[TWO CASES OF ALLERGIC VULVOVAGINITIS DIAGNOSED BY DIRECT MICROSCOPIC URINE SEDIMENT EXAMINATION].

Cedar pollen is known as a typical allergen that causes various allergic symptoms in the nasal mucosa, conjunctiva, and skin. However, inflammation of the vulvar mucosa due to sensitization to cedar pollen is not well-known. We experienced two cases in which the detection of cedar pollen during microscopic urine sediment examination led to the diagnosis of allergic vulvovaginitis caused by cedar pollen. The cases involved a 4-year-old girl and a 10-year-old girl. In both cases, the patients presented with chief complaints of pruritis in the vulva and insomnia due to frequent urination during the season of cedar pollen dissemination. Both patients were afebrile. No inflammatory skin changes such as erythema, swelling, or non-purulent discharge from mucous membranes of the vulva were observed. Microscopic urine sediment examination revealed large amounts of shed cedar pollen. The patients' conditions improved after treatment with oral antihistamines and instruction to dry their underwear indoors. Follow-up blood tests revealed high levels of specific anti-IgE antibodies to cedar pollen, thus confirming a diagnosis of allergic vulvovaginitis due to cedar pollen. Cedar pollen can cause allergic vulvovaginitis. Microscopic urine sediment examination is useful, and when combined with specific IgE antibody testing, leads to an appropriate diagnosis. This disease should also be considered in patients with complaints of vulvar discomfort during the season of cedar pollen dissemination.

Vaginal colonization of women after oral administration of Lactobacillus crispatus strain NTCVAG04 from the human microbiota.

BACKGROUND: The genomic approach has deeply changed the microbiology perspective, mainly concerning the microbioma identification. In this regard, some microbes colonize the healthy vagina. Vaginitis is a common gynecological ailment and includes bacterial vaginosis (BV), usually caused by local dysbiosis, such as a microbiota imbalance. Lactobacilli are the most prevalent bacteria colonizing the healthy vagina, so guaranteeing local eubiosis. In particular, vaginal colonization by L. crispatus is associated with low susceptibility to BV. Therefore, probiotics, such as life bacteria providing health advantages, are a current strategy in the prevention or treatment of vaginitis, including BV. However, there is a low level of evidence that probiotics after ingestion could really colonize the vagina. In particular, no study evidenced that L. crispatus after ingestion can colonize vagina. Therefore, the current study explored the capacity of Biovaginil® (NTC, Milan, Italy) dietary supplement containing Lactobacillus crispatus NTCVAG04 and vitamin A to colonize the gut and vagina in women with a history of vaginitis/vaginosis. METHODS: Twenty fertile females (mean age 34.0 years) were enrolled in the study. Rectal and vaginal swabs were collected at baseline and after the first and second cycle of Biovaginil®. Each cycle lasted 14 days within two consecutive menstrual periods. RESULTS: Seven women were excluded from the analysis because the samples were technically not evaluable. One woman dropped out because of mild adverse event. At the end of the study, nine women (75%) had positive rectal swab for L. crispatus NTCVAG04, and 8 of them also had positive vaginal swab. CONCLUSIONS: The current study provided the first evidence that L. crispatus NTCVAG04, administered by two Biovaginil® courses, colonized both the gut and vagina. Moreover, the L. crispatus NTCVAG04 strain could be considered the archetype of a new class of oral probiotics that actively colonize the vagina, and that could be called "colpobiotics."

Blue Light-Emitting Diode Therapy for Chronic Vulvovaginitis Symptoms: A Series of Cases.

Objective: This pilot study aimed to evaluate the characteristic signs and symptoms of chronic vulvovaginitis after blue light-emitting diode (LED) treatment. Methods: Women with characteristic signs and symptoms of vulvovaginitis were interviewed to obtain clinical and sociodemographic data. They answered the Female Sexual Function Index (FSFI) and the World Health Organization Quality of Life (WHOQOL)-bref questionnaires. Women with a suspected diagnosis of vulvovaginitis underwent clinical examination by a gynecologist, followed by microbiological evaluation, potassium hydroxide testing, vaginal pH assessment, and collection of vaginal fluid for oncotic cytology and fungal culture. The study participants were instructed to return after 15 days to undergo the 405 nm blue LED treatment, which consisted of three biweekly sessions. After 28 days of treatment completion, the patients returned for clinical re-evaluation and reassessment of the FSFI and WHOQOL-bref scores. Results: All eight women reported improvement or cure of at least one characteristic sign or symptom of vulvovaginitis, and five showed improvement in total FSFI and WHOQOL-bref scores. Conclusions: Treatment with blue LED may improve or cure symptoms associated with vulvovaginitis, sexual function, and the global quality of life score. Clinical Trial registration: NCT03075046 dated March 9, 2017.

