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Cleveland Clinic Journal of Medicine Mar 2017Vulvar and vaginal disorders are among the most common problems seen in ambulatory care. The cause is usually infectious, but noninfectious causes should also be... (Review)
Review
Vulvar and vaginal disorders are among the most common problems seen in ambulatory care. The cause is usually infectious, but noninfectious causes should also be considered, and differentiating them can be challenging. Accurate diagnosis based on patient history, physical examination, and laboratory testing is necessary so that effective therapy can be chosen.
Topics: Candidiasis, Vulvovaginal; Diagnosis, Differential; Female; Herpes Genitalis; Humans; Lichen Planus; Symptom Assessment; Trichomonas Vaginitis; Vaginosis, Bacterial; Vulvovaginitis
PubMed: 28322677
DOI: 10.3949/ccjm.84a.15163 -
Women's Health (London, England) 2023Recurrent urogenital infections such as bacterial vaginosis, vulvovaginal candidiasis, and urinary tract infections have a high prevalence and pronounced psychosocial... (Review)
Review
Recurrent urogenital infections such as bacterial vaginosis, vulvovaginal candidiasis, and urinary tract infections have a high prevalence and pronounced psychosocial impact. However, no review has compared the psychosocial impacts across infection types. This narrative review discusses the impact of common recurrent urogenital infections on psychosocial aspects, including quality of life, stress, mental health, sexual health, work productivity, race and ethnicity, and satisfaction of medical care. Validated questionnaires show that women with recurrent vulvovaginal candidiasis and urinary tract infections have decreased scores on all aspects of quality of life. Those with recurrent vulvovaginal candidiasis and urinary tract infections show lower mental health scores compared to the general population, with increased risk of anxiety and depression. Recurrent urogenital infections affect sexual relationships and intimacy, including avoidance due to symptoms or as a method of prevention. Recurrent infections also increase medical cost and negatively affect work productivity, leading to a combined estimated cost of over US$13 billion per year. There are clear effects of racial inequality involving minority populations that affect diagnosis, treatment, prevalence, and reporting of recurrent urogenital infections. Satisfactory medical treatment improves quality of life and mental health in those suffering from these conditions. Research evaluating psychosocial aspects of recurrent urogenital infections is variable and is not comparable across vulvovaginal conditions. Even so, psychosocial factors are important in understanding contribution and consequence of urogenital infections. Education, awareness, normalization, community support, and access to care can help to alleviate the negative implications of recurrent urogenital infections.
Topics: Humans; Female; Candidiasis, Vulvovaginal; Reinfection; Quality of Life; Vaginosis, Bacterial; Urinary Tract Infections
PubMed: 38099456
DOI: 10.1177/17455057231216537 -
International Journal of Dermatology Mar 2020Vulvovaginal lichen planus (VVLP) is a debilitating disease that causes significant pain and psychological distress. Management is made difficult by the chronic course... (Review)
Review
Vulvovaginal lichen planus (VVLP) is a debilitating disease that causes significant pain and psychological distress. Management is made difficult by the chronic course of the disease and its resistance to treatment. While topical steroids have been accepted as the first-line treatment, they fail to achieve symptomatic control in approximately 40% of patients. Second-line therapies include other topical treatments such as calcineurin inhibitors, systemic therapies including oral steroids, methotrexate, mycophenolate mofetil, biologics, and tacrolimus, and procedural options including surgery and dilation, photodynamic therapy, and ultrasound. This review provides an overview of the current treatments and explores the level of evidence supporting each of them.
Topics: Administration, Oral; Administration, Topical; Algorithms; Antibodies, Monoclonal; Calcineurin Inhibitors; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Gynecologic Surgical Procedures; Humans; Lichen Planus; Methotrexate; Mycophenolic Acid; Photochemotherapy; Tacrolimus; Ultrasonic Therapy; Vulvovaginitis
PubMed: 31631346
DOI: 10.1111/ijd.14692 -
Photobiomodulation, Photomedicine, and... Nov 2022This pilot study aimed to evaluate the characteristic signs and symptoms of chronic vulvovaginitis after blue light-emitting diode (LED) treatment. Women with...
This pilot study aimed to evaluate the characteristic signs and symptoms of chronic vulvovaginitis after blue light-emitting diode (LED) treatment. 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. 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. 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.
Topics: Humans; Female; Quality of Life; Pilot Projects; Vulvovaginitis; Surveys and Questionnaires
PubMed: 36395084
DOI: 10.1089/photob.2022.0038 -
JAMA Jun 2022
Topics: Candidiasis, Vulvovaginal; Causality; Female; Humans; Vaginitis
PubMed: 35699716
DOI: 10.1001/jama.2022.6375 -
Journal of Pediatric and Adolescent... Dec 2022The diagnosis and treatment of vulvovaginitis in children is poorly managed because it is difficult to determine whether the agent causing vulvovaginal inflammation is a...
