-
Le Mali Medical 2022Vulvovaginal candidiasis (VVC) is a fungal infection caused by yeasts of the genus that leads to vulvar pruritus and vaginal discharge.
UNLABELLED
Vulvovaginal candidiasis (VVC) is a fungal infection caused by yeasts of the genus that leads to vulvar pruritus and vaginal discharge.
METHOD
In order to evaluate the epidemiological and etiological Profile of vvc, we carried out a cross-sectional study among women in consultation in the gynecological department of the CHU-Gabriel Toure in Bamako. Two swabs were taken from each woman for mycological diagnosis. The presence of yeasts and pseudo-filaments was observed on direct examination. The culture was performed on Sabouraud-Chloramphenicol medium and at 37°C for 24 to 48 hours. Identification was based on the macroscopic and microscopic characteristics of the colonies, the germinative tube test and the Vitek•2 instrument. of the colonies, the germinative tube test and the VITEK® 2 instrument.
RESULT
A total of 240 women were included with a mean age of 31.5 ± 3.15 [15-64 years]. Married women represented 91.67% (n=220) and 51.25% were housewises. Pruritus 49.17% (118/240) and dyspareunia 42.08% (101/240) were the most frequent clinical signs. Previous use of antifungals was demonstrated in 85.83% of women. species were confirmed in 60.42% (145/240) of cases. was the most frequent species followed by .. This study allowed us to identify the most frequent cases of , followed by , and ..
UNLABELLED
Further studies are still needed to characterize the antifungal susceptibility profile of the Candida species involved.
PubMed: 38514949
DOI: No ID Found -
Journal of Obstetrics and Gynaecology... Dec 2021Fungal skin infections are on the rise in India, and pregnant women are not immune to them. They are one of the commonest causes of secondary pruritus in pregnancy and... (Review)
Review
Fungal skin infections are on the rise in India, and pregnant women are not immune to them. They are one of the commonest causes of secondary pruritus in pregnancy and can worsen the quality of life. Cutaneous dermatophytic infections have seen a recent emergence as a public health problem in India with increasing incidence as well as failure to appropriately respond to treatment. Vaginal candidiasis may cause obstetric and perinatal complications such as chorioamnionitis, premature rupture of membranes, preterm labor and neonatal candidiasis. Antifungal drugs are commonly prescribed in pregnancy. The common oral antifungals used are fluconazole, ketoconazole, itraconazole, terbinafine and griseofulvin; whereas the common topical antifungals are azoles, ciclopirox oleamine, terbinafine, amongst others. There have been reports of congenital abnormalities in the fetus and spontaneous abortions attributed to oral antifungals. Prescribing antifungal drugs in pregnancy needs careful consideration. In this article, we discuss the safety profile and recommendations regarding the use of these drugs during gestation. We have performed a literature search of recent large-scale cohort, case-control, and meta-analysis studies and presented them in this review. Antifungals such as echinocandins, amphotericin B, flucytosine, etc. which are indicated for systemic mycoses are beyond the scope of this article. Finally, we have given authors' perspective regarding the justifiable use of these antifungals in pregnant women.
PubMed: 34898894
DOI: 10.1007/s13224-021-01586-8 -
Archives of Gynecology and Obstetrics Sep 2022Despite the vaginal mucosa is able to respond to allergenic stimuli, vaginal allergic responses have been under investigated in clinical practice. Thus, we aimed to... (Review)
Review
PURPOSE
Despite the vaginal mucosa is able to respond to allergenic stimuli, vaginal allergic responses have been under investigated in clinical practice. Thus, we aimed to identify the most frequent etiological agents responsible for vulvovaginal allergies, the prevalent signs/symptoms, and the diagnostic tests applied in this clinical condition.
METHODS
Literature search was performed on PubMed, Scopus, Scielo, Web of Science, and EMBASE. The study protocol was registered on PROSPERO (CRD42020167238). Studies were divided in two groups depending on allergen exposure route. Due to a significant number of studies correlating allergy to Candida infection, subgroup analysis was included.
RESULTS
In direct exposure cases, Human Seminal Plasma was the most prevalent allergen, sensitizing 73% of affected women. These women presented localized swelling and burning as prevalent symptoms, affecting 42/68 and 36/68 women, respectively. Cutaneous Prick tests were applied in 58/68 women, either alone or combined with IgE measurements. Regarding cases of indirect/unidentified exposure, house dust mites was the most prevalent allergen (54%), followed by pollen (44%). Predominant symptoms were vulvar pruritus and burning, affecting 67/98 and 52/98 women. Skin prick test was the most prevalent diagnostic method used among different studies. Hypersensitivity toward Candida antigen was present in only half (163/323) of women presenting concomitant allergy and Candida infection.
