Episodes Of Vaginitis Research Articles

A Universal Combination Treatment for Vaginitis

Vaginitis, most often due to bacterial vaginosis or Candida species, remains the most common reason for visiting a gynecologist. The diagnosis may be difficult because the clinical findings are not specific for different causative agents and because some of the responsible pathogens are part of the vaginal flora. This randomized, double-blind, controlled, multicenter trial compared Clo-Met, a vaginal tablet containing 100 mg each of clotrimazole and metronidazole, with clotrimazole alone in 165 women presenting with vaginal discharge who were diagnosed as having vaginitis caused by Trichomonas vaginalis, bacterial vaginosis, Candida albicans, or any combination of these agents. Participants had not been treated for vaginitis during the past month. Eighty-four women taking part in this study were assigned to combined treatment and 81 to clotrimazole alone. The 2 groups were similar in age, educational level, and marital status. Women in both groups reported having had an average of about 5 past episodes of vaginitis. The only diagnosis made frequently enough to analyze was C. albicans vaginitis and, in these women, treatment with Clo-Met proved to be more effective than clotrimazole alone. The therapeutic cure rate, comprising both clinical and microbiologic cures, was 89.5% with Clo-Met and 64.7%, a statistically significant difference. Logistic regression analysis yielded an odds ratio for a beneficial response to Clo-Met 4.6 times greater than with clotrimazole alone. Among women with candidal growth at baseline, 83% of those given Clo-Met and 65.5% of those treated with clotrimazole alone had negative cultures 30 days after starting treatment. The patients, in general, regarded both treatments as being effective. One patient taking clotrimazole had a strong vaginal burning sensation that led her to discontinue medication. The Clo-Met vaginal table appears to be an effective and safe treatment for vaginitis. In this trial, Clo-Met was significantly more effective than clotrimazole alone in eliminating C albicans infection.

Vaginal delivery following vaginal inlay grafting

We report the case of a 30-year-old woman with acquired vaginal stenosis secondary to relapsing vaginitis, who became pregnant after partial split-thickness skin graft vaginoplasty. She had a normal pregnancy except for two episodes of vaginitis caused byH. influenzae, which is an uncommon infection during pregnancy, and a normal vaginal delivery. To our knowledge there is only one additional report of vaginal delivery following this kind of surgery. Nevertheless, these isolated cases probably do not demonstrate the suitability of a totally reconstructed vagina by split skin serving as a potentially expansile conduit for normal delivery.

Phenotype and genotype of Candida albicans strains isolated from pregnant women with recurrent vaginitis.

Fourteen out of 80 pregnant women receiving prenatal care presented signs and symptoms of recurrent vaginal candidiasis. Candida albicans strains were isolated from 12 patients (85.7%), and these were submitted to morphotyping (morphological characteristics of the colony), antifungal typing (pattern of sensitivity to amphotericin B, 5-fluorcytosine, myconazole, ketoconazole and fluconazole) and genotyping (electrophoretic migration of DNA fragments digested with EcoRI and HinfI). Alteration of morphotype and antifungal type was observed in 50% of the patients, but the genotype of the strains isolated from the same patients at different times was identical in all subjects. The predominant morphotypes presented continuous fringes and the basic changes observed among antifungal types was the emergence of strains resistant to myconazole, which was the drug used for the treatment of the first episode of vaginitis. We conclude that recurrent vaginal candidasis is caused by the persistence of a single yeast genotype that undergoes morphological and behavioral changes in the presence of antifungal agents due to the selective pressure to which it is submitted.