BLUE LIGTH EMITTING DIODE IN TREATMENT OF RECURRING VULVOVAGINAL CANDIDIASIS: A CASE REPORT

Simple SummaryThis study examined the effects of different intravaginal device types used for estrous cycle management in sheep, and the timing of their insertion, on vaginal features (characteristics of vaginal mucus discharge, pH and microbiota) and fertility under field conditions.Induction and synchronization of estrus and ovulation in sheep is based on intravaginal progestagen-impregnated polyurethane sponges or progesterone-loaded silicon-based devices (CIDR), in either short- (6–7 days) or long-term (12–14 days) protocols. Bearing in mind that the use of intravaginal sponges in long-term protocols has been related to the presence of vaginitis at removal, we compared the effects of sponges and CIDRs, maintained during either 7 or 14 days, on vaginal features (characteristics of vaginal mucus discharge, pH and microbiota) and fertility under field conditions. Almost all the ewes treated with intravaginal sponges showed vaginal discharge at device withdrawal, which was purulent and/or bloody in around 15% and 80% of the females treated for 7 and 14 days, respectively. The vaginal pH and microbiota changed in both groups when compared to control sheep, especially in ewes treated for 14 days, which showed a pH value around 8 and a higher incidence of Salmonella spp. and Staphylococcus aureus. On the other hand, independently of the length of the treatment, only around 15–20% of the sheep treated with CIDRs evidenced vaginal discharge (p < 0.00005 when compared to sponge groups), and such discharge was scarce, clear, and showed no changes in vaginal pH and microbiota when compared to control sheep. Fertility yields were associated with vaginal features, being higher in both short-term treatments (75%) and the long-term CIDR-based treatment (70%) than in the long-term sponge-based treatment (45%).

Effects of Marantodes pumilum (Kacip Fatimah) on vaginal pH and expression of vacoular ATPase and carbonic anhydrase in the vagina of sex-steroid deficient female rats

Increase in vaginal secretion pH is an indicator of bacterial vaginosis (BV), but is yet to be in use as a diagnostic tool by clinicians. Similarly, no reports are available on the effect of cervical chlamydia infection and different reproductive manifestations on vaginal secretion pH. This study evaluated the use of vaginal pH for screening of BV, the effect of Chlamydia trachomatis (C. trachomatis) infection, and different reproductive manifestations on vaginal pH of women attending the gynecology outpatient department of a general hospital. Vaginal pH was recorded while diagnosing infections in 358 women, among which 45 were with repeated spontaneous abortion, 79 with infertility, 185 had sign and symptoms of lower genital tract infection, and 49 had no history or symptom of any complications or infections. Normal vaginal pH, BV, and C. trachomatis infection were observed in 72.6, 21.5, and 10.1% of women, respectively. BV and C. trachomatis were observed in 78.6 and 4.1% of women, respectively, with high vaginal pH; 12.3% of women with normal vaginal pH had C. trachomatis infection. C. trachomatis infection or different reproductive manifestations do not lead to change in vaginal pH but high vaginal pH correlated with BV and should be used as a simple tool for its diagnosis.

Background: As many as 90% of Indonesian women have the potential to experience vaginal discharge because of Indonesia's tropical climate. Hot and humid weather causes mold to easily develop and cause vaginal discharge in women. For this reason, there needs to be an innovation that can be used as one of the efforts to overcome vaginal discharge in general. The purpose of this study is to prove the potential of turmeric-based vaginal soap that is able to overcome vaginal discharge. Subjects and Method: This was a quasi experiment study. The study was conducted at the Darussholah II Islamic Boarding School, North Pontianak, Indonesia from November to December 2023. The sample was divided into 3 groups: (1) , namely groups 1, 2 and 3 with 5%, 10%, and 15% turmeric liquid soap interventions. The dependent variables studied were vaginal discharge and vaginal ph, and the independent variable was Vaginal Turmeric Soap. The analysis technique uses Wilcoxon bivariate analysis. Results: The average value of 5% soap whiteness reduction was 0.96+0.20, 10% was 0.88+0.33 and 15% was 0.92+0.27 with a p value of 0.585. The average value of the pH reduction of 5% soap was 0.60 + 0.57, 10% soap was 0.52 + 0.65, and 15% soap was 0.48 + 0.65 with a p value of 0.904. At a dose of 5%, the reduction in vaginal discharge and pH was the highest compared to other groups. And the results of the analysis showed that the administration of 5%, 10%, and 15% doses did not have a significant difference in changes in vaginal discharge and pH. Conclusion: A 5% dose of turmeric-based vaginal soap was more effective at treating vaginal discharge and lowering vaginal pH, compared to other groups in this study. It is hoped that young women will be more selective in choosing soap in maintaining pH and vaginal discharge, especially if used for a long period of time.

