Recurrent Vulvovaginitis Research Articles

Genital-oral transmission of Candida lusitaniae.

Candida lusitaniae is a vaginal commensal. Cases of vaginitis, vulvovaginitis and recurrent vulvovaginitis caused by this yeast are very rare. In the oral cavity, C. lusitaniae causes stomatitis in immunocompromised patients. We describe a case of stomatitis and angular cheilitis caused by C. lusitaniae in a female patient with type 2 diabetes. The infection was most likely transmitted following genital-oral intercourse with the patient's girlfriend, who was affected by C. lusitaniae vulvovaginitis.

Mapping the Burden of Fungal Diseases in the United Arab Emirates.

The United Arab Emirates has very little data on the incidence or prevalence of fungal diseases. Using total and underlying disease risk populations and likely affected proportions, we have modelled the burden of fungal disease for the first time. The most prevalent serious fungal conditions are recurrent vulvovaginitis (~190,000 affected) and fungal asthma (~34,000 affected). Given the UAE's low prevalence of HIV, we estimate an at-risk population of 204 with respect to serious fungal infections with cryptococcal meningitis estimated at 2 cases annually, 15 cases of Pneumocystis pneumonia (PCP) annually, and 20 cases of esophageal candidiasis in the HIV population. PCP incidence in non-HIV patients is estimated at 150 cases annually. Likewise, with the same low prevalence of tuberculosis in the country, we estimate a total chronic pulmonary aspergillosis prevalence of 1002 cases. The estimated annual incidence of invasive aspergillosis is 505 patients, based on local data on rates of malignancy, solid organ transplantation, and chronic obstructive pulmonary disease (5.9 per 100,000). Based on the 2022 annual report of the UAE's national surveillance database, candidaemia annual incidence is 1090 (11.8/100,000), of which 49.2% occurs in intensive care. Fungal diseases affect ~228,695 (2.46%) of the population in the UAE.

A prospective observational study on species differentiation and antifungal susceptibility pattern in patients with genital candidiasis.

Candidial balanitis, balanoposthitis and vulvovaginitis can be diagnosed by direct microscopy, culture and treated with antifungals. Resistance to antifungals is emerging. Hence, we conducted a study to identify the causative species and antifungal susceptibility. To observe the species differentiation and antifungal susceptibility pattern in patients with genital candidiasis. A prospective observational study was carried out that included 54 patients of age group (18-60 years) diagnosed clinically and direct microscopically (KOH) for genital candidiasis. Culture was done using Sabouraud dextrose agar. Species identification and antifungal susceptibility were tested. Descriptive data were expressed in the form of frequency and percentage. Out of 54 patients, 41 had culture positive candidiasis. Among the isolated species, 68.3% were Candida albicans (28/41) and 31.7% were non- albicans Candida spp. Among non-albicans Candida species (13/41), Candida glabrata (19.5%), Candida tropicalis (7.3%), Candida guilliermondii (2.4%), Candida parapsilosis (2.4%) were identified. Antifungal susceptibility was tested for fluconazole (FLU), clotrimazole (CLTZ), itraconazole (ITZ), ketoconazole (KTZ), voriconazole (VOR), amphotericin-B (AMPH-B). Except C. glabrata and C.parapsilosis, all other species were sensitive to all tested antifungals. All isolated species were sensitive to KTZ, VOR, AMPH-B, and CLTZ. Nearly 22% of isolates were resistant to fluconazole. C. glabrata causes complicated, severe recurrent vulvovaginitis which is fluconazole resistant. Drug sensitivity prior prescribing antifungal agent identifies appropriate drug, decreases patient's disease morbidity and cross resistance.

Phenotypic characterization and antifungal susceptibility profile of Candida isolates from women with vulvovaginal candidiasis at a community health center linked to a teaching institution in the Sub-Himalayan region of North India.