BACKGROUND
The diagnosis and treatment of vulvovaginitis in children is poorly managed because it is difficult to determine whether the agent causing vulvovaginal inflammation is a single bacterial species.
STUDY OBJECTIVE
This study retrospectively evaluated genital microbiological findings in prepubescent girls with vulvovaginitis and then compared the findings to healthy controls without discharge.
METHODS
This was a retrospective case-control study of 483 prepubescent girls aged 2-10 years with vulvovaginitis and 50 age-matched healthy asymptomatic controls. Data were collected at the Pediatric General Outpatient Unit of the Hospital of the Bezmialem Vakıf University from December 2015 to March 2021.
RESULTS
Of the 483 positive vaginal cultures in the study group, 248 (51.3%) exhibited potential causative agents. Conversely, 8 of 50 (16%) of the vaginal cultures in the control group (P < .001) exhibited potential causative agents. Streptococcus pyogenes was the most frequently detected causative agent of vulvovaginitis in the study group. S. pyogenes was present in specimens from 74 girls (15.8%) with symptoms of vulvovaginitis vs 1 (4.1%) specimen in the control group. Other specific organisms identified in the study group were Escherichia coli (12%), Haemophilus influenzae (5%), Staphylococcus aureus (4.3%), Candida albicans (4.3%), and Streptococcus agalactia (3.3%).
CONCLUSIONS
Among prepubescent girls with vulvovaginitis, 51.3% of vaginal cultures exhibited potential causative agents in the study group. Our microbiological data indicated that the most common pathogens were S. pyogenes and E. coli.
Topics: Child; Female; Humans; Retrospective Studies; Escherichia coli; Case-Control Studies; Vulvovaginitis; Streptococcus pyogenes
PubMed: 35820605
DOI: 10.1016/j.jpag.2022.07.005 -
European Review For Medical and... Oct 2022Antimicrobial resistance remains a worldwide issue with a major clinical and economic impact, leading to exceeding mortality, increased frequency of hospitalization and... (Review)
Review
Antimicrobial resistance remains a worldwide issue with a major clinical and economic impact, leading to exceeding mortality, increased frequency of hospitalization and a great burden on the healthcare systems. Vulvovaginitis, especially when due to mixed infections, has emerged as a condition for which appropriate selection of antimicrobial therapy and proper antimicrobial stewardship programs (ASPs) may contribute to minimizing the resistance development. This review discusses the appropriateness of selecting treatment for vulvovaginitis in order to reduce the development of resistance in gynecological practice. Narrative review based on a selection of literature performed according to the Authors' experience and a MEDLINE search using the following keywords: "vaginitis" OR "Candida" OR "fungal infection" AND "antifungal therapy". No limits were applied, but papers were selected for inclusion in this narrative review according to their relevance to the topic, as judged by the Authors. Worldwide, antimicrobial treatment in gynecology and ASPs focuses on prescribing systemic and expensive antifungal drugs, while treatment selection should consider several factors. Recently, topical azoles have been recommended as suitable alternatives to oral systemic azoles, given their similar efficacy in limiting clinical recurrence. In particular, fenticonazole has already been proposed as an alternative to systemic antifungal drugs to limit the onset of resistance. Optimizing the selection of antimicrobial treatment can help reduce the development of resistance in gynecological practice. Given its wide action spectrum and ability to exert antimicrobial activity against fungi, bacteria and mixed infections, fenticonazole may be considered a suitable first-line, empiric therapy for vaginal and mixed infections, avoiding alteration of intestinal microflora and minimizing the risk of selection of drug-resistant microbial strains.
Topics: Female; Humans; Antifungal Agents; Coinfection; Vulvovaginitis; Azoles; Anti-Infective Agents; Anti-Bacterial Agents
PubMed: 36314342
DOI: 10.26355/eurrev_202210_30048 -
Best Practice & Research. Clinical... Apr 2018Vulvovaginitis is one of the most common gynecological complaints presenting in the pediatric and adolescent female. The common causes of vulvovaginitis in the pediatric... (Review)
Review
Vulvovaginitis is one of the most common gynecological complaints presenting in the pediatric and adolescent female. The common causes of vulvovaginitis in the pediatric patient differ than that considered in adolescent females. When a child present with vulvar itching, burning and irritation the most common etiology is non-specific and hygiene measures are recommended. However these symptoms can mimic more serious etiologies including infection, labial adhesion, lichen sclerosis, pinworms and foreign body must be considered. Yeast infection is rare in the pediatric population but common in the adolescent. In the adolescent patient infections are more common. Yeast and bacterial vaginosis are commonly seen but due to the higher rate of sexual activity in this population sexually transmitted infections must also be considered.
