 58-year-old woman residing in an urban area of Hanoi city, Vietnam. The patient with a 10-year history of depression and type 2 diabetes mellitus was admitted to the hospital due to vulvar itching and vaginal discharge. Vaginal swabs confirmed the presence of a yeast infection by direct microscopic examination with 10% KOH and culture on CHROMagar Candida. The yeast was identified as C victoriae using genetic sequencing tools. The patient's treatment plan involved topical clotrimazole and a daily oral dose of 200 mg of itraconazole for 7 days. This comprehensive treatment approach resulted in the patient's full recovery. This is the first reported case of vulvovaginitis attributed to C victoriae in humans worldwide.

Efficacy and safety of vaginal formulations with tyndallized ferments in subjects with nonspecific vulvovaginitis: A randomized study in Italy.

AIM: In this study, we tested the efficacy, safety, and tolerability of vaginal ovules and a vaginal douche containing tyndallized ferments in women affected by nonspecific vulvovaginitis, with or without the human papillomavirus (HPV). METHODS: The study included 91 female patients and had a randomized, controlled sequential design, with parallel groups. Ovules and douche were tested and compared to a control group treated with sterile physiological solution. Total symptom score (TSS), individual signs and symptoms, therapeutic success were evaluated, as well as safety and tolerability. RESULTS: The tyndallized ferments formulations (ovules and douche) had a safe and tolerable profile, and resulted in a significant decrease in TSS in patients affected by nonspecific vulvovaginitis, both at 5 and 10 days of treatment, when compared to a control group. The treatment was more effective than the control in reducing symptoms such as vulvar erythema, vulvar edema, itching, and burning. Patients affected by vulvovaginitis and HPV-positive received a 30 days treatment either with ovules or ovules + douche, and we observed an improvement at Day 30 compared to Day 0, for both regimens. CONCLUSIONS: Our study suggests that topical treatment with tyndallized ferments is a safe and effective strategy to reduce symptoms of nonspecific vulvovaginitis.

Efficacy and safety of Lactobacillus plantarum P 17630 strain soft vaginal capsule in vaginal candidiasis: a randomized non-inferiority clinical trial.

OBJECTIVE: To investigate the non-inferiority of efficacy and tolerability of Lactobacillus plantarum P 17630 soft vaginal capsules compared to the antifungal therapy with miconazole nitrate 400 mg soft vaginal capsules in patients with symptomatic vulvovaginal infection due to Candida. PATIENTS AND METHODS: Adult women with vulvovaginal candidiasis were randomized to either L. plantarum P17630 100,000,000 CFU soft vaginal capsules by vaginal route each day for 3 or 6 consecutive days or miconazole nitrate 400 mg soft vaginal capsule. Visual Analog Scale (VAS) scores for vaginitis symptoms were used, and vaginal fluid interleukin 6 (IL6) was dosed. The study was registered in EudraCT database (code LPP17630-C-018; number: 2018-003095-12). RESULTS: 200 patients were included in the study. The mean VAS scores for vaginitis symptoms were progressively reduced in both treatment groups at each visit, without significant difference between groups (p>0.05 for each symptom, at each time point). The efficacy of L. plantarum and the reference medicinal product was maintained at follow-up (day 21). The mean concentration of IL-6 decreased from visit 1 to visit 3 in both groups without a significant difference (p>0.05). No adverse events were reported. CONCLUSIONS: L. plantarum P17630 100,000,000 CFU soft vaginal capsules are effective and safe for treating vaginal candidiasis without the concomitant use of an antifungal product, which rules out the risk of antimicrobic resistance. The long-term effect on vaginal microflora may add the possibility of reducing the risk of recurrences.