Vulvovaginal candidiasis (VVC) is considered a common gynecological problem among females of reproductive age group. 70-75% of women report having had candidal vulvovaginitis at some point in their lifetimes and 40-50% suffer recurrent candidal vulvovaginitis. This study aims to identify the Candida species involved in VVC and to determine their antifungal susceptibility pattern. The present study was a cross-sectional study conducted on 257 females (18-55 yr) with complaints of abnormal vaginal discharge. For detection of Candida, the swab samples were subjected to Gram stain, 10% KOH mount, and culture on Sabouraud dextrose agar (SDA). Candida species identification was done by subculturing Candida isolates onto CHROMagar, corn meal agar (Himedia), and further confirmation was done by MALDI-TOF MS. Antifungal testing was done using the disk diffusion method. A total of 257 females with complaints of abnormal discharge were enrolled in this study. Out of 257, C. albicans 37 (58.7%) and 26 (41.3%) isolates were identified as non-albicans Candida. Out of 63 positive cases, a maximum number of study subject belongs to the age group 26-35 years (50.8%). Along with vaginal discharge, itching (65.37%) is the most common complaint. VVC was found to be most predominant in patients with prolonged antibiotic therapy (38.1%), and in pregnant females (15.9%). Understanding the emerging fungal pathogens and their drug susceptibility patterns is essential for the effective management of infections. Drug resistance can lead to treatment failure and highlights the need for alternative treatment options or strategies.

Fungal infections in Sudan: An underestimated health problem.

Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.

Clinical features of recurrent vulvovaginitis in prepubertal age girls with extragenital diseases

The purpose of the study is to investigate the clinical features of recurrent vulvovaginitis in prepubertal age girls with extragenital diseases. We examined 110 girls with recurrent vulvovaginitis, which were registered with the dispensary of pediatric gynecologist. We divided them into three groups depending on extragenital pathology: I group 38 patients with chronic urinary tract diseases; II 36 girls with allergic diseases; III 36 girls with gastrointestinal pathology, enterobiasis. Girls with chronic diseases of the urinary system complain of the pain and discomfort during urination, malaise in the genital area, discharge from the genital tract. Girls with allergic pathology complain of itching and burning in the genital area, restless behavior, dysuric phenomena. Girls with diseases of the gastrointestinal tract and enterobiasis complain of discomfort in the genital region, discharge from the genital tract because of constipation and bloating. The results of examination of the external genitalia, vulvoscopy also differed in girls. They depended on the acuty of the inflammatory process and predisposing factor. The clinical features of recurrent vulvovaginitis in prepubertal age girls with extragenital pathology were determined by the data of objective and instrumental examination of vulva.

The impact of combined contraceptive vaginal ring on vaginal environment: an observational, longitudinal study

Purpose To assess the relationship between combined contraceptive vaginal ring (CVR) and vaginal microbiome using 16S rRNA gene sequencing. Materials and methods We enrolled 20 women for 8 weeks in an open-label study using CVR (NuvaRing®) that delivered 15 mcg ethinylestradiol and 120 mcg etonogestrel daily. The vaginal microbiome was assessed at baseline and after 2 months by sequencing the 16S rRNA genes amplified from the total genomic DNA isolated from the sample. Results Bacterial distribution richness and equity did not significantly change after 2 months, and the dominant bacterial strain was Lactobacillus crispatus. Only one woman with a history of vestibulodynia and recurrent vulvovaginitis showed an increase in bacterial biodiversity, with a switch to the relative abundance of anaerobic bacteria. Conclusions Our results suggest that CVR does not adversely affect the composition and structure of the vaginal microbiome. However, special care should be taken in patients with a history of vestibulodynia and/or recurrent vulvovaginal infections.