CONCLUSION
From the two types of allergen exposure that can cause vulvovaginal allergic responses, direct contact of the antigen with the vulva and/or vagina was the most prevalent. Still, allergens can also sensitize the vaginal mucosa secondarily to other exposure route, specifically aeroallergens.
Topics: Allergens; Candidiasis; Female; Humans; Hypersensitivity; Skin Tests; Vulvovaginitis
PubMed: 34825938
DOI: 10.1007/s00404-021-06332-z -
Journal of Geriatric Oncology Apr 2022Vulvar dermatoses are often debilitating chronic skin conditions associated with pain and pruritus. In oncologic patients, cancer treatments can precipitate and... (Review)
Review
Vulvar dermatoses are often debilitating chronic skin conditions associated with pain and pruritus. In oncologic patients, cancer treatments can precipitate and exacerbate vulvar dermatoses. Cytotoxic chemotherapy, hormonal therapies, and local pelvic radiation therapy can lead to vulvar symptoms, and cancer treatment-induced vulvar conditions include graft-versus-host-disease and radiation dermatitis. There have also been reports of lichen sclerosus development or exacerbation secondary to hormonal therapy and immune checkpoint inhibitors, attributed to proposed hormonal and immunologic pathogenesis of lichen sclerosus. Early recognition and treatment of these conditions can significantly improve quality of life. In this review, we summarize the clinical features and management characteristics of six types of common vulvar dermatoses that may present in the oncologic patient.
Topics: Administration, Topical; Female; Humans; Lichen Sclerosus et Atrophicus; Quality of Life; Skin Diseases; Vulvar Diseases
PubMed: 34824022
DOI: 10.1016/j.jgo.2021.10.011 -
Indian Journal of Sexually Transmitted... 2021Vaginal candidiasis is one of the most common vaginal infections in women of reproductive age group caused by species of fungi, a normal inhabitant of vagina.
BACKGROUND
Vaginal candidiasis is one of the most common vaginal infections in women of reproductive age group caused by species of fungi, a normal inhabitant of vagina.
AIMS
The aim is to study the culture characteristics, species prevalence, and drug sensitivity of vulvovaginal candidiasis (VVC) among females with genital pruritus and discharge per vaginum who are proved to have infection by a vaginal smear study.
MATERIALS AND METHODS
A prospective study was done on female patients aged 18 years attending the Sexually Transmitted Diseases Clinic of the Department of Dermato-Venereo-Leprology (DVL), Tirunelveli Medical College, with complaints of genital pruritus and vaginal discharge over a period of 1½ years from 2013 to 2015. After clinical examination, vaginal discharge was smeared for wet mount, potassium hydroxide mount, and Gram stain. Those with pseudohyphae were chosen for culture, speciation, and drug sensitivity.
RESULTS
The most common age group affected was 18-35 years. The most common predisposing factor was HIV infection-induced immunosuppression (48.7%), followed by antibiotic usage and diabetes mellitus. Clinical presentation of VVC was similar in HIV-positive and HIV-negative patients. Recurrent VVC makes up 12% of total cases with most common species being whereas among the non-. Drug sensitivity pattern of showed the highest sensitivity to nystatin 85.7%, followed by triazoles (75%-85%) with ketoconazole being more resistant (40%-60%), and was similar in and non-.
LIMITATIONS
Exclusion of unmarried and pregnant women and lack of follow-up were limitations in our study.
CONCLUSIONS
According to our study, elimination of predisposing factors, speciation of fungus, and treatment based on drug sensitivity pattern will reduce the incidence of VVC.
PubMed: 34765939
DOI: 10.4103/ijstd.IJSTD_49_18 -
Indian Journal of Sexually Transmitted... 2021Vaginal discharge is a common clinical problem with varied etiologies, most common being bacterial vaginosis which presents as homogenous gray discharge caused by...
BACKGROUND
Vaginal discharge is a common clinical problem with varied etiologies, most common being bacterial vaginosis which presents as homogenous gray discharge caused by overgrowth of facultative and anaerobic bacterial species, next common is vulvovaginal candidiasis characterized by pruritus and cottage cheese like discharge followed by vaginal trichomoniasis associated with copious yellow or green and frothy discharge. This necessitates the need to identify the specific cause of vaginal discharge.