Accurate 16S Absolute Quantification Sequencing Revealed Vaginal Microecological Composition and Dynamics During Mixed Vaginitis Treatment With Fufang FuRong Effervescent Suppository.

Background: The diagnosis and treatment of mixed vaginitis are more complicated than single pathogenic infections, and there may be adverse reactions and several contraindications to conventional antibiotic therapy. Therefore, this study aimed to evaluate the preliminary effects of Fufang Furong Effervescent Suppository for the management of aerobic vaginitis (AV) mixed with bacterial vaginosis (BV) using Accurate 16S absolute quantification sequencing (Accu16S). Methods: In the present randomized, blind, multi-center clinical trial, women (20 to 55 years) who had received a diagnosis of AV+BV were randomly assigned into clindamycin positive control (n = 41) and Fufang Furong Effervescent Suppository (n = 39) groups. The follow-up occurred in three time periods (V1: -2~0 days; V2: 15-17 days; V3: 40 ± 3 days). At each visit, two vaginal swabs, one for clinical evaluation and one for laboratory examination, were taken from each patient. The Nugent score, Donders' score, drug-related complications, recurrence rates, and microecological changes of vaginal swabs were assessed in the time three periods. Results: At baseline, the two groups were similar in frequency of presentation with vaginal burning, odor, abnormal discharge, and itching. No meaningful differences in Nugent and Donders' scores were detected between the two groups at stage V2 (Nugent: p = 0.67; Donders': p = 0.85) and V3 (Nugent: p = 0.97; Donders: p = 0.55). The Furong group presented fewer complications compared to the Clindamycin group. However, this difference was not statistically significant (p = 0.15). Additionally, Accu16S indicated that the total abundance of bacteria in both groups sharply decreased in stage V2, but slightly increased in V3. In stage V3, the absolute abundance of Lactobacillus in the Furong group was considerably higher compared to untreated samples (p < 0.05). On the other hand, no momentous increase was detected in the Clindamycin group (p > 0.05). Conclusion: Fufang Furong Effervescent Suppository can be as effective as clindamycin cream in the management of AV+BV while may restore the vagina microecosystem better.

Chlorhexidine, clotrimazole, metronidazole and combination therapy in the treatment of vaginal infections.

This was a clinical trial study that aimed to investigate the efficacy of vaginal chlorhexidine gel in the treatment of vulvovaginal candidiasis, bacterial vaginosis, and nonspecific vaginitis. The study population included patients who complained of vaginal discharge and presented to our University Gynecology Clinic. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software. The student t-test and Mann-Whitney U test were used to analyze the quantitative and ordinal data, respectively. In order to analyze the qualitative data, the Chi-square or Fischer's exact tests were used. The mean satisfaction score in the vulvovaginal candidiasis patients who received chlorhexiine vaginal gel was 9.06 and 8.29 in the patients who received clotrimazole vaginal cream. The Mann-Whitney test did not show a statistically significant difference between mean scores of VAS in these two groups with vulvovaginal candidiasis (P=0.027). Among the patients with bacterial vaginosis, the mean satisfaction score was 8.91 in the chlorhexidine vaginal gel group and 8.72 in the metronidazole tablet group (P=0.607). In the nonspecific vaginitis group, the mean satisfaction score was 8.83 in the chlorhexidine vaginal gel group and 9.17 in the combination group (metronidazole + clotrimazole vaginal cream)(P=0.401). The highest mean visual analog scale score (VAS) score was documented in the combination therapy group. We found that chlorhexidine vaginal gel is a more effective method for the treatment and improvement of vaginal infections. The benefits of chlorhexidine gel have a positive therapeutic effect as a single drug in nonspecific vaginitis, rather than simultaneous administration of two agents.

Real-world effectiveness and tolerability of Zelesse cream® for treating vulvovaginitis in adult women: an observational, prospective study.

OBJECTIVE: To assess the efficacy, acceptability, and tolerability of a vaginal cream based on plant extracts for treating signs and symptoms of vulvovaginitis (VV) (Zelesse cream®), either as monotherapy (non-infectious VV) or adjuvant to antimicrobial therapy (infectious VV). METHODS: This prospective, observational, multicenter study included women who attended outpatient offices for VV. The severity of signs (vaginal discharge, erythema, and edema) and symptoms (pruritus, burning, and dysuria) was assessed before and after 15±5 days of daily treatment with Zelesse cream on a 4-point scale (18-point global score). RESULTS: The study included 58 women aged 43.0±13.2 years, including 42 who were treated with Zelesse cream only and 16 who used Zelesse cream as adjuvant to antimicrobial therapy. All participants showed significantly reduced scores and absolute prevalence of individual signs and symptoms in both groups. Similarly, the median signs/symptoms decreased by 4.0 and 8.0 points in women using Zelesse only and those using Zelesse plus antimicrobial therapy, respectively. This product was well tolerated and had high acceptability. CONCLUSIONS: Zelesse cream relieves signs and symptoms of VV, either as monotherapy in non-infectious VV or as adjuvant to antimicrobial therapy in infectious VV. Future randomized, placebo-controlled trials with larger sample sizes are warranted.