(008) Psychosexual, Relational and Clinical Correlates of Orgasmic Function and Female Orgasm Disorder in Women Consulting for Sexual Symptoms

Abstract Introduction Female Orgasm Disorder and its risk factors are still under-investigated. Objective To describe the psychological, relational and clinical correlates of orgasmic function during partnered sexual activity in women consulting for sexual symptoms. Methods In an observational retrospective study, we collected data from a consecutive sample of 430 heterosexual, sexually active women (mean age 46±12.9 years) consulting for sexual symptoms. All patients underwent a structured interview and a physical, gynecologic and laboratory examination; they completed a series of validated questionnaires, including the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale-Revised (FSDS-R), the Middlesex Hospital Questionnaire (MHQ), the Body Uneasiness Test (BUT-A and BUT-B), the Sexual Inhibition/Excitation Scale (SIS/SES), and the Dyadic Adjustment Scale (DAS). Results 268 subjects (62%) reported a persistent distressing decrease of the frequency of orgasm for at least six months. Among them, 93 (22% of the whole sample) reported a mild decrease, 91 (21%) a severe decrease, and 19% reported anorgasmia. Nine women described Anorgasmia as lifelong. The severe decrease of orgasm frequency during partnered sexual activity was associated with the inability to reach orgasm with masturbation (p=0.009). After adjusting for age and menopausal status, the FSFI Orgasm (FSFI-O) domain was negatively associated with MHQ total score (p=0.001), an index of general psychopathology, and with body image concerns, explored through both BUT-A and BUT-B global measures. The stronger correlation emerged with the BUT-A Avoidance subscale (p=0.005). Among other psychological parameters, significant, negative correlations were observed between FSFI-O and a reported diagnosis of psychiatric disease, including mood disorders (p=0.001), use of antidepressants (p=0.001), chronic stress (p=0.002), and familiar conflicts (p=0.008). Noteworthy, no correlation was observed between FSFI-O and Inhibition/Excitation measures. When exploring sexual and relational parameters, we found that women displaying higher FSFI-O scores were more likely to be engaged in a stable sexual relationship (p=0.003), to report at least three sexual encounters per month (p<0.001) and lack of marital conflict (p=0.004). Among sexual dysfunctions in the male partner, as perceived by the woman, only low desire showed a clear negative correlation with FSFI-O (p=0.002). FSFI-O was also positively correlated with the Dyadic Satisfaction (p<0.001) and the Dyadic Cohesion subscales (p=0.032). Finally, when considering clinical parameters, women with a history of endometriosis (p=0.008), genitourinary disorders (i.e., recurrent vulvovaginitis or urinary tract infections; p=0.027), urinary incontinence (0.017) and pelvic surgery (i.e. hysterectomy; p=0.017) reported significantly lower FSFI-O scores. FSFI-O was not correlated with metabolic or hormonal laboratory parameters, including estradiol, prolactin or testosterone levels. When considering the diagnosis of severe FOD, the main clinical risk factors were psychiatric diseases (OR 1.566, CI 1.034;2.370), past Unwanted sexual experiences (OR 1.679, CI 1.109;2.541), urinary incontinence (OR 1.644, CI 1.132;1.387) and past pelvic surgery (OR 1.710, CI 1.129;2.591). Conclusions Orgasmic function was correlated with anxiety and depressive symptoms, use of antidepressants, body image concerns, marital conflicts and low partner’s desire, independently of age and menopausal status. Risk factors for severe FOD were psychiatric diseases, abuse history, urinary incontinence and past pelvic surgery. Disclosure No

(101) Ovarian Hyperthecosis as a Cause of Hypersexualization in a Post-menopausal Female

