Key Content Recurrent vulvovaginal candidiasis (RVVC) affects millions of women worldwide. Defined as four or more episodes per year of vulvovaginal candidiasis (VVC), it is a cause of significant morbidity, affecting quality of life, relationships and ability to work. RVVC is uncommon in prepubertal girls and the incidence markedly declines following menopause. Some gynaecologists and trainees have unmet training needs in the optimal assessment and management of RVVC. A multifaceted approach is often required, including vulval skin care, avoidance of triggers and induction and suppression regimes with antifungal drugs. This review combines the current literature on VVC, incorporating data on novel therapies with established standard management protocols. Learning objectives To be able to assess risk factors and correctly diagnose VVC. To know the current management strategies for RVVC and the efficacy of novel therapies. To be aware of the common differentials of bacterial vaginosis and trichomonas vaginalis and their recommended management.
BackgroundMycoplasma genitalium (Mgen) causes non-gonococcal urethritis (NGU) and is believed to cause pelvic inflammatory disease (PID). High rates of macrolide resistance are well documented globally for Mgen. In Brighton, patients with NGU and PID are tested for Mgen and test of cure (TOC) offered post-treatment.MethodsDemographic, clinical and treatment history data were collected over a 12-month period for all Mgen-positive patients in a Brighton-based genitourinary clinic.ResultsThere were 114 patients with Mgen. 18% (61/339) of men with NGU and 9% (15/160) of women with PID had Mgen. 62/114 (54%) returned for first test TOC 4 weeks after treatment. 27/62 (44%) had a positive TOC; 25/27 (92.6%) had received azithromycin first line (500 mg stat then 250 mg OD for 4 days), 1/27 (3.7%) had received moxifloxacin first line (400 mg OD for 14 days) and 1/27 (3.7%) had received doxycycline first line (100 mg BD for 7 days). 20/27 (74%) returned for a second TOC 4 weeks later. 5/20 (25%) patients were positive on second TOC; 3/5 (60%) had received azithromycin second line and 2/5 (40%) had received moxifloxacin second line. Patients were more likely to have a positive TOC if they were at risk of reinfection (9/27 positive TOC vs 3/35 negative TOC; p=0.02). Patients given moxifloxacin were more likely to have a negative TOC (1/27 positive TOC vs 9/35 negative TOC; p=0.03) than those who received other antibiotic regimens.ConclusionsTreatment failure rates for Mgen following azithromycin use are substantial, raising concerns regarding resistance. However, reinfection risk may contribute, suggesting a requirement for improved public awareness and clinician knowledge.
IntroductionTesting forM. genitaliumin the UK is limited and detection has relied on realtime PCR assays. The Hologic AptimaMycoplasma genitaliumTMA assay for use on the Panther® system is now available. This study compared a commercial realtime PCR and the Aptima assay using stored clinical specimens.MethodsClinical specimens (76 urines, 33 vaginal swabs, 2 rectal swabs, 1 pooled sample and 2 unknowns) from men with urethritis and women with pelvic inflammatory disease were tested forM. genitaliumDNA using the FastTrack Diagnostics (FTD) Urethritis Basic assay. Residual specimen was then transferred to an Aptima urine tube and tested for the presence ofM. genitaliumribosomal RNA using the Aptima TMA assay.ResultsOf the 113 specimens tested, 24 (21%) were positive and 87 (77%) negative on both assays. There were two discrepant results (1.7%) in urine specimens that were positive on the Aptima TMA assay and negative on the FTD Urethritis assay. One was confirmed as positive by the Reference Laboratory using their in-house MgPa PCR, indicating a false negative result on the FTD Urethritis assay. The other discrepant result was low level positive on the Aptima TMA assay and negative at the Reference Laboratory.Discussion98% of samples gave concordant results, indicating that both assays are appropriate for use in clinical service. However, the additional positive detected by the Aptima assay, explained by detection of target in multiple copies in each bacterial cell, suggests that this assay is more sensitive.
P atients often present to GPs with intimate problems that they find embarrassing. GPs need to be comfortable dealing with a vast array of sexual health problems and know when to refer to specialist genitourinary medicine (GUM) physicians. Anogenital warts are common, with approximately 130 000 cases treated annually in GUM clinics throughout the UK. However, for patients who do not wish to attend GUM services, or when these are not easily accessible, a basic knowledge of current guidance is essential to ensure that patients can be effectively managed in primary care. The GP curriculum and anogenital warts A combination of Clinical module 3.08: Sexual health and Clinical module 3.21: Care of people with skin problems list the learning objectives required for a GP to adequately diagnose and manage the care of patients with anogenital warts in the community. In particular, GPs are expected to be able to:. Take a sensitive, non-judgemental patient-centred approach to handling sexual health problems. Describe a skin lesion or rash using dermatologically accurate terms. Be prepared to carry out appropriate examination of the skin, including: difficult areas, such as genitalia and mucous membranes. Apply the information gathered from the patient's sexual history and examination to generate a differential diagnosis and formulate a management plan. Recognise how disfigurement and cosmetic skin changes fundamentally affect patients' confidence, mood, interpersonal relationships and even employment opportunities. Coordinate care and make timely, appropriate referrals to specialist services Background and epidemiology Anogenital warts are benign epithelial skin tumours, caused by an infection of keratinocytes with the human papilloma virus (HPV). HPV infection is very common. The virus has over 100 genotypes. However, over 90% of cases of anogenital warts are caused by infection with HPV types 6 and 11. Infection often resolves spontaneously within a year and many people do not develop visible cutaneous lesions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.