Investigating natural antibiofilm components: a new therapeutic perspective against candidal vulvovaginitis.

The rampant emergence of Candida albicans in the vagina and its ability to thrive as a biofilm has outstood the prevalence of candidal vulvovaginitis (CVV), a gender-based fungal infection approximately affecting 75% of the global female population. The biofilm represents a multidimensional microbial population, which often dictates prominent caveats of CVV such as increased fungal virulence, drug resistance and infection relapse/recurrence. Additionally, the conjugated issues of the ineffectiveness of conventional antifungals (azoles), prolonged treatment durations, compromised patient compliance, economic and social burden, exacerbates CVV complications as well. Henceforth, the current hypothesis narrates an investigational proposal for exploration and combination of naturally derived antibiofilm components with luliconazole (imidazole antifungal agent) as a new therapeutic paradigm against CVV. The purported hypothesis unravels a synergistic approach for fabricating Nanostructured Lipid Carriers, NLCs loaded transvaginal gel with dual APIs of natural (antibiofilm) as well as the synthetic (antifungal) origin to target high therapeutic efficacy, delivery, retention, controlled release and bioadhesion in a vaginal milieu. The multipronged effect of antibiofilm and antifungal agents will expectably enhance drug susceptibility thus, maintaining Minimum Inhibitory Concentration (MIC) against cells of C. albicans and targeting its biofilm in planktonic, adherent, and sessile phases. The effective disruption of a biofilm could further lower infection resistance and recurrence as well. In conclusion, the purported hypothesis could speed up the emergence of novel drug combinations and accelerates new product development with solid, synergistic, and complementary activities against C. albicans and its biofilm, making it amenable for generating pre-clinical and clinical results therebycreating a suitableroadmap for commercialization.

Myofascial Release for Vulvar Pain and Pubic Shear After a Straddle Injury in a 3-Year-Old Girl.

Pelvic malalignment is a somatic dysfunction that can lead to pelvic discomfort, despite normal genital examination findings. A 3-year-old girl presented with vulvar discomfort after a straddle injury sustained while riding a tricycle. The symptoms persisted despite standard medical treatment for vulvovaginitis and chronic vulvar irritation. An osteopathic structural examination revealed distortions of the bony pelvis, often associated with genitourinary complaints. After 5 osteopathic manipulative treatment sessions, the patient experienced significant relief. With persistent vulvar pain, somatic dysfunction should be considered in the differential diagnosis. A brief musculoskeletal examination of the pubic tubercles, iliac crest, and iliac spines can help to identify somatic dysfunction in a gynecologic patient with symptoms that are unresponsive to standard treatments.

Acceptability, tolerability, and effects on symptoms and signs of vulvovaginitis of a non-soap, herbal-based intimate hygiene solution (Zelesse®).

OBJECTIVE: To evaluate the acceptability, tolerability, and effects on vulvovaginitis symptoms and signs of a non-soap, herbal-based intimate solution (Zelesse®). METHODS: We conducted a prospective, observational, multicenter study including adult women with symptoms and signs of vulvovaginitis with various etiologies, including candidiasis, trichomoniasis, bacterial vaginosis, and atrophic and irritative vaginitis. The presence and intensity of signs (edema, erythema, vaginal discharge) and symptoms (pruritus) of vulvovaginitis were evaluated before and after 5-15 days of daily use of Zelesse® alone or as a coadjuvant in antimicrobial therapy. Variables following a normal distribution and categorical variables were analyzed using the Student t-test and chi-square or Fisher's exact test, respectively. RESULTS: A total 137 women were enrolled in the study; 87 (63.5%) women received concomitant antimicrobials and 50 (36.5%) used Zelesse® only. Global symptom scores and frequency of patients with vulvovaginitis signs and symptoms, and their mean intensity, decreased after treatment in both patient groups. Vaginal pH and (in the Zelesse®-only group) vaginal flora remained unaltered. The product was safe, well tolerated, and highly accepted by patients. CONCLUSIONS: Zelesse®, the non-soap herbal-based solution in this study, may represent a safe and effective option for symptomatic relief of vulvovaginitis.