Abstract Introduction Ovarian Hyperthecosis (OH) is a rare benign virilizing ovarian syndrome characterized by androgen overproduction due to stromal and thecal hyperplasia resulting in hirsutism and virilization(1). It is believed to be similar to polycystic ovarian syndrome (PCOS) however, presents with more robust androgen overproduction and an ovarian vein ratio of androstenedione/testosterone less than one, compared with values around 20 in pre-menopausal females and patients with PCOS(2). Specifically in post-menopausal women, the phenotypical presentation is due to unmasking of the increased thecal cell testosterone release which results from lack of granulosa cell mediated aromatization of testosterone to estradiol.(3) Some have described treatment of OH with medications that inhibit ovarian production of estrogen and progesterone especially in pre-menopausal women. However, results are mixed and oophrectomy seems to be the most effective treatment modality for OH(3). Objective Here we describe a case of OH resulting in elevated androgen levels and distressing hypersexualization in a post-menopausal female who was effectively treated with bilateral oophorectomy resulting in normalization of laboratory values and resolution of hypersexualization. Methods The patient is a 75-year-old female with past medical history significant for bipolar disorder, Sjogren’s syndrome and hypothyroidism who presented to the office for evaluation of recurrent vulvovaginitis and urinary tract infections related to vigorous and frequent sexual activity. She reported symptoms of hypersexuality developing a few years prior to presentation at which time she began engaging in sexual activity 2-3 times daily and masturbating with a variety of objects. She had also noted new heavy facial hair and scalp hair loss. There were no changes in her medical history at the time. She was bothered by the increased need for sexual stimulation and orgasm, prompting further evaluation and treatment. Her exam was notable for vulvar contact dermatitis, mild vulvovaginal atrophy, and no prolapse or urinary incontinence. Vaginal infection testing was negative. Results of an endocrine work up are summarized in Table 1. Abdominal imaging showed normal adrenal glands and ovaries. An MRI of the brain showed a normal pituitary gland. She had been started on Prozac by her psychiatrist, which reduced her libido but worsened her mania and therefore was discontinued. A diagnosis of OH was suspected and bilateral oophorectomy was planned. Results The patient underwent a laparoscopic bilateral salpingo-ophrectomy with surgical pathology confirming stromal hyperplasia and hyperthecosis. Post-operatively, her labs rapidly normalized. She noted normalization of her libido, significant improvement in vulvar contact dermatitis and increased scalp hair growth. Conclusions Bilateral oophorectomy in a post-menopausal woman with OH was an effective treatment to normalize androgen levels and restore normal libido resulting in resolution of vulvar contact dermatitis from excessive masturbation. Although an uncommon diagnosis, this disease is an important consideration in the workup of excess androgen production in post-menopausal women. Disclosure No

The role of estriol in the treatment of atrophy of the mucous membrane of the lower genitourinary tract in postmenopausal women

Studies of recent decades show a steady increase in the average life expectancy of a person, and women in particular. The World Health Organization predicts a four-fold increase in the number of women over 70 by 2030, and many of them over the age of 45 may face menopausal problems. Menopause is a physiological state in a woman's life, during which, against the background of age-related changes, there is a gradual decrease and shutdown of ovarian function and the cessation of estrogen production. Genitourinary syndrome occurs in every third woman in this period. Estriol is the main estrogen that specifically addresses problems associated with estrogen deficiency: dyspareunia, dryness and itching in the vagina and lower genitourinary tract, urinary incontinence, moderate urinary incontinence, and recurrent vulvovaginitis and cystitis. Vulvovaginal dystrophy in women of the older age group is a multidisciplinary problem at the intersection of gynecology, urology and dermatology, which can and should be solved to prevent more severe gynecological and urological pathologies.

First detection of mutated ERG11 gene in vulvovaginal Candida albicans isolates at Ouagadougou/Burkina Faso

BackgroundVulvovaginal candidiasis is an important cause of morbidity among women due to Candida species. In the last decades, resistance to azoles, first-line antifungals has increased. One molecular mechanism of azole resistance by Candida involves mutations in the ERG11 gene encoding lanosterol 14-α-demethylase, the target enzyme. This study was conducted to identify the clinical Candida species associated in vulvovaginal candidiasis; to determine the rate of antifungal resistance among Candida albicans isolates and to determine mutated ERG11 gene at Saint Camille Hospital in Ouagadougou, Burkina Faso.MethodsAntifungals susceptibility were performed using Kirby–Bauer disk diffusion method. ERG11 gene was detected using conventional PCR in C. albicans isolates resistant to at least one azole.ResultsOut of 262 clinical strains isolated, C. albicans accounted for 59.90%, followed by Candida glabrata 27.86%, Candida famata 7.25%, Candida tropicalis 3.05% and Saccharomyces cerevisiae 1.91%. Resistance rate of fluconazole to C. albicans was 59.54%. ERG11 gene was found in 9.79% of 92 C. albicans strains resistant to azoles.ConclusionsThis detection of mutated ERG11 gene in C. albicans is the first in Burkina Faso and may be a cause of azole resistance in recurrent Candida vulvovaginitis.