We investigated the efficacy of oral fluconazole, alone or in combination with oral flucytosine (5FC), in treating Candida endophthalmitis using a rabbit model. Albino rabbits were infected with an intravitreal inoculation of 1,000 CFU of susceptible Candida albicans and randomized 5 days later to receive treatment with oral fluconazole alone (80 mg/kg of body weight per day), a combination of fluconazole and 5FC (100 mg/kg/12 h), or no treatment. The treatment effect was assessed at 2 and 4 weeks after therapy by funduscopy, quantitative vitreous culture, and histopathology. Intravitreal levels of fluconazole, 2 to 24 h after the first dose, were measured to be > 10 times the MIC of the drug for C. albicans. Among rabbits treated with fluconazole for 2 weeks, 67% had a > 90% reduction in fungal load (P < 0.05) and 33% were sterile. After 4 weeks, all had a > 99% reduction in fungal load (P < 0.05) and 75% were sterile (P = 0.01). This treatment effect was unchanged 4 weeks after discontinuation of fluconazole. Among rabbits treated with fluconazole and 5FC for 2 weeks, 67% died during therapy. Among the surviving rabbits, 75% had a > 90% reduction in fungal load (P < 0.05) and 25% were sterile. We conclude that oral fluconazole may be useful for treatment of Candida endophthalmitis. Addition of 5FC was associated with high toxicity and minimal additional antifungal effect in our rabbit model.

Bacterial vaginosis (BV) is a common dysbiosis of unclear etiology but with potential consequences representing a public health problem. The diagnostic strategies vary widely. The Amsel criteria and Nugent score have obvious limitations, while molecular biology techniques are expensive and not yet widespread. We set out to evaluate different diagnostic strategies from vaginal samples using (1) a combination of abnormal vaginal discharge and vaginal pH > 4.5; (2) the Amsel-like criteria (replacing the "whiff test" with "malodorous discharge"); (3) the Nugent score; (4) the molecular quantification of Fannyhessea vaginae and Gardnerella vaginalis (qPCR); (5) and MALDI-TOF mass spectrometry (we also refer to it as "VAGI-TOF"). Overall, 54/129 patients (42%) were diagnosed with BV using the combination of vaginal discharge and pH, 46/118 (39%) using the Amsel-like criteria, 31/130 (24%) using qPCR, 32/130 (25%) using "VAGI-TOF", and 23/84 (27%) using the Nugent score (not including the 26 (31%) with intermediate flora). Of the 84 women for whom the five diagnostic strategies were performed, the diagnosis of BV was considered for 38% using the combination of vaginal discharge and pH, 34.5% using the Amsel-like criteria, 27% using the Nugent score, 25% using qPCR, and 25% using "VAGI-TOF". When qPCR was considered as the reference, the sensitivity rate for BV was 76.2% for the combination of vaginal discharge and pH, 90.5% for the Amsel-like criteria, 95.2% for the Nugent score, and 90.5% for "VAGI-TOF", while the specificity rates were 74.6%, 84.1%, 95.3%, and 95.3%, respectively. When the Nugent score was considered as the reference, the sensitivity for BV was 69.6% for the combination of vaginal discharge and pH, 82.6% for the Amsel-like criteria, 87% for qPCR, and 78.7% for "VAGI-TOF", while the specificity rates were 80%, 94.3%, 100%, and 97.1%, respectively. Overall, the use of qPCR and "VAGI-TOF" provided a consistent diagnosis of BV, followed by the Nugent score. If qPCR seems tedious and for some costly, "VAGI-TOF" could be an inexpensive, practical, and less time-consuming alternative.