Efeito da suplementação de lactobacillus spp. no tratamento e prevenção de candidíase vulvovaginal e vaginose bacteriana / Effect of supplementation of lactobacillus spp. in the treatment and prevention of vulovo-vagandal candidiasis and bacterial vaginosis

Este artigo de revisão avaliou os benefícios do uso dos Lactobacillus spp. no tratamento das vulvovaginites, utilizando artigos experimentais com humanos entre 2005 e 2015, através da suplementação de Lactobacillus spp. via oral e intravaginal. Verificou-se que os Lactobacillus spp. têm a capacidade de restaurar a microbiota vaginal e, quando combinados com o tratamento convencional das vulvovaginites, apresentam melhores resultados na redução de recorrências das infecções e dos sintomas, aumentando a competência imunológica do hospedeiro. Além disso, podem ser utilizados por um longo período sem efeitos secundários prejudiciais, diferentemente da terapia padrão, representando uma opção otimista de tratamento alternativo.

This review article evaluated the benefits of the use of Lactobacillus spp. in vulvovaginitis treatment, using experimental articles with humans between 2005 and 2015, through the Lactobacillus spp. Supplementation oral and intravaginal. It was found that Lactobacillus spp. have the ability to restore the vaginal microbiota and, when combined with vulvovaginitis conventional treatment, show better results in the reduction of recurrence of infection and symptoms, increasing the immunocompetence of the host. Futhermore, Lactobacillus spp. can be used for a long period without harmful side effects, unlike the standard therapy, representing an option optimistic alternative treatment.

Epidemiological Features and Antibiotic Resistance Patterns of Haemophilus influenzae Originating from Respiratory Tract and Vaginal Specimens in Pediatric Patients.

STUDY OBJECTIVE: Haemophilus influenzae (H. influenzae) is a common pathogen of respiratory tract infections in children, however, as a possible cause of vulvovaginitis in prepubertal girls, its epidemiological features, antibiotic-resistance patterns, and treatment are seldom noted. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Specimens obtained from patients were inoculated on Haemophilus selective medium; and drug-sensitivities tests were determined using the disk diffusion method. A cefinase disk was used to detect ß-lactamase. RESULTS: A total of 610 H. influenzae strains, 81.6% (498/610) from the respiratory tract and 18.0% (110/610) from the vagina, were identified in the Children's Hospital in 2015. The age of the children with respiratory tract strains were significantly younger than those with vaginal strains (P < .001). The H. influenzae isolation rate in May was the highest. The ß-lactamase positive rate was 51.5% (314/610), and 52.5% (320/610) were resistant to ampicillin. The susceptibilities rates to cefuroxime, ampicillin/sulbactam, cefotaxime, clarithromycin, and sulfamethoxazole-trimethoprim were 72.1% (440/610), 95.9%, 96.4% (588/610), 81.8% (499/610), and 36.4% (222/610), respectively. Higher resistance to ampicillin, cefuroxime, clarithromycin, and sulfamethoxazole-trimethoprim were found in respiratory tract strains, compared with vaginal strains (P < .05). All of the patients with H. influenzae in the respiratory tract were cured with oral or intravenous ß-lactam antibiotics. Of all patients with vaginal strains, 50% (55/110) were cured with topical ofloxacin gel, and 44.5% (49/110) were cured with oral ß-lactam antibiotics. CONCLUSION: The drug-resistance rates of H. influenzae isolated from vagina were lower than those from the respiratory tract. Topical ofloxacin gel or oral ß-lactam antibiotics are effective treatments to eliminate the H. influenza causing infection in the vagina.

The in vitro and in vivo efficacy of fluconazole in combination with farnesol against Candida albicans isolates using a murine vulvovaginitis model.

Farnesol is a quorum-sensing molecule that inhibits biofilm formation in Candida albicans. Previous in vitro data suggest that, in combination with certain antifungals, farnesol may have an adjuvant anti-biofilm agent. However, the in vivo efficacy of farnesol is very questionable. Therefore, the in vitro and in vivo activity of fluconazole combined with farnesol was evaluated against C. albicans biofilms using fractional inhibitory concentration index (FICI) determination, time-kill experiments and a murine vulvovaginitis model. The median biofilm MICs of fluconazole-sensitive C. albicans isolates ranged between 4 -> 512 mg/L and 150-300 µM for fluconazole and farnesol, respectively. These values were 512 -> 512 mg/L and > 300 µM for fluconazole-resistant clinical isolates. Farnesol decreased the median MICs of fluconazole by 2-64-fold for biofilms. Based on FICI, synergistic interaction was observed only in the case of the sessile SC5314 reference strain (FICIs: 0.16-0.27). In time-kill studies, only the 512 mg/L fluconazole and 512 mg/L fluconazole + 75 µM farnesol reduced biofilm mass significantly at each time point in the case of all isolates. The combination reduced the metabolic activity of biofilms for all isolates in a concentration- and time-dependent manner. Our findings revealed that farnesol alone was not protective in a murine vulvovaginitis model. Farnesol was not beneficial in combination with fluconazole for fluconazole-susceptible isolates, but partially increased fluconazole activity against one fluconazole-resistant isolate, but not the other one.

