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American Family Physician Dec 2004Common infectious forms of vaginitis include bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Vaginitis also can occur because of atrophic changes.... (Review)
Review
Common infectious forms of vaginitis include bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Vaginitis also can occur because of atrophic changes. Bacterial vaginosis is caused by proliferation of Gardnerella vaginalis, Mycoplasma hominis, and anaerobes. The diagnosis is based primarily on the Amsel criteria (milky discharge, pH greater than 4.5, positive whiff test, clue cells in a wet-mount preparation). The standard treatment is oral metronidazole in a dosage of 500 mg twice daily for seven days. Vulvovaginal candidiasis can be difficult to diagnose because characteristic signs and symptoms (thick, white discharge, dysuria, vulvovaginal pruritus and swelling) are not specific for the infection. Diagnosis should rely on microscopic examination of a sample from the lateral vaginal wall (10 to 20 percent potassium hydroxide preparation). Cultures are helpful in women with recurrent or complicated vulvovaginal candidiasis, because species other than Candida albicans (e.g., Candida glabrata, Candida tropicalis) may be present. Topical azole and oral fluconazole are equally efficacious in the management of uncomplicated vulvovaginal candidiasis, but a more extensive regimen may be required for complicated infections. Trichomoniasis may cause a foul-smelling, frothy discharge and, in most affected women, vaginal inflammatory changes. Culture and DNA probe testing are useful in diagnosing the infection; examinations of wet-mount preparations have a high false-negative rate. The standard treatment for trichomoniasis is a single 2-g oral dose of metronidazole. Atrophic vaginitis results from estrogen deficiency. Treatment with topical estrogen is effective.
Topics: Administration, Intravaginal; Administration, Oral; Anti-Infective Agents; Antifungal Agents; Family Practice; Female; Humans; Metronidazole; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious; Vaginitis
PubMed: 15606061
DOI: No ID Found -
Acta Obstetricia Et Gynecologica... Jan 2005The objective of this study was to determine the prevalence of urogenital complaints in postmenopausal women aged 50 and over.
OBJECTIVE
The objective of this study was to determine the prevalence of urogenital complaints in postmenopausal women aged 50 and over.
METHODS
The study was carried out in the city of Istanbul on women within the age range of 50 and over. The statistical figures for these women were obtained from the latest national census. The number of sampling was determined to be 500, each representing a population of 10,000 women. Thus, the sampling consisted of 500 postmenopausal women who had applied to various health centers either to seek remedy for their health problems other than urinary incontinence (UI) or to accompany inpatients. Women in the surgical stage of menopause were excluded from the study group. A specifically designed questionnaire was used to gather data on urogenital complaints. The data obtained by this means was analyzed according to Thomas criteria, which classifies incontinence as rare, regularly and serious. UI was defined according to the International Continence Society (ICS) classification.
RESULTS
Of the interviewees 68.8% reported UI, 28.8% of whom had serious UI requires continuously the use of ped. It was determined that 37.2% of the women with UI had stress incontinence symptoms, 32.3% urge incontinence symptoms, and 30.5% mixed incontinence. Of the women 46.5% had UI problems for 5 years or longer, and 75% reported that their complaints had started after menopause; 18.2% of the women suffered from vaginal discharge and pruritus, while 23% experienced vaginal dryness; 51.2% of the women were sexually active. However, 83.6% of this group of women reported a decrease in sexual desire and frequency of intercourse. Likewise, 78.1% experienced a decline in sexual satisfaction, 77.7% difficulty in having orgasm, and 45.3% dyspareunia. Logistic regression analysis showed that existence of a chronic illness, frequent urethral infections, a high value of body mass index and chronic constipation increased the prevalence of UI.
CONCLUSIONS
Urinary incontinence and sexual problems, particularly decline in sexual desire, are widespread among postmenopausal women. Frequent urinary tract infections, obesity, chronic constipation and other chronic illnesses seem to be the predictors of UI.
Topics: Aged; Female; Female Urogenital Diseases; Humans; Logistic Models; Middle Aged; Postmenopause; Prevalence; Risk Factors; Sampling Studies; Surveys and Questionnaires; Turkey; Urinary Incontinence
PubMed: 15603571
DOI: 10.1111/j.0001-6349.2005.00645.x -
Infectious Diseases in Obstetrics and... 2001To investigate whether clinical criteria could differentiate between women with vulvovaginitis who were culture positive or negative for vaginal Candida species.