Effect of amphotericin B lipid formulation on immune response in aspergillosis

Introduction Previous studies have shown that semen negatively affects the vaginal microbiome, which predisposes women to urinary tract infections (UTI) and bacterial vaginosis (BV). The exposure of semen changes the vaginal flora by increasing pH levels, in turn altering the bacterial growth pattern. Furthermore, factors in semen directly contribute to growth of pathogenic bacteria and inhibit lactobacilli protection. Vaginal pH imbalance is a key indicator of the vaginal microbiome, which in turn is a key indicator for yeast infections, UTIs, and BV. Objective A novel postcoital tampon study device, has been developed specifically to absorb semen after sexual activity. A previous pilot study demonstrated efficacy and rapid semen absorption in sexually-active non-condom users. This study evaluated alterations in vaginal pH at various time intervals after sex, both with and without use of this novel postcoital product. Methods Sexually-active heterosexual women who do not use condoms were recruited in the ambulatory setting of a Urology and Urogynecology clinic. After informed consent, participants had a baseline vaginal pH checked. Subjects were given home pH test-kits, with instructions to measure vaginal pH at 2-6 hours and 10-14 hours after sex, both with and without using the study device. A post-use questionnaire was administered electronically. Results 34 completed the study and submitted pH results. Mean baseline pH was 4.54. After sexual activity, mean vaginal pH increased to 5.54 at 2-6 hours following sex, and 5.17 at 10-14 hours after sex. When using the study device, subjects showed a statistically significant restoration of vaginal pH closer to baseline with pH levels at 5.19 (p = 0.01) at 2-6 hours and 4.63 (p = 0.0001) at 10-14 hours after sex (Fig. 1). The use of the study device resulted in a 35% improvement in vaginal pH restoration toward baseline at 2-6 hours and an 85.7% improvement at 10-14 hours, compared to not using the study device. Additionally, the majority of women using the study device reported improvements in vaginal discharge (n = 31; 91%) and odor (n = 28; 82%) after sex. A high percentage of users (n = 32; 94%) expressed interested in continued use of the product. Conclusions The use of an absorptive post-sex tampon restores baseline vaginal pH after sex quicker than the body can do on its own and improves common complaints after sex including vaginal odor and discharge. The clinical utility of this pH drop is not yet known. Further studies should be done on semen and its effects on pH and the vaginal microbiome, to determine if similar products might lower infection risk and common vaginal health complaints. Disclosure Yes, this is sponsored by industry/sponsor: Liviwell. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Liviwell.

Background: Preterm birth is a major cause of death and a significant cause of long-term loss of human potential amongst survivors all around the world. Complications of preterm birth are the single largest direct cause of neonatal deaths. Aim of work: is to evaluate and compare the diagnostic value of vaginal pH and cervical length measurement in the second trimester of pregnancy as a preterm labor predictor. Patients and methods: This prospective analytical study was done on a cohort of 100 selected pregnant women who were fulfilled the inclusion criteria in their antenatal visits at Al-Husien university hospital. Patients coming for routine antenatal care between 18 and 24 weeks gestations were enrolled in the study. Results: The results showed that the minimum cervical length measured was 2.1 (Cm) and the maximum was 4.4 (Cm). The mean cervical length was 3.71 ± 0.64(Cm). The minimum vaginal pH was 3.5 and the maximum pH was 5.5. The mean vaginal pH was 4.7 ± 0.6. The statistical analysis found that there is significance correlation between the cervical length and preterm labor. Also, cervical length had better predictive parameters than vaginal pH. Conclusion: This comes to conclusion that the measuring cervical length by trans vaginal ultrasound has a better predictive value for preterm labor than measuring vaginal pH in the second trimester of pregnancy. Keywords: Vaginal fluid PH, Cervical length, Predictor of preterm labor, Second trimester of pregnancy

Effects of miphil, a new polycarbophil vaginal gel, in suspected bacterial vaginosis: a randomized study versus vaginal douche