AIM
To determine the etiology of pathological vaginal discharges in women attending tertiary care hospital.
METHODOLOGY
698 sexually active females in age group of 15 to 65 years with complaints of vaginal discharge attending Department of Dermatology Venereology and Leprosy at a Tertiary care hospital from June 2017 to May 2018 participated in the study. After presumptive clinical diagnosis vaginal discharge was collected. Wet mounts and 10% KOH preparations were examined immediately. Identification of pathogens was done by Gram stain and culture.
RESULTS
18.33% of 698 patients showed vulvovaginal candidiasis, 13.75% had bacterial vaginosis, 1.86% showed trichomoniasis. Gold standard was considered to be culture for candidiasis & trichomoniasis whereas for bacterial vaginosis it was Nugent's score.
CONCLUSIONS
Vaginal discharge is of multiple yet specific etiologies hence simple and minimal tests like microscopy available in most laboratories (supported by culture wherever possible) would help in accurate diagnosis without over or under treatment of patient due to the empirical therapy. Syndromic management of STIs (WHO guidelines) should be used only in non-specific cases.
PubMed: 34765936
DOI: 10.4103/ijstd.IJSTD_92_18 -
Photobiomodulation, Photomedicine, and... Nov 2021We aimed to evaluate real-world data for the use of fractional CO laser therapy for treating symptoms of vulvovaginal atrophy (VVA). VVA is widespread and can reduce...
We aimed to evaluate real-world data for the use of fractional CO laser therapy for treating symptoms of vulvovaginal atrophy (VVA). VVA is widespread and can reduce the patients' quality of life. There is a lack of data regarding its therapy with laser, especially for daily practice (i.e., real-world data). Thirty-six patients were treated in a single medical center. They consisted of pre- and postmenopausal women and received three fractional CO laser therapy treatments with 3-6 weeks between each treatment. Each patient financed the treatment privately. The symptoms pain, pruritus, dyspareunia, burning, dryness, and dysuria were recorded with a visual analog scale (1-10) before the first, second, and third laser treatment. The data were examined retrospectively. Pain was reduced from a mean of 2.5 points (minimum 0, maximum 9 points) to 1.1 (minimum 0, maximum 8 points) before the third laser treatment. Pruritus showed a mean score of 3.8 (minimum 0, maximum 10 points). This decreased to 1.4 (minimum 0, maximum 8 points). Dyspareunia scored a mean of 6.8 (minimum 0, maximum 10 points). After two laser therapies, the score was 3.3 (minimum 0, maximum 8 points). Burning showed 4.2 points (minimum 0, maximum 10 points). Having experienced two laser therapy sessions, the patients scored 1.5 (minimum 0, maximum 9 points) points. The severity of dryness dropped from 6.5 (minimum 0, maximum 10 points) to 3.3 (minimum 0, maximum 9 points). Dysuria was stated with 1.8 points (minimum 0, maximum 10 points) before the first and 0.5 points (minimum 0, maximum 6 points) before the third laser therapy. All changes showed statistical significance ( < 0.002). This real-world data propose fractional CO laser to reduce VVA-associated genital discomfort, thus being a valuable therapy option for pre- and postmenopausal women.
Topics: Atrophy; Carbon Dioxide; Female; Humans; Quality of Life; Retrospective Studies; Treatment Outcome; Vagina; Vulva
PubMed: 34705527
DOI: 10.1089/photob.2021.0058 -
Taiwanese Journal of Obstetrics &... Sep 2021We report a case of diffuse large B-cell urethral lymphoma initial presenting with non-healing urethra ulcer. (Review)
Review
OBJECTIVE
We report a case of diffuse large B-cell urethral lymphoma initial presenting with non-healing urethra ulcer.
CASE REPORT
A 68-year-old woman presented with a non-healing urethral ulcer accompanied with vulvar pruritus, which failed to medical treatment. Her medical history was unremarkable, lacking fever, weight loss or unexplained fatigue. There were no enlarged lymph nodes or palpable liver or spleen upon physical examination. Pelvic examination revealed an ulcerative lesion arising from the posterior wall of the urethral meatus. Cystourethroscopy showed no bladder involvement. Surgical excision of the urethral ulcer was done and immunohistochemical report showed a diffuse large B-cell lymphoma. Bone marrow needle biopsy and computed tomography were done and the diagnosis of primary diffuse large B-cell urethral lymphoma stage IEA was made. She underwent six cycles of cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab and was free of disease for 51 months.