A rare case of recurrent group A streptococcal vulvovaginitis in a premenopausal woman.

A rare case of recurrent group A streptococcal vulvovaginitis in a premenopausal woman.

Helminth Infections in Children.

Helminth Infections in Children.

Topical Treatment of Recurrent Vulvovaginal Candidiasis: An Expert Consensus.

Background: Recurrent vulvovaginal candidiasis (RVVC), defined as three or more confirmed infections over 1 year, occurs in up to 10% of women. In these women, the objective is often symptomatic control rather than mycologic cure. Current Centers for Disease Control and Prevention (CDC) guidelines recommend oral fluconazole as first-line maintenance, but state if this oral regimen is not feasible, intermittent topical treatments can be considered. No specific recommendations for type or frequency of topical applications are provided by the CDC.Methods: A panel of vulvovaginal experts convened to develop a consensus recommendation for topical maintenance dosing for RVVC.Results: Data suggest that clotrimazole, miconazole, terconazole, and intravaginal boric acid are suggested recommendations for recurrent vulvovaginitis caused by both Candida albicans and nonalbicans species. Nystatin ovules may not be as effective as azoles. Identification of species will influence treatment decisions. In addition, treatment may be modified based on prior response to a specific agent, especially in nonalbicans species. Fluconazole, ibrexafungerp, and intravaginal boric acid should be avoided during pregnancy.Conclusions: The expert consensus for women with RVVC is an initial full course of treatment followed by topical maintenance beginning at one to three times weekly, based on chosen agent. Twice a week dosing was the regimen most often utilized. In some women, episodic treatment may be used, but maintenance should remain an option for this population.

Current opportunities for treatment and prevention of recurrent vulvovaginitis in reproductive aged women

Vulvovaginal candidiasis is an urgent medical and social problem, a common reason for women to see a doctor. This disease occurs in women of different ages, which leads to a significant decrease in the quality of life, and to more serious complications in some cases (genitourinary system diseases, miscarriage, vaginal stenosis, etc.).Research objective. Comprehensive assessment of the effectiveness of treatment and prevention of recurrent vulvovaginal candidiasis (RVVC) with Candivac (contains inactivated microorganisms in the form of frozen lyophilized 4 original strains, which are the most common causative agents of vaginal candidiasis).Materials and methods. 76 women of reproductive age with RVVC were examined and randomized into 2 groups: the main group consisted of 40 patients who received anti-candidiasis therapy with fluconazole and Candivac; the control group included 36 women who received only the standard fluconazole antifungal regimen. The duration of observation was 12 months.Criteria for evaluating treatment efficacy were no/reduction of clinical symptoms and changes in the vaginal mucosa, positive dynamics of laboratory tests (with control after 3 and 12 months) from the start of treatment. Results. Clinical efficacy of treatment (regression of complaints and normalization of objective data) in two groups was observed in the majority of patients. At the same time, clinical efficiency in the main group was 87% and exceeded that in the comparison group (63%), which was accompanied by the normalization of the vaginal microbiocenosis. However, after complex therapy with Candivac a more reliable result was observed, which was accompanied by a significant decrease in the frequency of disease recurrence.Conclusions. Study showed that Candivac in combination with antifungal therapy and probiotic promotes the elimination of systemic inflammation and the rapid return of normal intravaginal microflora, and reduces the number of RVVC recurrences.

A Case Report of Microperforate hymen presented with primary infertility

Micro perforate hymen is an uncommon congenital defect in which the hymen has a microscopic pinpoint aperture. It is a different entity from imperforate hymen, but it might present with more or less similar complaints. Here we are discussing about a unique case of pinpoint hymenal opening or microperforate hymen where the patient presented to us with primary infertility. Most cases of micro perforate hymen present in the paediatric age group with recurrent urinary tract infections and recurrent vulvovaginitis. Rare cases in a review of literature noted that a patient was seen to present with urethral dilatation during coital activity. In this case report, we present a patient who came with primary infertility who has never been examined in the past. She had regular menstrual cycles but scanty flow with the main complaint of dyspareunia. After examination, she was found to have microperforate hymen and suspected transverse vaginal septum defect. Hence, routine investigations were done, and we proceeded with hymenectomy. This example demonstrates the importance of a thorough genital examination and the inclusion of hymenal abnormalities in the differential diagnosis of women with recurrent dysuria, vaginitis, primary infertility, and oligomenorrhoea, so that early intervention can be done to improve the woman's quality of life and reduce pregnancy difficulties.