To evaluate endocervical and vaginal environment changes in women using a levonorgestrel-releasing intrauterine system (LNG-IUS). A quasi-experimental study included sixty women who had an LNG-IUS inserted in the Family Planning Clinic of UNICAMP between April and November of 2016. Women in reproductive age, non-pregnant, without the use of antibiotics and contraceptives seeking for LNG-IUS insertion were selected for this study. All women were evaluated with regard to vaginal and endocervical pH, vaginal and endocervical Gram-stained bacterioscopy, and Pap-smear before and two months after LNG-IUS insertion. Clinical aspects such as cervical mucus, vaginal discharge, and cervical ectopy were also observed. After LNG-IUS insertion, there was an increase in the following parameters: endocervical pH>4.5 (p=0.02), endocervical neutrophil amount (p<0.0001), vaginal cytolysis (p=0.04). There was a decrease in vaginal discharge (p=0.01). No statistically significant changes were found in vaginal pH, neutrophils amount in the vaginal mucosa, vaginal discharge appearance, vaginal candidiasis, bacterial vaginosis, vaginal coccobacillary microbiota, cervical mucus appearance, or cervical ectopy size. Short-term LNG-IUS use did not increase vulvovaginal candidiasis or bacterial vaginosis, and led to diminished vaginal discharge. Notwithstanding, this device promoted reactional changes in the vaginal and endocervical environment, without modification on cervical ectopy size.

This cross-sectional study aimed to characterize the viable vaginal microbiota and identify host factors influencing this microbiota by employing a combination of relative and quantitative analyses. Twenty-four vaginal fluid samples were collected from healthy adult Japanese women for analysis. Vaginal fluid pH was measured using a portable pH meter. DNA was extracted from the vaginal fluid, and the 16S ribosomal RNA gene sequences in the V3-V4 regions were analyzed to identify bacterial species. Additionally, the vaginal fluid was cultured on four types of selective agar plates. The predominant species in the growing colonies were identified using colony polymerase chain reaction, and the colonies were counted. The vaginal microbiota was classified into four categories based on the characterization of the dominant bacterial population: Lactobacillus crispatus, Lactobacillus iners, Lactobacillus gasseri, and a diversity group. The predominant bacterial species were consistent across methods; however, the levels of the viable population varied significantly. Body mass index had a significant influence on the total number of viable bacteria and vaginal pH, while age only affected vaginal pH. Our findings indicate that the vaginal microbiome of healthy Japanese women is not only highly diverse but also affected by host factors such as BMI and age.

…. is sure design'd, by fraud or force: trust not their presents, nor admit the horse. Virgil, Aeneid Human immunodeficiency virus type 1 (HIV-1), the lymphotropic virus that causes AIDS, has infected more than 60 million people worldwide since its clinical appearance in 1981. Despite intensive prevention efforts, the HIV/AIDS epidemic continues to spread, particularly in developing countries in sub-Saharan Africa, southeast Asia and the Caribbean, as well as the developed world [1]. Although HIV can be transmitted very efficiently parenterally, the advent of routine blood screening prior to transfusion and harm reduction programs for injection drug users, have made this mode of transmission much less common than mucosal transmission. Most new HIV infections are attributable to mucosal transmission: through genital and rectal mucosae in the case of sexual transmission and through oral or gastrointestinal mucosae in the case of mother-to-child transmission [2]. Much has been learned about HIV pathogenesis and infection mechanisms at the molecular level, but the scientific community has yet to develop an effective vaccine or microbicide for HIV prevention. Many unanswered questions remain concerning HIV-1 sexual transmission. In 1983, barely 2 years into the AIDS epidemic, we hypothesized that the agent that was subsequently identified as HIV-1 may be sexually transmitted by infected ‘Trojan Horse’ leukocytes in semen [3]. This hypothesis was based on our knowledge at the time that human semen contains substantial numbers of T lymphocytes and macrophages, which could host a T-cell tropic virus, and the following assumptions: intracellular virus would be better protected than free virus from adverse effects of antiviral factors in the genital environment such as antiviral antibodies likely to be present in genital secretions of the virus-infected transmitter, as well as antimicrobial peptides that play an important role in genital innate immune defense; and virus-infected allogeneic cells could also escape early detection by major histocompatibility complex (MHC)-restricted cytotoxic T cells in a new host. Over the intervening 25+ years, others have also championed this cause [4,5], and convincing evidence has emerged from clinical research as well as in-vitro and animal studies that infected leukocytes indeed play a role in HIV transmission. Yet, most recent research on sexual HIV transmission has focused on cell-free HIV in genital secretions because of the wide availability of HIV RNA quantification assays. Furthermore, the majority of HIV vaccines and microbicides have been designed to block transmission of cell-free virus and have been tested in animal and in-vitro models that use cell-free virus as the only infectious inoculum. As the molecular events underlying cell-associated HIV transmission differ from those underlying cell-free virus transmission, many of the current vaccine and microbicide candidates might not be expected to protect against cell-associated HIV transmission. The failure of several recent vaccine and microbicide clinical trials may be due in part to this oversight. It should be possible to design strategies that block cell-associated HIV transmission as well as cell-free HIV transmission. In this article, we present an overview of research that has been conducted on cell-associated HIV mucosal transmission and recommendations for future research. We focus on sexual HIV transmission, but this review also has relevance for mother-to-child HIV transmission, which may occur through mucosal transmission of cell-associated HIV from maternal genital or mammary gland secretions [6–8]. We review published reports that describe and enumerate HIV-infected cells in genital secretions, and compelling evidence from clinical, animal and in-vitro studies demonstrating that such cells can transmit HIV across genital tract epithelial surfaces; potential molecular mechanisms underlying cell-associated HIV transmission that could be specifically targeted by future HIV prevention strategies; and in-vitro and animal cell-associated HIV transmission models currently used for studies on cell-associated HIV transmission mechanisms and for testing vaccine and microbicide candidates. Using this information as a foundation, we discuss the evidence and probability that various current microbicide and vaccine approaches prevent cell-associated HIV transmission, and suggest additional microbicide and vaccine concepts and experiments that will move this field forward.

