No abstract

A malodorous, homogeneous, grey, thin and non-purulent discharge, which resembles non-specific vaginitis occurs in 20% of women with an intrauterine contraceptive device (IUCD); four times more common than in non-users. The aim of this investigation was to study the bacteriological aetiology of this IUCD-associated vaginal discharge, and to assess whether the infection was ascendent. No specific microbiological aetiology was found, but the normal, Lactobacillus-dominated microbial vaginal flora was replaced by Gardnerella vaginalis and certain anaerobic species in TUCD-users with the discharge. Clue cells, pepper-salt phenomenon and curved rods andlor fusiform-shaped rods demonstrated by microscopy, were typical of symptomatic patients. The endometrium and the IUCD were infected with these species in the symptomatic group more often than in IUCD-users who had no symptoms or in the control women who did not use the IUCD.

The intracervical device described in this paper consists of copper wire around a small plastic frame that is anchored to the inner wall of the cervix, at about 1.5 cm from the external os. The device represents a radical departure from conventional intrauterine contraception and 'frameless' IUDs, which are anchored to the uterine fundus. The device was evaluated in a preliminary study of 11 women. During the 3-month evaluation period, there were no expulsions or removals for any reason. The device was well tolerated. Expanded clinical trials are planned.

SummaryTo assess the effectiveness and convenience of use ofitraconazole oral capsules in comparison with econazole vaginal capsules, a total of 81 patients with vaginal candidosis were treated for 3 days. The itraconazole group received active itraconazole capsules and placebo vaginal capsules, and the econazole group received active econazole vaginal capsules and placebo capsules in a double-blind (double-dummy) randomised parallel group study. Patients were instructed to both take 2 oral capsules and place I vaginal capsule deep into the vagina each evening. Only outpatients with symptomatic vaginal candidosis proven by yeast culture were included in this trial. Endpoints for evaluation of effectiveness of treatment included mycological cure (the primary variable) at weeks I and 2, symptoms present at weeks I and 2, and counts of the total number of symptomatic days during the treatment and follow-up periods. Significantly more patients in the itraconazole group responded well to the treatment compared with the econazole group at week 1 after the treatment (p = 0.014). At week 2, the difference was not statistically significant, but approached a significant level in favour of itraconazole (p = 0.093). Also, the proportion of asymptomatic patients at week I was higher in the itraconazole group (72.5%) than in the econazole group (63.5%); however, this difference did not reach statistical significance. At week 2, the proportions were similar. The total number of symptomatic days during the study was lower in the itraconazole group compared with the econazole group for all individual symptoms. 80% of patients preferred oral treatment and 5% preferred topical vaginal capsules (p < 0.001). Oral itraconazole was a more effective and more convenient treatment than topical econazole. Both drugs were safe and well tolerated.

This study is based on a uniform material of 3 500 copper IUD insertions at the Family Planning Unit of Turku Health Center, including 72 cases resulting in pregnancy. Among the pregnant subjects there were significantly more women with a retroverted flexed or mid-positioned uterus than in the control material. Repeat IUD pregnancies were rather common. These observations should be taken into account in practice, especially regarding great care with the insertion technique and a close follow-up of these women. The predisposing factors and the outcome of accidental pregnancies are discussed.