Determination of somatic status of girls with chronic vulvovaginitis in the neutral period of life

The objective: a determination of the spread of somatic pathology and polymorphism of the MSM6 gene in the development of chronic recurrent vulvovaginitis in girls. Materials and methods. The study involved 54 girls 1–6 years old. Inclusion criteria: complaints of patients on itching or pain in the genital area, dysuria, the presence of synechiae of the vulva, clinical manifestations of vulvitis during the visual examination. General laboratory diagnostic methods were used (blood test, general urine analysis with determination of ketone bodies, bacterioscopic examination of vaginal smears, vaginal culture for flora and antibiotic sensitivity, determination of glucose levels in blood serum and urine). For diagnosis of lactose malabsorption by polymerase chain reaction, a mutation in the MCM6 gene was studied, the genetic marker of which is C (-13910). Results. The somatic status of patients with chronic vulvovaginitis was presented by pathology of the gastrointestinal digestive tract in 68.5 % cases, atopic dermatitis – 53.7 %, diseases of the respiratory system – 33.3 %, infectious processes of the kidneys and urinary tract – 24.1 %. 77.6 % of girls had nondiabetic acetone syndrome, 75.9 % – dysmetabolic nephropathy. The presence of lactose malabsorption was revealed by homozygosity for the MCM6 gene mutation (C/C) in 26.1% of patients, heterozygosity for the MCM6 gene mutation (C/T) - in 56.5 %, the absence of the MCM6 gene mutation (T/T) was in 8 (17.4 %). Conclusions. In girls in the neutral period of life with chronic vulvovaginitis, non-infectious forms of the disease were found, which were not independent pathology, but associated with other pathological processes of metabolic disorders. Taking into account the obtained data on lactose malabsorption, we consider to include in the examination the algorithm of the verification of the MCM6 gene mutation and examination of urine for lactosuria and blood with lactose load.

Chronic recurrent vulvovaginitis is not only due to Candida

BackgroundRecurrent vulvovaginitis is a growing problem that affects millions of women worldwide. In many cases it is treated as vulvovaginal candidiasis, but there is not always microbiological confirmation. AimsTo determine the etiology of vulvovaginitis in a group of patients. MethodsThis is a cross-sectional study in which the data from the medical records of 316 adult patients who consulted for vulvovaginitis were analyzed. Eighty nine percent of the cases had already suffered previous episodes. ResultsThe median age was 34 (265 patients were between 16 and 45 years old). Yeasts were isolated in culture from 211 (66.8%) patients, although pseudo-hyphae and yeasts were observed in only 166 samples (52.5%) in the direct microscopic examination. Multiple predisposing factors were found, among which the use of contraceptives or previous antibiotics stand out. Most of the patients (almost 90%) had been treated with antifungals, with or without microbiological confirmation. Candida albicans was isolated in 187 (88.6%) patients, followed by Candida glabrata in 6 (2.8%) patients. Association with bacterial vaginosis was found in 35.1% and with intermediate bacterial microbiota in 33.2% of the cases. A remarkably high proportion of C. albicans isolates resistant to fluconazole (80.1%) and itraconazole (58.8%) was found. ConclusionsA microbiological analysis is essential to confirm the diagnosis of vulvovaginal candidiasis, whether simple, complicated, or recurrent. Identifying the isolated yeast species and determining its susceptibility to antifungal agents are particularly important.

Guideline: Vulvovaginal candidosis (AWMF 015/072, level S2k).

