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Dermatology Online Journal Oct 2010A 60-year-old menopausal female presented with vulvar itching for one year. She had noticed a whitish lesion on the vulva that slowly increased in size over the year....
A 60-year-old menopausal female presented with vulvar itching for one year. She had noticed a whitish lesion on the vulva that slowly increased in size over the year. She had been unsuccessfully treated with oral fluconazole and topical clotrimazole-mometasone combinations and the plaque had gradually spread to involve the clitoris and peri-urethral area. She was neither diabetic nor hypertensive and had no other systemic complaints. Examination revealed a well-defined non-tender whitish plaque situated on her left labia minora and clitoris (Figure 1). A swab from the plaque did not grow any organism. Routine blood chemistry including a VDRL and HIV ELIZA were within normal limits. A punch biopsy from the lesion was taken and histopathology findings were as seen in (Figures 2 and 3).
Topics: Aminoquinolines; Antineoplastic Agents; Diagnosis, Differential; Female; Humans; Imiquimod; Middle Aged; Paget Disease, Extramammary; Pruritus Vulvae; Vaginal Creams, Foams, and Jellies; Vulvar Neoplasms
PubMed: 21062604
DOI: No ID Found -
Taiwanese Journal of Obstetrics &... Jun 2010Mastocytosis is a rare disorder characterized by abnormal accumulation of mast cells in various organs. Clinical complaints include pruritus, cutaneous flushing,...
OBJECTIVE
Mastocytosis is a rare disorder characterized by abnormal accumulation of mast cells in various organs. Clinical complaints include pruritus, cutaneous flushing, dyspepsia, and episodes of anaphylaxis, and are usually the result of local and systemic mast cell mediator release. The triggers include a variety of factors including drugs, exercise, stress, anxiety, and temperature extremes.
CASE REPORT
A 26-year-old primigravida at 40 weeks' gestation with urticaria pigmentosa presented to our hospital. She was diagnosed with cutaneous mastocytosis based on pathologic examination of her skin biopsy. There were no complications during pregnancy, except for cutaneous manifestations with pruritus and premature uterine contractions at 27 weeks' gestation. After admission, antihistamine agents were administered during labor to treat the above symptoms, and antibiotic agents were given for prophylaxis of chorioamnionitis. Labor pain was successfully managed with warm showers, frequent position changes and massage, and therefore, epidural analgesia was not carried out. After 6 hours of labor, the patient gave birth to a healthy female infant via normal spontaneous vaginal delivery with right mediolateral episiotomy. Neither local anesthetic agents nor antibiotic agents caused any reaction. The postpartum period was uneventful.
CONCLUSION
Pregnant women with mastocytosis should be treated symptomatically and should avoid factors that may exacerbate symptoms of disease. Clinicians should be aware of preterm labor during pregnancy. As a preventive measure, resuscitation equipment should be available during the labor, delivery and postpartum period to treat unanticipated hypotension and shock.
Topics: Adult; Biopsy; Female; Humans; Mastocytosis, Cutaneous; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications; Premature Birth; Pruritus; Skin
PubMed: 20708527
DOI: 10.1016/S1028-4559(10)60040-X -
Tropical Medicine & International... Jun 2009Bacterial vaginosis (BV) and Trichomonas vaginalis infection (TV) have been associated with adverse birth outcomes and increased risk for HIV. We compare the performance...
OBJECTIVE
Bacterial vaginosis (BV) and Trichomonas vaginalis infection (TV) have been associated with adverse birth outcomes and increased risk for HIV. We compare the performance of simple inexpensive point-of-care (POC) tests to laboratory diagnosis and syndromic management of BV and TV in poor settings.
METHODS
Between November 2005 and March 2006, 898 sexually active women attending two reproductive health clinics in Mysore, India were recruited into a cohort study investigating the relationship between vaginal flora and HSV-2 infection. Participants were interviewed and screened for reproductive tract infections. Laboratory tests included serology for HSV-2; cultures for TV, Candida sp., and Neisseria gonorrhoeae; Gram stains; and two POC tests: vaginal pH; and Whiff test.
RESULTS
Of the 898 participants, 411 [45.7%, 95% confidence interval (95% CI): 42.4-49.0%] had any laboratory diagnosed vaginal infection. BV was detected in 165 women (19.1%, 95%CI: 16.5-21.9%) using Nugent score. TV was detected in 76 women (8.5%, 95%CI: 6.7-10.4%) using culture. Among the entire study population, POC correctly detected 82% of laboratory diagnosed BV cases, and 83% of laboratory diagnosed TV infections. Among women with complaints of vulval itching, burning, abnormal vaginal discharge, and/or sores (445/898), POC correctly detected 83% (60 of 72 cases) of laboratory diagnosed BV cases vs. 40% (29 of 72 cases) correctly managed using the syndromic approach (P < 0.001). Similarly, POC would have detected 82% (37 of 45 cases) of TV cases vs. 51% (23 of 45 cases) correctly managed using the syndromic approach (P = 0.001).