OBJECTIVE
To investigate whether clinical criteria could differentiate between women with vulvovaginitis who were culture positive or negative for vaginal Candida species.
METHODS
Vulvovaginal specimens were obtained from 501 women with a vaginal discharge and/or pruritus. Clinical information and wet mount microscopy findings were obtained. All specimens were sent to a central laboratory for species identification.
RESULTS
A positive culture for Candida species was obtained from 364 (72.7%) of the specimens. C. albicans was identified in 86.4% of the positive cultures, followed by C. glabrata in 4.5%, C parapsilosis in 3.9%, C. tropicalis in 2.7% and other Candida species in 1.4%. Women with a positive Candida culture had an increased utilization of oral contraceptives (26.1% vs. 16.8%, p = 0.02) and antibiotics (8.2% vs. 0.7%, p = 0.001), and were more likely to be pregnant (9.1% vs. 3.6%, p = 0.04) than the culture-negative women. Dyspareunia was more frequent in women without Candida (38.0% vs. 28.3%, p = 0.03) while vaginal erythema (p = 0.01) was more common in women with a positive Candida culture.
CONCLUSIONS
Although quantitative differences were observed, the presence of vaginal Candida vulvovaginitis cannot be definitively identified by clinical criteria.
Topics: Adult; Brazil; Candida; Candidiasis, Vulvovaginal; Diagnosis, Differential; Female; Humans; Pregnancy
PubMed: 11916179
DOI: 10.1155/S1064744901000369 -
Infectious Diseases in Obstetrics and... 2001To compare the efficacy and safety of a 3-day regimen of clindamycin vaginal ovules with a 7-day regimen of clindamycin vaginal cream for the treatment of bacterial... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
OBJECTIVE
To compare the efficacy and safety of a 3-day regimen of clindamycin vaginal ovules with a 7-day regimen of clindamycin vaginal cream for the treatment of bacterial vaginosis (BV).
METHODS
Women with a clinical diagnosis of BV were treated with a 3-day course of clindamycin ovules or a 7-day course of clindamycin cream administered intravaginally. Three hundred and eighty-four patients received study drug and were included in the evaluable patient population (ovule group, n = 204; cream group, n = 180). Assessments included pelvic examination and diagnostic testing. Primary efficacy endpoints were a resolution of two of three diagnostic criteria at the first follow-up visit and three of three diagnostic criteria at the second.
RESULTS
Cure rates in the evaluable patient population were similar between treatment groups: 53.7% (109/204) for the ovule group and 47.8% (85/180) for the cream group (p = 0.2471, 95% CI -4.1-16.0%). The most commonly reported medical event, vulvovaginal pruritus, had similar incidence in both treatment groups.
CONCLUSIONS
A 3-day course of clindamycin vaginal ovules is as effective and well-tolerated as a 7-day course of clindamycin vaginal cream in the treatment of BV.
Topics: Administration, Intravaginal; Adolescent; Adult; Anti-Bacterial Agents; Clindamycin; Drug Administration Schedule; Female; Humans; Middle Aged; Prospective Studies; Statistics, Nonparametric; Vaginal Creams, Foams, and Jellies; Vaginosis, Bacterial
PubMed: 11368263
DOI: 10.1155/S1064744901000035 -
Infectious Diseases in Obstetrics and... 2000Recurrent vulvovaginitis remains difficult to diagnose accurately and to treat. The present investigation evaluated the utility of testing vaginal specimens from women...
OBJECTIVES
Recurrent vulvovaginitis remains difficult to diagnose accurately and to treat. The present investigation evaluated the utility of testing vaginal specimens from women with symptomatic recurrent vulvovaginitis for Candida species by polymerase chain reaction (PCR) and for cytokine responses.
METHODS
Sixty-one consecutive symptomatic women with pruritus, erythema, and/or a thick white discharge and a history of recurrent vulvovaginitis and 31 asymptomatic women with no such history were studied. Vaginal swabs were tested for Candida species by PCR, for the antiinflammatory cytokine interleukin (IL)-10, and for the proinflammatory cytokine IL-12.