CONCLUSION
This report of urethral lymphoma was presented as a non-healing ulcer initially, which was totally different previous reports, presenting with bleeding, either vaginal or urinary, urinary frequency, dysuria, urine retention and self-perceived mass, suggesting that unhealed ulcer on the perineal area should be promptly evaluated and avoidance of unnecessary delayed therapy for possible curable disease.
Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cyclophosphamide; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Ulcer; Urethra; Urethral Neoplasms; Vincristine
PubMed: 34507675
DOI: 10.1016/j.tjog.2021.07.025 -
Annals of Medicine Dec 2021In puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation,... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
In puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation, contributing to the onset of sexual dysfunction.
MATERIAL AND METHODS
This was a prospective, randomized, controlled, open-label study (NCT04560283) for evaluating the effects of application of a prolonged-release hyaluronic acid derivative vaginal gel in restoring sexual function during the postpartum period. Eighty-five patients were randomized to apply prolonged-release Hydeal-D 0.2% vaginal gel (Fidia Farmaceutici, Abano Terme, Italy; = 43) every three days for 12 consecutive weeks or expectant management ( = 42).
RESULTS
Women undergoing treatment had a more elevate increase in Female Sexual Function Index (FSFI) total score (+15.1 ± 11.9 vs +6.5 ± 8.9, < 0.001) and a higher decrease in vaginal pH (-1.2 ± 0.7 vs -0.2 ± 1.1; < 0.001). Moreover, the proportion of vaginal smears with maturation index (VMI) >65 was significantly higher in patients treated (80.6% vs 35.3%; = 0.004). Edinburgh Postnatal Depression Scale (EPDS) decreased significantly in both groups with no inter-group difference ( = 0.459). Only two cases (4.8%) of moderate vaginal burning sensation were reported in patients undergoing local vaginal therapy.
CONCLUSIONS
The results of our study demonstrated that hyaluronic acid derivative vaginal gel (Hydeal-D) was able to improve sexual function of puerperal women in the short-term treatment.KEY MESSAGEIn the puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation, contributing to the onset of sexual dysfunction.Hydeal-D is a prolonged-release hyaluronic acid derivative characterised by elevated resistance to enzymatic breakdown. During puerperium, its local application may improve the vaginal microenvironment by ensuring a better migration and proliferation of cells involved in local tissue repair.Among puerperal women, Hydeal-D vaginal gel causes a significant improvement of sexual function, including desire, arousal, and lubrification, compared to expectant management. Furthermore, it leads to a decrease in vaginal pH and an increase of the trophic status of vaginal epithelium.
Topics: Adult; Depression, Postpartum; Female; Humans; Hyaluronic Acid; Italy; Postpartum Period; Prospective Studies; Pruritus; Sexual Dysfunction, Physiological; Vaginal Creams, Foams, and Jellies; Vaginal Diseases
PubMed: 34477473
DOI: 10.1080/07853890.2021.1974083 -
International Journal of Gynaecology... Jun 2022To evaluate the efficacy of the injection of microfragmented adipose tissue in the treatment of women with genitourinary syndrome of menopause (GSM). (Observational Study)
Observational Study
OBJECTIVE
To evaluate the efficacy of the injection of microfragmented adipose tissue in the treatment of women with genitourinary syndrome of menopause (GSM).
METHODS
This observational cohort study included 12 women who received one session of multiple injections of microfragmented adipose tissue using the SEFFIGYN medical device. Symptoms such as burning, itching, dryness, pain on penetration, pain during deep intercourse, and pain on urination were assessed before the patient's treatment (T0), after 15 days (T15), and after 5 months (5Mo) using the Numerical Rating Scale (NRS).
RESULTS
An improvement of vulvar trophism was clinically evident already 2 weeks after treatment; all symptoms were notably attenuated compared with the initial visit, as demonstrated by statistically significant reductions of the NRS scores (P = 0.003 for itching, P = 0.008 for pain on urination, and P < 0.001 for the other symptoms, Sign test). Moreover, all symptoms continued to improve over time. All patients reported a positive change in their quality of life and a resumption of sexual life.
CONCLUSION
The use of microfragmented adipose tissue in GSM is promising. Nevertheless, more studies will be fundamental to exclude a potential placebo effect and better understand the underlying molecular mechanism of action.
Topics: Female; Gynecology; Humans; Menopause; Pain; Pruritus; Quality of Life; Regenerative Medicine; Vagina; Vaginal Diseases
PubMed: 34463351
DOI: 10.1002/ijgo.13906