Características clínicas, prevalência e diagnóstico de vulvovaginites em ambulatório do interior do Rio Grande do Sul / Clinical characteristics and prevalence of vulvovaginitis in a clinic in the interior of the Rio Grande do Sul

Introdução: As vulvovaginites são uma das principais queixas no atendimento rotineiro de ginecologia. O diagnóstico correto e o tratamento precoce dessas afecções são importantes além de prevenir possíveis repercussões no trato genital superior. Objetivo: Conhecer as características clínicas e a prevalência das vulvovaginites. Metodologia: Estudo transversal de natureza exploratória e descritiva, de abordagem quantitativa sobre mulheres que foram atendidas na Unidade de Atendimento de um Ambulatório de Ginecologia do Sistema Integrado de Saúde (SIS) na Universidade de Santa Cruz do Sul, no período de setembro de 2014 a maio de 2015. As variáveis analisadas foram: idade, queixas clínicas, exame ginecológico e achados no exame a fresco. Os dados foram analisados no SPSS 22.0. Resultados: Do total de 200 pacientes atendidas no ambulatório, 66 (33%) foram selecionadas para realização do exame a fresco. A leucorreia fisiológica foi diagnosticada em 35 pacientes (53,0%), a vaginose bacteriana em 24 (36,5%), a candidíase em 6 (9,0%) e a tricomoníase em 1 (1,5%). Na vaginose bacteriana leucorreia com odor fétido, na candidíase leucoréia grumosa branca, prurido, ardência, vulva eritematosa e dispaurenia foram significativos para o diagnóstico (p < 0,05). Conclusões: Observou-se que a faixa etária das mulheres acometidas por vulvovaginites foi compatível com a literatura, predominando em idade reprodutiva. Constatou-se que a vaginose bacteriana foi a mais diagnosticada e que a leucorreia com odor fétido foi o sintoma estatisticamente significativo para o diagnóstico. Da mesma forma, a candidíase, com leucorreia grumosa branca, prurido, ardência, vulva eritematosa e dispareunia. (AU)

Introduction: vulvovaginitis are one of the main complaints in the routine care of gynecology. The proper diagnosis and early treatment are important to the patient and prevent possible repercussions in the upper genital tract. Objective: To analyze the clinical characteristics and the prevalence of vulvovaginitis. Methods: Cross-sectional study of exploratory and descriptive, quantitative approach, by applying a structured questionnaire and conducting fresh examination in women who were treated at the Unit Clinical Care of Gynecology of the Integrated Health System (IHS) at the University of Santa Cruz do Sul, from September 2014 to May 2015. The variables analyzed were: age, symptoms, gynecological examination and findings in fresh examination. Data were analyzed by using SPSS 22.0. Results: From a total of 200 patients seen at the clinic, 66 (3.3%) were selected for the performance of the fresh examination. The most common query reason was the collection of cytological (56.0%). Physiological leukorrhea was diagnosed in 35 patients (53.0%), bacterial vaginosis in 24 (36.5%), candidiasis 6 (9.0%) and trichomoniasis in 1 (1.5%). In bacterial vaginosis, a vaginal discharge with foul odor was a significant symptom for diagnosis, in candidiasis, white crumbly leukorrhea, pruritus, burning sensation, dyspareunia, vulvar erythema were also significant for diagnosis (p <0.05). Conclusions: It was observed that the age of women affected by vulvovaginites was consistent with the literature, predominantly at reproductive age. It was found that bacterial vaginosis was the most diagnosed and that foul-smelling vaginal discharge was a statistically significant (p<0.05) symptom for diagnosis. Likewise, in the case of candidiasis, crumbly white leukorrhea, pruritus, burning, vulvar erythema and dyspareunia were statistically significant for diagnosis and considered the cardinal symptoms of vulvovaginites. (AU)

Vulvovaginitis por Shigella sonnei / Shigella sonnei vulvovaginitis

Los microorganismos del género Shigella causan habitualmente infecciones en el tracto gastrointestinal y solo en muy raras ocasiones pueden ser responsables de infecciones extraintestinales, como la vulvovaginitis. En la infancia, la vulvovaginitis por Shigella es muy inusual, aunque debe ser tenida en cuenta ya que puede ser responsable de hasta un 2-4% de los casos pediátricos. Se presenta el caso de una niña de ocho años, de origen boliviano, que acude a nuestra consulta por presentar desde hace dos meses un sangrado vaginal intermitente junto a flujo vaginal mucopurulento y maloliente. Ante la cronicidad y características del cuadro clínico, se derivó al hospital para descartar cuerpo extraño vaginal o indicios de abuso sexual y se recogió un cultivo del exudado vaginal que resultó positivo a Shigella sonnei; se realizaron también coprocultivo, cultivo de exudado perianal y urocultivo, que resultaron negativos. Se estableció tratamiento antibiótico dirigido según antibiograma, consiguiendo la resolución completa del cuadro tras dos tandas del mismo. La mayoría de las vulvovaginitis en niñas en edad prepuberal son inespecíficas y secundarias a malos hábitos higiénicos o irritantes locales y el resultado del cultivo del exudado muestra las más de las veces flora mixta bacteriana, pero en casos de vulvovaginitis crónica de evolución tórpida debemos recordar estudiar otras causas específicas, como cuerpo extraño vaginal, abuso sexual si existen indicios o buscar bacterias patógenas específicas que precisen tratamiento (AU)