Approximately 70‐75% of women will have vulvovaginal candidosis (VVC) at least once in their lifetime. In premenopausal, pregnant, asymptomatic and healthy women and women with acute VVC, Candida albicans is the predominant species. The diagnosis of VVC should be based on clinical symptoms and microscopic detection of pseudohyphae. Symptoms alone do not allow reliable differentiation of the causes of vaginitis. In recurrent or complicated cases, diagnostics should involve fungal culture with species identification. Serological determination of antibody titres has no role in VVC. Before the induction of therapy, VVC should always be medically confirmed. Acute VVC can be treated with local imidazoles, polyenes or ciclopirox olamine, using vaginal tablets, ovules or creams. Triazoles can also be prescribed orally, together with antifungal creams, for the treatment of the vulva. Commonly available antimycotics are generally well tolerated, and the different regimens show similarly good results. Antiseptics are potentially effective but act against the physiological vaginal flora. Neither a woman with asymptomatic colonisation nor an asymptomatic sexual partner should be treated. Women with chronic recurrent Candida albicans vulvovaginitis should undergo dose‐reducing maintenance therapy with oral triazoles. Unnecessary antimycotic therapies should always be avoided, and non‐albicans vaginitis should be treated with alternative antifungal agents. In the last 6 weeks of pregnancy, women should receive antifungal treatment to reduce the risk of vertical transmission, oral thrush and diaper dermatitis of the newborn. Local treatment is preferred during pregnancy.

Neonatal and Maternal Outcome after Conservative Management of Preterm Premature Rupture of Membranes (PPROM) between 24-28 Weeks Gestation

Background:The Incidence of preterm pre maturerupture of membranes ranges from 3.0-10.0% of alldeliveries and leads to one third of preterm births.There are several risk factors for PPROM, such asintrauterine infection at early gestational age, sexually transmitted infections, vaginal bleeding, andsmoking during pregnancy.Methods: An observational prospective studyincluded 100 pregnant females with PPROM between the 24th and 28th week’s gestation that wereadmitted to Mansoura University Hospital (MUH)between April 2018 and December 2019. Pregnancies with known fetal malformations, multiplefetuses, stillbirths, placenta previa, pre-eclampsia& Eclampsia and diabetes mellitus were excludedfrom this study group. Women who deliver within24 hours of PPROM were also excluded.Results: Out of 100 pregnant females were eligible for the study only 88 patients continued thestudy. Data from our study showed that the mediangestational age at delivery after conservative management of patient diagnosed to have PPROM was33 weeks. 85.2% of patients delivered by cesareansection. Recurrent urinary tract infection and Vulvo-vaginitis are the most common associated riskfactors (28 %, 24 %) respectively.The percentageof live born neonates was (65.9%) while still birthoccurred in (15.9%) and miscarriage occurred in(18.2%) of the females who completed the study.The main neonatal complications reported in thestudy was 55 out of 58 live birth cases were admitted to NICU (62.5%). Twenty-nine cases developedrespiratory distress syndrome (32.9 %), 17 casesdeveloped bronchopulmonary dysplasia (19.3%), 6cases developed pulmonary hypoplasia (6.8%),47casesdeveloped neonatal sepsis (53.4%) and 34cases developed perinatal death after admission toNICU (38.6%). Fourteen neonates were dischargedwith different degrees of disability (15.9%). Theoverall survived neonates were 24 cases (27.3%).For maternal complications we noticed that 43 cases developed signs of chorioamnionitis (48.9%).Also cord prolapse was reported in 3 cases (3.4%).After delivery postpartum hemorrhage occurredin 14 cases (15.9%) and 10 cases (11.4%) were inneed of blood transfusion. Signs of maternal sepsisdeveloped only in 3 cases (3.4%).Conclusion: Data from our study showed thatafter conservative management of patients withPPROM the overall neonatal survival rate was27.3 %. 3.4% of neonates were discharged withoutneed of NICU, 7.95% of neonates were healthyafter being discharged form NICU and 15.9 % ofneonates were discharged with different degreesof disability. Most of material complication werenot fatal and showed improvement after giving theappropriate care.