CONCLUSIONS
In the absence of laboratory diagnostics, POC is not only inexpensive and practical, but also significantly more sensitive than the syndromic management approach, resulting in less overtreatment. .
Topics: Adolescent; Adult; Diagnostic Techniques, Obstetrical and Gynecological; Female; Humans; Hydrogen-Ion Concentration; India; Medically Underserved Area; Odorants; Point-of-Care Systems; Prospective Studies; Pruritus; Trichomonas Vaginitis; Vaginal Discharge; Vaginal Smears; Vaginosis, Bacterial; Young Adult
PubMed: 19392745
DOI: 10.1111/j.1365-3156.2009.02274.x -
Journal of Acquired Immune Deficiency... Apr 2009To determine the safety of the candidate vaginal microbicide SPL7013 gel (VivaGel) when applied to the penis. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To determine the safety of the candidate vaginal microbicide SPL7013 gel (VivaGel) when applied to the penis.
METHODS
A randomized, double-blind, placebo-controlled study. Thirty-six healthy men (18 circumcised, 18 uncircumcised) were randomized in a 2:1 ratio and treated with 3% SPL7013 gel (n = 24) or placebo gel (n = 12), applied once daily for 7 days. Genital toxicity was determined by interview, diary, and examination.
RESULTS
There were 10 genital adverse events (AEs) in 6 men (25%) receiving SPL7013 gel and 5 genital AEs in 4 men (33%) receiving the placebo that were possibly or probably related to the study product (difference of -8%, 95% confidence interval: -40% to 23%, P = 0.70). The most common genital AEs were genital pruritus and application site erythema. All genital AEs were mild (grade 1), and all but 1 in the placebo group were transient. Analysis of vital signs, nongenital AEs, and laboratory results indicated no safety or tolerability issues with SPL7013 gel, irrespective of circumcision status. There was no detectable absorption of SPL7013 into the plasma.
CONCLUSIONS
Three percent SPL7013 gel was safe and well tolerated, and comparable with placebo, when administered to the penis of both circumcised and uncircumcised men once daily for 7 days, with no evidence of systemic absorption or toxicity.
Topics: Adult; Aged; Anti-Infective Agents; Dendrimers; Double-Blind Method; Female; Gels; HIV Infections; Humans; Male; Medication Adherence; Middle Aged; Penis; Polylysine
PubMed: 19214122
DOI: 10.1097/QAI.0b013e318198a7e6 -
Tropical Medicine & International... Dec 2008To examine the association between schistosomiasis and reproductive tract symptoms.
Female genital schistosomiasis--a differential diagnosis to sexually transmitted disease: genital itch and vaginal discharge as indicators of genital Schistosoma haematobium morbidity in a cross-sectional study in endemic rural Zimbabwe.
OBJECTIVE
To examine the association between schistosomiasis and reproductive tract symptoms.
METHOD
A cross-sectional study was conducted in a Schistosoma haematobium-endemic area of rural Zimbabwe. A total of 483 permanently resident adult women of Mupfure Ward aged 20-49 were interviewed and examined clinically, each providing three consecutive urine samples. Logistic regression analysis was used to control for sexually transmitted diseases (STDs).
RESULTS
Women with genital sandy patches had significantly more genital itch (P = 0.009) and perceived their discharge as abnormal (P = 0.003). Eighty percent of the women who had genital itch, yellow discharge, and childhood or current waterbody contact had sandy patches. Fifty-two percent of the women with genital sandy patches did not have detectable S. haematobium ova in urine. Genital schistosomiasis was associated with stress incontinence and pollakisuria, but not with menstrual irregularities, current or previous ulcers, or tumours.
CONCLUSION
Genital schistosomiasis may be a differential diagnosis to the STDs in women who have been exposed to fresh water in endemic areas. Because of the chronic nature of the disease in adults, we suggest to pay special attention to the prevention of morbidity.
Topics: Adult; Animals; Cross-Sectional Studies; Diagnosis, Differential; Endemic Diseases; Female; Genital Diseases, Female; Humans; Middle Aged; Morbidity; Pruritus; Rural Population; Schistosoma haematobium; Schistosomiasis; Sexually Transmitted Diseases; Vagina; Vaginal Discharge; Young Adult; Zimbabwe
PubMed: 19055625
DOI: 10.1111/j.1365-3156.2008.02161.x -
Acta Dermato-venereologica 2008Pramiconazole (R126638) is a novel azole with potent antifungal activity against yeasts, dermatophytes and many other fungal species. The aim of this study was to...