Topics: Adolescent; Age Factors; Candidiasis, Vulvovaginal; Child; Diagnosis, Differential; Female; Gynecology; Humans; Sexual Behavior; Sexually Transmitted Diseases; Vulvovaginitis
PubMed: 28927766
DOI: 10.1016/j.bpobgyn.2017.08.014 -
The Australian & New Zealand Journal of... Apr 2017Recurrent vulvovaginal candidiasis (VVC) is a difficult-to-manage condition that affects 5-8% of women of reproductive age. Current treatment regimes have high relapse... (Comparative Study)
Comparative Study Review
BACKGROUND
Recurrent vulvovaginal candidiasis (VVC) is a difficult-to-manage condition that affects 5-8% of women of reproductive age. Current treatment regimes have high relapse rates, resulting in poor quality of life for the women affected.
AIM
To compare the quality and content of current guidelines concerned with recurrent VVC and to develop a summary of recommendations to assist in the management of women with this condition.
METHODS
Relevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE II instrument. Guideline recommendations were extracted, compared and contrasted.
RESULTS
The identified guidelines were of mixed quality. This is not related to the level of evidence supporting them but is because of poor stakeholder involvement, applicability and lack of clarity concerning editorial independence. Current international guidelines for recurrent VVC are consistent in terms of their definition of the condition, diagnostic techniques and utilising induction and maintenance therapy as the treatment of choice. However, the regimen suggested by most guidelines (fluconazole weekly for six months) is not particularly effective; only 42.9% of patients are disease free after 12 months. An alternative regimen put forward by one of the guidelines cites a 77% cure rate after 12 months. Most guidelines lacked specific recommendations for the induction part of induction and maintenance treatment.
CONCLUSION
The current most recommended treatment of recurrent VVC is sub-optimal. Studies performed on a larger scale are required to identify more effective treatments.
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Female; Humans; Maintenance Chemotherapy; Practice Guidelines as Topic; Recurrence; Remission Induction
PubMed: 28299777
DOI: 10.1111/ajo.12592 -
Microbial Pathogenesis Jul 2022Vaginosis is a condition experienced by most women at least once in their lifetime. This condition arises due to the imbalance in the microbiome of the vaginal... (Review)
Review
Vaginosis is a condition experienced by most women at least once in their lifetime. This condition arises due to the imbalance in the microbiome of the vaginal ecosystem. Most of the pathogens of this disease are organisms which are commonly found in a normal healthy vagina. The vaginal microbiome is important as they act as a primary defence against secondary infections and Sexually transmitted diseases and infections (STDs and STIs). The vagina is mostly dominated by Lactobacillus along with other microbes including Gardnerella vaginalis, Atopobium vaginae., Prevotella spp., Mobiluncus spp., etc. Vaginal microbiome also includes Candida albicans and other species of the genus. The ratio in which these species are present varies from person to person and the dominant species decides the whether a vagina is "normal" or not. Lactobacillus dominated vagina is considered normal and if dominated by Gardnerella and such it is considered to be Bacterial vaginosis (BV) and similarly for Vulvovaginal Candidiasis (VVC). The microbiome also undergoes changes during menstrual cycles and menopausal stages. Due to the dynamic nature of this microbiome, it is tough to perfectly restore the balance. But several treatments are currently available with antibiotics like Clindamycin and derivatives of 5-nitroimidazole drugs like Metronidazole. The extensive use and the non-adherence to the treatment regimen has led to drug resistance through biofilm formation, efflux pumps, single nucleotide polymorphisms and resulting recurrent episode of vaginosis in women. Alternative medicines, preparations from plant sources, anti-microbial peptides and nano formulations are also being explored. Most of these medicines tend to focus on reducing the pathogen load rather than restoring the balance of the ecosystem. Vaginal microbiome transplant, an effort to restore the normalcy in the vaginal environment is becoming a popular treatment. In this review we discuss about the types of vaginosis, available treatments, challenges in treating the condition and the new drugs that are under investigation.
Topics: Candidiasis, Vulvovaginal; Female; Gardnerella vaginalis; Humans; Lactobacillus; Microbiota; Vagina; Vaginosis, Bacterial
PubMed: 35644292
DOI: 10.1016/j.micpath.2022.105606