The epidemiology of mycotic vulvovaginitis and the use of antifungal agents in suspected mycotic vulvovaginitis and its implications for clinical practice / Epidemiología de la Vulvovaginitis Micótica y el uso de Agentes Antifungales Ante la Sospecha de Vulvovaginitis Micótica, y sus Implicaciones en la Práctica Clínica

Data in the Caribbean documenting the speciation of yeast associated with vulvovaginitis are lacking. The widespread use of antibiotics and increased availability of antimycotic agents, both prescribed and over-the-counter, predisposes both to a change in the epidemiologic patterns and the possible development of secondary resistance among previously susceptible yeast. This study was conducted to evaluate the aetiologic agents associated with mycotic vulvovaginitis and to review the appropriateness of prescribed antifungal therapy. Of 134 positive isolates, the most frequent yeast isolate was C. albicans accounting for 78%, C. tropicalis 10%, Prototheca wickerhamii (P. wickerhamii) 5%, C. glabrata 4%, Cryptococcus albidus (C. albidus) 2% and C. lusitaniae (1%) were also isolated. Of the positive cases, 75% were treated with antifungals, 17% with antibiotics and 8% were not treated. The azole group was the most frequently prescribed antifungal (71%). Of cases with negative yeast cultures, 83% were treated with antifungals. The presence of non-albicans Candida species and other opportunistic fungi is an important finding and combined with the pattern of therapy, represents a major challenge for future empirical therapeutic and prophylactic strategies in the treatment of mycotic vulvovaginitis

La región del Caribe carece de datos que documenten la especiación de la levadura asociada con la vulvovaginitis. El uso extendido de antibióticos y la mayor disponibilidad de agentes antimicóticos ­ tanto los adquiridos mediante prescripción facultativa como los que pueden comprarse sin receta médica ­ predisponen por un lado a un cambio en los patrones epidemiológicos, y por otro al posible desarrollo de resistencia secundaria en la levadura previamente susceptible. Este estudio se llevó a cabo con el fin de evaluar los agentes etiológicos asociados con la vulvovaginitis micótica y examinar cuán adecuada resulta la terapia antifúngica prescrita. De 134 aislados positivos, el aislado de levadura más frecuente fue el C albicans responsable del 78%. También fueron aislados C tropicalis 10%, Prototheca wickerhamii (P wickerhamii) 5%, C glabrata 4%, Cryptococcus albidus (C albidus) 2% y C lusitaniae (1%). El 75% de los casos positivos fueron tratados con antifúngicos, el 17% con antibióticos, en tanto que un 8% no recibió tratamiento alguno. Los medicamentos antifungosos de la familia azol (71%) fueron los más frecuentemente prescritos. El 83% de los casos con cultivos de levadura negativos, fue tratado con antifúngicos. La presencia de especies de Candida no albicans y otros hongos oportunistas, constituye un hallazgo importante, y en combinación con el modelo de terapia, representa un desafío de importancia considerable para las futuras estrategias empíricas ­ tanto terapéuticas como profilácticas ­ en el tratamiento de la vulvovaginitis micótica.

Vulvovaginitis bacteriana en la prepúber / Bacterial vulvovaginitis in prepubertal girl

Considerando la alta incidencia de vulvovaginitis en la consulta de ginecología pediátrica y de adolescentes, y los aspectos únicos de la microbiología y endocrinología de la paciente prepúber se presenta una revisión de la literatura con lo más relevante de los últimos 5 años, en lo que se refiere a epidemiología, etiología, diagnóstico y tratamiento de la vulvovaginitis bacteriana específica de la niña prepúber. No existe claridad acerca de la microflora vaginal normal, lo cual dificulta en gran medida la interpretación de muestras. De acuerdo con la evidencia actual podemos decir que ante la vulvovaginitis específica de la prepúber debemos tener en consideración como principales agentes causales: patógenos respiratorios, epidérmicos y entéricos; higiene defectuosa, cuerpos extraños, irritantes, enfermedades dermatológicas vulvares, defectos anatómicos y abuso sexual. Streptococcus hemolitico del grupo A y Haemophilus influenzae son patógenos prevalentes.