RESULTS
C. albicans was detected in 19 (31.1%) of the patients as well as in three (9.7%) controls (P = 0.03). Both IL-10 (31.1% vs. 0%) and IL-12 (42.6% vs. 6.5%) were also more prevalent in the recurrent vulvovaginitis patients (P < 0.001). However, there was no relation between the presence or absence of Candida and either cytokine. Detection of IL-12 in 14 women indicated the stimulation of a vaginal cell-mediated immune response possibly from an infectious agent. The presence of only IL-10 in six patients indicated a suppression of vaginal cell-mediated immunity and was consistent with a possible allergic etiology. The absence of both IL-10 and IL-12 in other patients, similar to that found in healthy controls, suggested a noninfectious, nonallergic etiology of their symptoms.
CONCLUSION
Many women with recurrent vulvovaginitis are not infected with Candida. Testing for Candida should be required in this population. Treatment with only anti-Candida medication will clearly be inadequate for the majority of women with this condition.
Topics: Candida albicans; Candidiasis, Vulvovaginal; Diagnosis, Differential; Female; Humans; Interleukin-10; Interleukin-12; Polymerase Chain Reaction; Recurrence; Sensitivity and Specificity; Vagina; Vulvovaginitis
PubMed: 11220486
DOI: 10.1155/S1064744900000363 -
Acta Obstetricia Et Gynecologica... Jul 1998To compare women with and without a history of recurrent symptoms suggestive of a urinary tract infection but a current negative urine culture regarding symptoms and...
BACKGROUND
To compare women with and without a history of recurrent symptoms suggestive of a urinary tract infection but a current negative urine culture regarding symptoms and signs of a genital infection, carriership of sexually transmitted agents and vaginal flora changes, sexual behavior and genital hygiene practice.
SETTINGS
Contraceptive attendees at family planning and youth clinics.
MATERIALS AND METHODS
Two hundred and seventeen women who reported recurrent symptoms of dysuria, frequent micturition, and urgency and had a negative bacterial urine culture were recruited as cases. Seven hundred and ten culture-negative women lacking such symptoms served as controls. A careful record was made including details about gynecological symptoms, sexual behavior and genital hygiene practice. Gynecological signs were noted at gynecological examination. Genital infections, including sexually transmitted diseases, were diagnosed.
RESULTS
The mean age of the two groups studied was 26.2 and 25.8 years, respectively. Symptoms, such as dysmenorrhea, vaginal discharge, genital pruritus, abdominal pain and superficial dyspareunia were more frequent in the study group than among the controls. On examination, only erythema was observed more often. However, the cases more often had a history of genital herpes and vulvovaginal candidosis. They used tampons only for menstrual purposes, and soap for genital hygiene, but more often used low-pH solutions and took hot baths less frequently. The women with recurrent urinary symptoms more often masturbated and more often had experience of anal sex and sex during menstruation than the control group.
CONCLUSIONS
Sexual behavior and genital hygiene habits may play an etiological role in the lives of women with recurrent episodes of urinary symptoms with a negative bacterial urine culture.
Topics: Adult; Case-Control Studies; Female; Humans; Hygiene; Recurrence; Sexual Behavior; Sexually Transmitted Diseases; Sweden; Urinary Tract Infections; Women's Health
PubMed: 9688244
DOI: 10.1034/j.1600-0412.1998.770613.x -
CMAJ : Canadian Medical Association... Oct 1996
Topics: Clothing; Consumer Behavior; Diagnosis, Differential; Female; Humans; Incontinence Pads; Menstruation; Pruritus Vulvae; Risk Factors; Sexual Behavior; Soaps; Vulvovaginitis
PubMed: 8873621
DOI: No ID Found -
CMAJ : Canadian Medical Association... Oct 1996
Topics: Consumer Behavior; Dermatitis, Contact; Diagnosis, Differential; Female; Humans; Incontinence Pads; Menstruation; Pruritus Vulvae; Vulvovaginitis
PubMed: 8873620
DOI: No ID Found -
The British Journal of General Practice... Nov 1995A variety of definitions have been applied to premenstrual syndrome. The severity of the syndrome is also variable. (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
A variety of definitions have been applied to premenstrual syndrome. The severity of the syndrome is also variable.