Shigella´s group of microorganisms are pathogens that usually cause infections in the gastrointestinal tract and only in rare occasions may be responsible for extraintestinal infections such as vulvovaginitis. In childhood, vulvovaginitis caused by Shigella is very inusual, although it must be taken into account as it can be responsible for up to 2-4% of the pediatric cases. In a particular case an eight-year-old Bolivian girl came to our center as she showed intermittent vaginal bleeding as well as mucopurulent and fetid vaginal discharge. Given the chronicity and the characteristics of the clinical profile, the girl was transferred to the hospital in order to rule out a possible intravaginal foreign body or signs of sexual abuse. Furthermore, a culture of vaginal exudates was obtained which tested positive for Shigella sonnei. Stool, perianal exudate and urine cultures were done and the results were negative. Antibiotic treatment was provided, conducted according to the results obtained by an antibiogram, getting the complete resolution of the case after two series of it. The vast majority of vulvovaginitis in prepubertal girls are unspecific and caused by bad hygienic habits, local irritants or mixed bacteria flora, however, in cases of chronic vulvovaginitis with torpid evolution, we must remember to study other specific causes such as intravaginal foreign body, sexual abuse in the event that there were signs or isolate specific pathogen bacterias which may require treatment (AU)

Safety, efficacy, and tolerability of differential treatment to prevent and treat vaginal dryness and vulvovaginitis in diabetic women.

BACKGROUND: Problems affecting the vaginal tract in diabetic women are very often neglected. The efficacy and safety of three gynecological treatments in diabetic women have been assessed. MATERIALS AND METHODS: A single-blind randomized progressive trial on 48 diabetic women affected by vaginal dryness, dyspareunia, and recurrent Candida infections was carried out. The ICIQ Vaginal Symptoms (ICIQ-VS) questionnaire was administered. RESULTS: The analysis of the parameters of ICIQ-VS questionnaire among the three groups showed significant difference only for "dragging pain" (p = 0.0 19) and "soreness" (p = 0.028). In all groups and for all parameters of the questionnaire, improvement of symptoms was observed. In particular, in Group 1 for all symptoms a highly significant difference was observed, to support the already known benefits of the products and of the proposed combination. Significant improvement was also observed in Group 2. CONCLUSIONS: The proposed treatment with DermoXEN® Ultracalming Special for diabetics and DermoXEN® Vitexyl vaginal gel exert effective moisturizing and soothing action. Indeed, the aforementioned products have been proven effective for the main gynecological problems of diabetic women.

Reflujo vaginal: no se puede diagnosticar lo que no se conoce / Vaginal reflux: what is not known cannot be diagnosed

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Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis.

OBJECTIVE: To review the evidence and provide recommendations on screening for and management of vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis. OUTCOMES: OUTCOMES evaluated include the efficacy of antibiotic treatment, cure rates for simple and complicated infections, and the implications of these conditions in pregnancy. EVIDENCE: Published literature was retrieved through searches of MEDLINE, EMBASE, CINAHL, and The Cochrane Library in June 2013 using appropriate controlled vocabulary (e.g., vaginitis, trichomoniasis, vaginal candidiasis) and key words (bacterial vaginosis, yeast, candidiasis, trichomonas vaginalis, trichomoniasis, vaginitis, treatment). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials. Searches were updated on a regular basis and incorporated in the guideline to May 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies. VALUES: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Summary Statements 1. Vulvovaginal candidiasis affects 75% of women at least once. Topical and oral antifungal azole medications are equally effective. (I) 2. Recurrent vulvovaginal candidiasis is defined as 4 or more episodes per year. (II-2) 3. Trichomonas vaginalis is a common non-viral sexually transmitted infection that is best detected by antigen testing using vaginal swabs collected and evaluated by immunoassay or nucleic acid amplification test. (II-2) 4. Cure rates are equal at up to 88% for trichomoniasis treated with oral metronidazole 2 g once or 500 mg twice daily for 7 days. Partner treatment, even without screening, enhances cure rates. (I-A) 5. Current evidence of the efficacy of alternative therapies for bacterial vaginosis (probiotics, vitamin C) is limited. (I) Recommendations 1. Following initial therapy, treatment success of recurrent vulvovaginal candidiasis is enhanced by maintenance of weekly oral fluconazole for up to 6 months. (II-2A) 2. Symptomatic vulvovaginal candidiasis treated with topical azoles may require longer courses of therapy to be resolved. (1-A) 3. Test of cure following treatment of trichomoniasis with oral metronidazole is not recommended. (I-D) 4. Higher-dose therapy may be needed for treatment-resistant cases of trichomoniasis. (I-A) 5. In pregnancy, treatment of symptomatic Trichomonas vaginalis with oral metronidazole is warranted for the prevention of preterm birth. (I-A) 6. Bacterial vaginosis should be diagnosed using either clinical (Amsel's) or laboratory (Gram stain with objective scoring system) criteria. (II-2A) 7. Symptomatic bacterial vaginosis should be treated with oral metronidazole 500 mg twice daily for 7 days. Alternatives include vaginal metronidazole gel and oral or vaginal clindamycin cream. (I-A) 8. Longer courses of therapy for bacterial vaginosis are recommended for women with documented multiple recurrences. (I-A).