Pramiconazole (R126638) is a novel azole with potent antifungal activity against yeasts, dermatophytes and many other fungal species. The aim of this study was to evaluate the efficacy and tolerance of a single oral dose of 200 mg pramiconazole in acute and recurrent vulvovaginal yeast infections. Thirty-two patients (15 acute and 17 recurrent cases) were KOH microscopy- and culture-positive at inclusion. Clinical cure was 53% at one week and 66% at one month. Mycological eradication was obtained in 88% at one week, whereas at one month 75% of the patients were still culture-negative. Effects in both acute and recurrent cases appeared to be similar for mycological cure. The composite sign and symptom score (sum of scores for oedema, erythema, excoriation pruritus, burning and irritation) had a median value of 7.5 (range 2-17) at inclusion. At one week this value was reduced to 1.0 (range 0-8) and at one month a further reduction to 0 (range 0-11) was seen. p-values compared with baseline at both follow-up visits were <0.001. The drug was well tolerated and the reported adverse events were rare and minimal. In conclusion, the results of this trial indicate that pramiconazole possesses properties that warrant further clinical studies in a larger number of patients with acute and recurrent vulvo notvaginal yeast infection to confirm its efficacy and tolerability.
Topics: Administration, Oral; Adult; Antifungal Agents; Candidiasis, Vulvovaginal; Dose-Response Relationship, Drug; Female; Humans; Imidazoles; Microscopy; Secondary Prevention; Triazoles
PubMed: 18779883
DOI: 10.2340/00015555-0494 -
Postgraduate Medical Journal Aug 2006A Medline search shows that this is the first reported case where vulvovaginal pruritus was treated successfully with a GnRH analogue. The report describes a patient...
A Medline search shows that this is the first reported case where vulvovaginal pruritus was treated successfully with a GnRH analogue. The report describes a patient with chronic premenstrual vulvovaginal pruritus thought to be attributable to autoimmune progesterone dermatitis.
Topics: Adult; Antipruritics; Chronic Disease; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Menstruation Disturbances; Progesterone; Progestins; Pruritus; Pruritus Vulvae; Vaginal Diseases
PubMed: 16891434
DOI: 10.1136/pgmj.2005.043950 -
Infectious Diseases in Obstetrics and... Dec 2005It is estimated that as many as 13 million cases of vulvovaginal infection occur in the United States annually, the majority of which are the result of Candida albicans... (Comparative Study)
Comparative Study Randomized Controlled Trial
An evaluation of butoconazole nitrate 2% site release vaginal cream (Gynazole-1) compared to fluconazole 150 mg tablets (Diflucan) in the time to relief of symptoms in patients with vulvovaginal candidiasis.
BACKGROUND
It is estimated that as many as 13 million cases of vulvovaginal infection occur in the United States annually, the majority of which are the result of Candida albicans infection. The symptoms of vulvovaginal infections are often painful and distressing to the patient. The objective of this study was to compare the time to symptomatic relief of vulvovaginal candidiasis (VVC) with butoconazole nitrate 2% Site Release vaginal cream (Gynazole-1) and oral fluconazole 150 mg tablets (Diflucan).
METHODS
This randomized, open-label, parallel study evaluated 181 female patients with moderate to severe symptoms of VVC. Patients were randomized to single-dose therapy with either butoconazole nitrate 2% Site Release vaginal cream or fluconazole. The primary outcome measure was the time to onset of first relief of symptoms. Secondary measures included the time to overall relief of symptoms and the reinfection rate over the first 30 days following treatment. The overall safety of both products was investigated through the collection of adverse event reports.
RESULTS
The median time to first relief of symptoms occurred at 17.5 h for butoconazole patients as compared to 22.9 h for fluconazole patients (p < 0.001). The time at which 75% of patients experienced first relief of symptoms was 24.5 h versus 46.3 h for butoconazole and fluconazole, respectively (p < 0.001). By 12- and 24-h post-treatment, 44.4% and 72.8% of patients in the butoconazole treatment group reported first relief of symptoms versus 29.1% and 55.7% of patients in the fluconazole group (p = 0.044 and p = 0.024 respectively). In patients experiencing first relief of symptoms within 48 h of dosing, the median time to first relief of symptoms in the butoconazole treatment group was significantly shorter at 12.9 h compared to 20.7 h for the fluconazole treatment group (p = 0.048). There were no significant differences between the two groups with respect to time to total relief of symptoms or reoccurrence of infection within 30 days of treatment. Butoconazole therapy was shown to have fewer reported adverse events, including drug-related adverse events, than fluconazole therapy. Vulvovaginal pruritus and vulvovaginal burning were the most common drug-related adverse events attributed to butoconazole. Headache, diarrhea, nausea, upset stomach and skin sensitivity were the most common drug-related adverse events attributable to fluconazole.