Corrimento Vaginal na Infância: Como abordá-lo / Management of vulvovaginitis during childhood

As vulvovaginites, mais especificamente o corrimento vaginal, e uma doença comum na infância e freqüente causa de procura de atençäo médica pediátrica. Essa alta freqüência, deve-se principalmente a higiene precária dos genitais externos, o que coloca as vulvovaginites inespecíficas como a causa mais freqüente de vulvovaginites na infância. É muito importante que na abordagem da criança com corrimento vaginal, seja determinado se o mesmo é fisiológico ou patológico, evitando-se tratamentos desnecessários. Sabe-se ainda, que a maioria dos corrimentos vaginais cessam com uma adequada higiene dos genitais. Nos casos em que o agente etiológico da vulvovaginite é considerado um agente de Doenças Sexualmente transmissíveis e deve ser feita uma investigaçäo para determinar se houve estupro. O sucesso do tratamento, depende além do correto diagnóstico etiológico da patologia, do minucioso esclarecimento à família da importância e conseqüência do mesmo. Fez-se uma abordagem prática de como manusear o corrimento vaginal na infância, apontando suas principais características, seu diagnóstico e o tratamento

Corrimento vaginal durante a gravidez / Vulvovaginal discharge in pregnancy

O corrimento Vaginal durante a gestaçäo podera sevir como um importante marcador das doenças de transmissao sexual que em última análise poderäo estar ligadas a resultados bastante desfavoráveis e comprometedores do bem-estar materno-fetal. Por outro lado, a presença do corrimento vaginal, achado muito freqüente nesta ocasiäo, näo obrigatoriamente terá que estar ligado a um processo infeccioso ou patológico. Cabe ao obstetra, a difícil responsabilidade de näo errar nem por excesso e nem por falta. Os autores fazem uma revisäo destes aspéctos, enfocando as mudanças fisiológicas próprias do período gestacional relacionando-as com os aspéctos clínicos relevantes. Pontos fundamentais da epidemiologia , diagnóstico clínico/laboratorial e tratamento das principais vulvovaginites/cervicites (Candidiases, Tricomoniases, vaginose s bacterianas, clamidiase, gonococcia) foram revisados, mostrando a importância do diagnóstico precoce. Säo apontados de forma compreensiva, os principais passos necessários para a abordagem do corrimento vaginal na grávida, estabelecendo-se prioridades de investigaçäo e dando um esquema prático de tratamento

Vulvovaginitis en pediatría: un problema frecuente / Vulvovaginitis in pediatrics: a frequent problem

La vulvovaginitis es un problema frecuente en las niñas. Por lo general, no constituye el motivo principal de consulta sino que es una patología por la que el pediatra debe preguntar. Es importante conocer las situaciones normales como la leucorrea fisiológica de la recién nacida y previo a la menarquia. La recomendación de medidas generales de higiene permiten prevenir la vulvovaginitis. Una vez diagnosticada la descripción de las características de la leucorrea así como el cultivo se podrá indicar el tratamiento específico

Avaliaçäo terapêutica do Malvatricin Ginecológico em processo inflamatório nas vulvites e vulvovaginites pré-puberal / Therapeutic evaluation of Malvatricin Ginecológico in infant patients with inflammatory disease in the genital tract

Dezessete pacientes com patologia inflamatória vulvovaginal foram acompanhados com Malvaticin Ginecológico em um estudo aberto, no sexo feminino, näo comparativo, no Estado do Rio de Janeiro, visando avaliar à eficácia e a telerância do fármaco, composto de Quinosol, Tirotricina, Ácido lático e Hidrolato de Malva. Demonstrou ser ificaz e com uma tolerância excelente em 100 por cento dos casos

Uretritis y vulvovaginitis en pacientes en control en policlínicos de control sanitario y ETS / Urethritis and vulvovaginitis in patients at sanitary control and sexual transmission diseases clinics

Se analizan retrospectivamente 466 casos de uretritis y vulvovaginitis en pacientes de policlínico de control sanitario y de enfermedades de transmisión sexual en Concepción, entre mayo y octubre de 1995. Los hallazgos diagnósticos y microbiológicos son discutidos con una referencia especial a gonorrea, tricomonas, cándida y gardnerella. Se enfatiza la necesidad de experiencia y entrenamiento en este campo clínico, junto con una conceptualización adecuada para efectuar una diferenciación entre organismos patógenos y otros organismos presentes. Clamidias y micoplasmas no fueron estudiados y ameritan una investigación de rutina