AIM
A study was undertaken to compare progesterone pessaries with placebo in the relief of symptoms of premenstrual syndrome. In this study the condition was characterized by a wide range of symptoms recurring in the late luteal phase but absent in the follicular phase (that is, the specific definition published by Dalton in 1953).
METHOD
A multicentre, prospective, double-blind, randomized, parallel group study was undertaken by 45 general practitioners. Patients were deemed eligible after two prospective menstrual cycles of observation (selection phase) in which a precise definition of symptoms was applied. Patients were randomized to use either progesterone pessaries (400 mg twice a day) or matching placebo, by vaginal or rectal administration, from 14 days before the expected onset of menstruation until the onset of vaginal bleeding, for four consecutive cycles. Baseline data for the outcome variables were determined in the selection phase. The main outcome variables were changes in the severity (categorized as none, mild, moderate or severe) of each patient's most severe symptom, and in the average score of all the patient's symptoms characteristic of premenstrual syndrome. Spontaneous reports of adverse events were recorded.
RESULTS
A total of 281 patients were screened for premenstrual syndrome; of these, 141 patients were randomized to treatment or placebo groups. Efficacy was evaluated in 93 patients. Reductions in the scores of the highest scoring, most severe, symptoms and in the average symptom score, were consistently observed in patients receiving progesterone pessaries and in those receiving placebo. The response to progesterone was greater than to placebo during each cycle; the differences were clinically and statistically significant. Adverse events were reported by 51% of patients in the progesterone treatment group and by 43% in the placebo group. Irregularity of menstruation, vaginal pruritus and headache were reported more frequently by patients taking active therapy.
CONCLUSION
In this study, progesterone, given as pessaries by vaginal or rectal administration, was more effective than placebo in the relief of symptoms of premenstrual syndrome in a population of patients selected by strict entry criteria.
Topics: Adolescent; Adult; Double-Blind Method; Female; Humans; Middle Aged; Pessaries; Premenstrual Syndrome; Progesterone
PubMed: 8554838
DOI: No ID Found -
Genitourinary Medicine Jun 1995To assess the prevalence of lower genital tract symptoms and the association between reported symptoms and past and present signs of sexually transmitted diseases (STD)...
OBJECTIVES
To assess the prevalence of lower genital tract symptoms and the association between reported symptoms and past and present signs of sexually transmitted diseases (STD) in young women.
DESIGN
All women belonging to the 19-, 21-, 23- and 25-year age cohorts and living in the catchment area of the community health centre, were invited by mail to take part in a population-based study. The participants answered a structured questionnaire and a gynaecologic examination was performed. Samples for wet smear, cervical Pap smear, HPV DNA determination and Chlamydia trachomatis culture were taken at the gynaecologic examination. The presence of genital warts was noted. A blood sample was analysed for antibodies against C trachomatis and HSV-2.
SETTING
The community health care centre was located in Umeå, a city in Northern Sweden.
RESULTS
Of the 886 women who were eligible, 611 (70%) participated in the investigation. One out of four women reported symptoms from the lower genital tract. The most commonly reported symptoms were itching, followed by discharge, and soreness. The most commonly reported STD was C trachomatis (15%). The most prevalent present STD was HPV infection (20%) whereas C trachomatis infection could be isolated from 2.7% of the women. Antibodies against C trachomatis and HSV-2 were present among 22% and 6% of the women, respectively. There was a significant correlation between the women's complaint of vaginal discharge and previous C trachomatis infection, lack of lactobacilli and presence of leucocytosis in wet smear.
CONCLUSIONS
We have in a population-based study of young healthy women found that one out of four women had some kind of lower genital tract complaint. Itching was the most commonly reported symptom and was associated with pseudohyphae and acetowhite patches. Reported vaginal discharge and soreness were associated with the history of a past C trachomatis infection and signs of a disturbed vaginal flora.
Topics: Adult; Chlamydia Infections; Chlamydia trachomatis; Female; Genital Diseases, Female; Gonorrhea; Humans; Papillomaviridae; Papillomavirus Infections; Prevalence; Pruritus; Sexually Transmitted Diseases; Tumor Virus Infections
PubMed: 7635491
DOI: 10.1136/sti.71.3.158