CONCLUSIONS
Single-dose butoconazole nitrate 2% Site Release vaginal cream provides statistically significant improvement in time to first relief of symptoms in the treatment of VVC compared to fluconazole. There is no difference between these two treatments with respect to total relief of symptoms or reinfection rate. Although there was no significant difference in the incidence of adverse events judged by the investigator to be treatment-related, butoconazole treatment did result in fewer patients experiencing adverse events than fluconazole.
Topics: Administration, Topical; Adult; Aged; Antifungal Agents; Candidiasis, Vulvovaginal; Drug Administration Schedule; Female; Fluconazole; Humans; Imidazoles; Middle Aged; Ointments; Tablets; Treatment Outcome
PubMed: 16338779
DOI: 10.1080/10647440500240615 -
MedGenMed : Medscape General Medicine Nov 2004Vaginal symptoms such as discharge, odor, and itch are among the most common presenting complaints in primary care. We undertook to determine if the symptoms associated... (Review)
Review
PURPOSE
Vaginal symptoms such as discharge, odor, and itch are among the most common presenting complaints in primary care. We undertook to determine if the symptoms associated with vaginitis (discharge, odor, irritation) occur in normal women.
METHODS
To answer this question, we performed a literature review. We conducted a Medline search using the following terms: "vagina," "vaginal discharge," "secretion," "odors," discharge," "pruritus," "normal," "irritation," "itch," "physical examination," "healthy," "asymptomatic," "quantity," and "physiology." To find additional references we reviewed textbooks in gynecology, primary care, and physical diagnosis and contacted authors.
RESULTS
There are few primary studies, and most are not of high quality. Existing data show that the quantity and quality of vaginal discharge in healthy women vary considerably both across individuals and in the same individual during the menstrual cycle. Most studies indicate that discharge is greatest at midcycle. Vaginal fluid contains malodorants, and one study of intact vaginal fluid found it to be malodorous. Two studies found that normal women reported irritative symptoms in the course of their menstrual cycle.
CONCLUSIONS
The primary literature indicates that there is a wide variation in the normal vagina and that some of the symptoms associated with vaginal abnormality are found in well women. Both clinicians and their patients would benefit from a better understanding of the range of normal as well as what constitutes a meaningful departure from that range.
Topics: Female; Humans; Prevalence; Pruritus; Vaginal Discharge; Vaginal Diseases
PubMed: 15775876
DOI: No ID Found -
Regional Anesthesia and Pain Medicine 2005Pain after vaginal delivery may result from episiotomy, perineal laceration, or uterine involution. Many women have indwelling epidural catheters in place at delivery.... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Pain after vaginal delivery may result from episiotomy, perineal laceration, or uterine involution. Many women have indwelling epidural catheters in place at delivery. We hypothesized that a small dose of epidural morphine would be an effective strategy for postpartum analgesia.
METHODS
Eighty-one healthy parturients receiving epidural analgesia for labor were enrolled. Patients were randomized in double-blind fashion to 1 of 3 groups: all groups received a 4-mL volume of epidural solution consisting of saline (group 1, control), 1 mg (group 2), or 2 mg morphine (group 3) after vaginal delivery. During the first 24 hours postpartum, patients were evaluated for the amount of oral pain medication requested; visual analog scale scores for pain at rest and with movement; satisfaction with postpartum pain treatment; and opioid side effects including nausea, pruritus, urinary retention, and respiratory depression.
RESULTS
Patients who received 2 mg of epidural morphine used an average of 0.7 (0-1, interquartile range) opioid-containing pain pills (acetaminophen with codeine or oxycodone) compared with 1.2 (0-2) in the 1-mg group and 1.9 (0-3) in the control group ( P = .07). There was a statistically significant difference in oral drug usage between those who received epidural morphine and those who did not ( P < .03). There were no differences in side effects except that at 12 hours postpartum there was an increase in Foley catheterization in the 1-mg morphine group ( P = .007).
CONCLUSIONS
These results suggest that epidural morphine decreases the need for oral pain medication in the first 24 hours postpartum. No significant dose-dependent side effects were found.
Topics: Adolescent; Adult; Analgesia, Epidural; Analgesia, Obstetrical; Analgesics, Opioid; Codeine; Double-Blind Method; Female; Humans; Morphine; Oxycodone; Pain; Pain Measurement; Patient Satisfaction; Postoperative Nausea and Vomiting; Postpartum Period; Prospective Studies; Treatment Outcome; Urinary Retention
PubMed: 15765455
DOI: 10.1016/j.rapm.2004.11.010