Avaliaçäo terapêutica do malvatricin ginecológico em processo inflamatório vulvovaginal / Therapeutic evaluation of malvatricin ginecológico in patients with inflammatory disease in the genital tract

Vinte e quatro pacientes com patologia inflamatória vulvovaginal foram tratados com Malvatricin ginecológico em um estudo aberto no sexo feminino, näo comparativo, nos estados de Säo Paulo e Rio de Janeiro, visando avaliar a eficácia e a tolerância do fármaco, composto de Quinosol, Tirotricina, ácido Lático

Vulvovaginite na criança e adolescente / Vulvovaginite in the child and adolescent

Os autores discorrem sobre os fatores predisponentes das vulvovaginites na infância e adolescência. Informam sobre a grande incidência dessa patologia nesta faixa etária. Relatam sobre a importância dos hábitos de higiene na gênese e no tratamento das infecçöes vaginais e vulvares. Discorrem sobre os meios diagnósticos dessa patologia e indicam os tratamentos mais eficazes.

Bencidamina tópica en el tratamiento de las vulvovaginitis / Benzamine for treatment of vulvovaginitis

A fin de evaluar la eficacia de la Bencidamina en forma de lavado vaginal, fue llevado a cabo un estudio doble ciego controlado contra placebo en 55 pacientes portadoras de vaginitis bacteriana y vulvovaginitis candidiásica. Al tratamiento específico se adicionó en forma randomizada lavado vaginal con Bencidamina (n=30) o Placebo (n=25) durante 10 días. Los resultados obtenidos mostraron una mejoría significativa del grupo Bencidamina con respecto al Placebo en la totalidad de los síntomas y signos evaluados (p < 0,05). En el análisis de evaluación global del tratamiento, en forma independiente del germen causal y la patología, se aprevió en el grupo tratado con Bencidamina un número significativamente mayor de pacientes curadas (p < 0,01) y de igual modo una incidencia menor de recidivas. En conclusión, consideramos a la aplicación de Bencidamina como lavado vaginal de utilidad en el tratamiento coadyuvante de este tipo de patología

Itraconazol: evaluación de su seguridad y eficacia en el tratamiento de vulvovaginitis por candida / Itraconazol: evaluation of it security and efficacy in the treatment of vulvovaginitis by candida

La vulvovaginitis constituye una patología muy frecuente en la mujer en edad fértil, siendo Candida spp uno de los principales agentes. Existen numerosos tratamientos tópicos y orales, señalándose las ventajas del tratamiento oral y siendo lo más utilizados los derivados azólicos. El objetivo de este trabajo es evaluar la eficacia y seguridad de itraconazol, una nueva droga triazólica en vulvovaginitis por Candida (VVC). Se estudiaron 111 pacientes con diagnóstico de vulvovaginitis. Se incorporaron al estudio 25 pacientes en las que se estableció el diagnóstico clínico y microbiológico de VVC. Se inició terapia con itraconazol (200 mg cada 12 h) por un día, realizándose control clínico y microbiológico a los 7 y 30 días. Un 60% (15/25) demostró mejoría clínica con erradicación microbiológica a los 7 días. Al resto de los pacientes (10) se les indicó un 2- esquema terapeútico con Itraconazol (200 mg diarios) por 3 días. Todas estas pacientes presentaron mejoría clínica a la 1ª semana postratamiento. Sin embargo, en sólo 5 de ellas se obtuvo la erradicación microbológica. Por lo tanto, 100% (25/25) de las pacientes presentaron curación clínica, en 80% (20/25) se logró erradicación microbiológica de Candida spp. Según estos resultados itraconazol demuestra eficacia y seguridad en el tratamiento de VVC. Se recomienda el primer esquema para las primoinfecciones y el 2- esquema a pacientes con VVC recurrente