Objectif : Analyser les données probantes et formuler des recommandations quant au dépistage et à la prise en charge de la candidose vulvovaginale, de la trichomonase et de la vaginose bactérienne. Issues : Parmi les issues évaluées, on trouve l'efficacité de l'antibiothérapie, les taux de guérison en ce qui concerne les infections simples et compliquées, et les implications de ces pathologies pendant la grossesse. Résultats : La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans MEDLINE, EMBASE, CINAHL et The Cochrane Library en juin 2013 au moyen d'un vocabulaire contrôlé (p. ex. «â€¯vaginitis ¼, «â€¯trichomoniasis ¼, «â€¯vaginal candidiasis ¼) et de mots clés (p. ex. «â€¯bacterial vaginosis ¼, «â€¯yeast ¼, «â€¯candidiasis ¼, «â€¯trichomonas vaginalis ¼, «â€¯trichomoniasis ¼, «â€¯vaginitis ¼, «â€¯treatment ¼) appropriés. Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n'a été appliquée en matière de date, mais les résultats ont été limités aux documents rédigés en anglais ou en français. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en mai 2014. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats est évaluée au moyen des critères décrits par le Groupe d'étude canadien sur les soins de santé préventifs (Tableau). Déclarations sommaires 1. La candidose vulvovaginale affecte 75 % des femmes à au moins une reprise. Les azoles antifongiques topiques et oraux comptent une efficacité équivalente. (I) 2. Pour être qualifiée de récurrente, la candidose vulvovaginale doit donner lieu à quatre épisodes ou plus par année. (II-2) 3. Trichomonas vaginalis est un organisme à l'origine d'une infection transmissible sexuellement non virale courante. Le dépistage des antigènes (écouvillonnages vaginaux analysés au moyen d'un immunoessai ou d'un test d'amplification des acides nucléiques) constitue la meilleure façon d'en détecter la présence. (II-2) 4. La prise en charge de la trichomonase au moyen de métronidazole oral, que ce soit à raison de 2 g en une dose unique ou de 500 mg deux fois par jour pendant 7 jours, permet l'obtention de taux de guérison équivalents pouvant atteindre 88 %. Le traitement du partenaire, même sans dépistage préalable, améliore les taux de guérison. (I-A) 5. Les données probantes dont nous disposons à l'heure actuelle quant à l'efficacité des traitements de médecine parallèle contre la vaginose bactérienne (probiotiques, vitamine C) sont limitées. (I) Recommandations 1. À la suite du traitement initial, la réussite de la prise en charge de la candidose vulvovaginale récurrente est favorisée par la mise en œuvre d'un traitement d'entretien hebdomadaire au fluconazole oral pendant une période pouvant atteindre six mois. (II-2A) 2. La résolution de la candidose vulvovaginale symptomatique prise en charge au moyen d'azoles topiques pourrait nécessiter un traitement d'une durée prolongée. (1-A) 3. À la suite de la prise en charge de la trichomonase au moyen de métronidazole oral, la tenue d'un test de guérison n'est pas recommandée. (I-D) 4. Le recours à des doses accrues pourrait être requis dans les cas de trichomonase qui présentent une résistance au traitement. (I-A) 5. En présence d'une infection à Trichomonas vaginalis symptomatique pendant la grossesse, la prévention de l'accouchement préterme justifie la mise en œuvre d'un traitement au métronidazole oral. (I-A) 6. La vaginose bactérienne devrait être diagnostiquée au moyen de critères cliniques (Amsel) ou de laboratoire (coloration de Gram et système objectif de notation). (II-2A) 7. La vaginose bactérienne symptomatique devrait être prise en charge au moyen de métronidazole oral, à raison de 500 mg deux fois par jour pendant sept jours. Parmi les solutions de rechange, on trouve le gel vaginal de métronidazole et la clindamycine (comprimés oraux ou crème vaginale). (I-A) 8. Chez les femmes qui présentent de multiples récurrences documentées, la prolongation du traitement contre la vaginose bactérienne est recommandée. (I-A).

