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A prospective, randomized, nonblind study was performed to compare the efficacy of a 7-day vaginal regimen with 500 mg metronidazole (Flagyl®) once a day and that of oral treatment with 400 mg metronidazole twice daily for 7 days in the treatment of nonspecific bacterial vaginosis. No treatment was given to the sexual partners and there was no restriction of sexual intercourse. 38 women completed the study and at follow-up after 4 weeks, women receiving vaginal therapy had a cure rate of 79% compared with 74% in the women on oral therapy. Cure rates were lower among users of an intrauterine contraceptive device (57 versus 88% among nonusers). The occurrence of lactate-producing bacteria (lacto-bacilli and aerobic streptococci) in the vagina was significantly higher in women after vaginal compared with oral therapy. Gardnerella vaginlis was isolated in 58% of the women after vaginal and in 44% of the women after oral treatment. It is concluded that vaginal application of 500 mg metronidazole daily for 7 days is equally effective as oral administration in the treatment of bacterial vaginosis.

Because cost-effectiveness of different cervical cytology screening strategies with and without human papillomavirus (HPV) DNA testing is unclear, we used a Markov model to estimate life expectancy and health care cost per woman during the remaining lifetime for 4 screening strategies: (i) cervical cytology screening at age 32, 35, 38, 41, 44, 47, 50, 55 and 60, (ii) same strategy with addition of testing for HPV DNA persistence at age 32, (iii) screening with combined cytology and testing for HPV DNA persistence at age 32, 41 and 50, iv) no screening. Input data were derived from population-based screening registries, health-service costs and from a population-based HPV screening trial. Impact of parameter uncertainty was addressed using probabilistic multivariate sensitivity analysis. Cytology screening between 32 and 60 years of age in 3-5 year intervals increased life expectancy and life-time costs were reduced from 533 to 248 US Dollars per woman compared to no screening. Addition of HPV DNA testing, at age 32 increased costs from 248 to 284 US Dollars without benefit on life expectancy. Screening with both cytology and HPV DNA testing, at ages 32, 41 and 50 reduced costs from 248 to 210 US Dollars with slightly increased life expectancy. In conclusion, population-based, organized cervical cytology screening between ages 32 to 60 is highly cost-efficient for cervical cancer prevention. If screening intervals are increased to at least 9 years, combined cytology and HPV DNA screening appeared to be still more effective and less costly. ' 2007 Wiley-Liss, Inc.Key words: Markov model; health economics; cervical cancer; organized screening Human Papillomavirus (HPV) DNA testing has been accepted as an adjunct to cytology for primary cervical screening in women over 30 years of age. 1,2 The combination of HPV testing and cervical cytology is more sensitive in detecting cervical intraepithelial neoplasia (CIN) lesions with risk for progression to invasive cancer than either method alone, with extremely high negative predictive values. [3][4][5] Several studies have evaluated the economic impact of cervical screening with and without HPV testing, but have reported variable results. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Possible reasons for discrepancies include different modeling methodologies, use of surrogate endpoints and use of input data based on clinical studies that may not have been representative of the population as a whole. However, most modeling studies have consistently found similar reductions of the cumulative lifetime risk of invasive cervical cancer as a result of cytology and HPV DNA screening. 6,11,12,19,[23][24][25] State transition models are used in more than 85% of all costeffectiveness analyses and several cervical cancer state transition models have been reported previously. 26,27 The long-term effects and cost of cytology and HPV screening cannot be captured in clinical trials, where all studies have used surrogate endpoints, such as CIN grade 2 or 3 (CIN2-3). ...