Introduction: Bacterial vaginosis is one of the most common vaginal infections affecting women of reproductive and also post menopausal age groups worldwide. It is characterized by a decrease in number of good bacteria like, lactobacilli and an overgrowth of pathological anaerobic bacteria, leading to symptoms such as abnormal foul smelling vaginal discharge. Till date metronidazole, ornidazole, tinidazole and clindamycin are the standard antibiotic treatment, at a same time recurrence rates have been found to be high. Probiotics have emerged as a potential adjunct therapy to restore and maintain a healthy vaginal microbiome, leads to reducing bacterial vaginosis recurrence. Aims: To evaluate the efficacy of metronidazole alone versus metronidazole added with oral probiotics in preventing bacterial vaginosis recurrence. Methods: A randomized comparative study was carried out at Nepalgunj Medical College Teaching Hospital from October 2022 to September 2023. Seventy-two non-pregnant women diagnosed with bacterial vaginosis were divided into two groups: Group A (metronidazole alone) and Group B (metronidazole with probiotics). Primary outcomes, including vaginal discharge, odor, vaginal pH, Nugent score, and bacterial vaginosis recurrence, were assessed at 8, 30, and 60 days post-treatment. Results: At the 8th day follow-up, Group B (metronidazole + probiotics) demonstrated a statistically significant reduction in abnormal vaginal discharge compared to Group A (p=0.013). By Day 60, Group B maintained superior outcomes across all measured parameters, including vaginal discharge (p=0.089), odor (p=0.230), pH (p=0.009) and Nugent scores (p&lt;0.001). The recurrence rate of bacterial vaginosis was consistently minimum in Group B throughout the study period. Conclusion: The addition of probiotics to metronidazole therapy significantly prevent recurrence of bacterial vaginosis.

Vaginal discharge is often a disturbing complaint for women, especially those using hormonal contraception. Although common, this condition can be concerning, especially if accompanied by changes in color, odor, or itching. This study aims to identify factors associated with vaginal discharge among hormonal contraception users at the Tapa Community Health Center. This study used a quantitative research design with a cross-sectional approach. A sample of 58 respondents was selected using purposive sampling. Data were analyzed using the Chi-Square test.The results showed a relationship between age and vaginal discharge (p-value =0.009 &lt;0.05), occupation and vaginal discharge (p-value = 0.005 &lt;0.05), type of contraception and discharge (p-value = 0.005 &lt;0.05), and vaginal pH and discharge (p-value = 0.000 &lt;0.05). These findings underscore the importance of healthcare professionals providing appropriate education and counseling to hormonal contraceptive users to effectively prevent and manage vaginal discharge.