Evidencias clínicas de la fitoterapia en las infecciones genitales bajas / Clinical evidences of phytotherapy in lower genital tract infections

El interés por la fitoterapia en el tratamiento dela vulvovaginitis es reciente y se debe principalmente a las reacciones adversas, la toxicidad y las recidivas que se producen que se producen a menudo con los tratamientos farmacológicos habituales. Se realizó una búsqueda en bases bibliográficas médicas y páginas web de medicina alternativa, detectándose un total de 13 ensayos clínicos. Tres de ellos están escritos en chino, de los que sólo fue posible obtener el resumen. Se valoró su calidad metodológica, infiriéndose el nivel de evidencia. Se comentan los hallazgos fundamentales (AU)

The interest of Phytotherapy in the treatment of vulvovaginitis is recent and it is mainly due to the adverse reactions, toxicity and relapses that are often produced by standard drug therapies. A literature search using medical bibliography databases and alternative medicine websites detected a total of 13 clinical trials. Three of them were in Chinese, for which it was only possible to obtain the summary. Methodological quality was assessed, inferring the level of evidence. Key findings are discussed. We emphasize the usefulness of green tea catechins in the syntomatic treatment of genital warts (AU)

[Statement of the Polish Gynecological Society Expert Group on the use of Macmiror Complex 500]. / Stanowisko Zespolu Ekspertów Polskiego Towarzystwa Ginekologicznego dotyczace preparatu Macmiror Complex 500.

The group of experts representing the Polish Gynecologic Society has issued this statement based on the review of available literature on the potential benefits of the use of Macmiror Complex 500 in obstetrical and gynecologic practice. Mixed Vaginitis (MV) eg. the vaginal infection caused by at least two out of the triad of pathogens (fungi, bacteria and Trichomonas Vaginalis [TV]), constitutes the type of vaginitis which is underestimated as for its prevalence. Mixed pathogens are responsible for as much as one third of all vaginal infections. Macmiror Complex 500 contains two active ingredients: nifuratel and nystatin. Macmiror Complex 500 affects all common causes of vulvovaginitis, i.e. bacteria, yeasts and TV. At the same time, it is not effective against Lactobacillus spp., which is a clear advantage in the treatment of vaginal infections. The antibacterial spectrum of nifuratel includes aerobic and anaerobic bacteria. Moreover nifuratel is effective against Chlamydia trachomatis and Mycoplasma spp., it has an anti-trichomonal effect comparable to metranidazole and shows certain activity against Candida spp. Nystatin is effective against Candida albicans and is even very effective against Candida glabrata which is usually more resistant to imidazole antifungal agents. Nystatin's importance is rising due to the current increase of candidoses caused by non-albicans types. This increase is especially perceptible in recurring candidoses. The review of the available literature on the effectiveness of Macmiror Complex 500 in the OB/GYN practice leads to the following conclusions: the exeptionally broad antibacterial and antifungal and trichomonicidal activity of this formulation makes it a drug of choice in cases where MV is suspected. The possibility to treat both partners, favorable safety profile in pregnant patients and the availability of both vaginal ovules and the cream with applicator makes this drug an effective and suitable treatment option in obstetrical and gynecologic practice.

Voiding dysfunction: another etiology of vulvovaginitis in young girls.

OBJECTIVE: To determine the prevalence of voiding dysfunction (VD) in patients with persistent vulvovaginitis (PVV), and to evaluate the clinical response of PVV in the treatment of VD. PATIENTS AND METHODS: Girls four years or older who consulted for PVV for at least one month and who did not respond to general measures. A physical examination was performed with visual inspection and colposcopy; vaginal samples for culture and vaginoscopy were carried out. On every patient urodynamic studies were performed. Girls who were diagnosed with VD were treated. A pediatric gynecologist did the follow-up; a successful response was considered when inflammatory symptoms and vaginal discharge ceased. RESULTS: Twenty patients were included, mean age 8.6 years (range: 4.6-14 years); 75% prepubertal symptoms lasted for 1.8 years; 19 (95%) had urodynamia, 10 (52.6%) had an overactive bladder, 8 (42.1%) external bladder sphincter dyssynergia, 1 (5.2%) hypotonic bladder, and 13 (65%) showed improvement. CONCLUSION: VD is an important cause when considering the etiology of PVV.