Vulvovaginitis: Screening for and Management of Trichomoniasis, Vulvovaginal Candidiasis, and Bacterial Vaginosis

Schalkwyk, Julie van; Yudin, Mark H.; Allen, Victoria M.; Bouchard, Céline; Boucher, Marc; Boucoiran, Isabelle; Caddy, Sheila; Castillo, Eliana; Kennedy, V. Logan; Money, Deborah; Murphy, Kellie; Ogilvie, Gina; Paquet, Caroline

doi:10.1016/s1701-2163(15)30316-9

Cited by 136 publications

(123 citation statements)

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“…Ciprofloxacin and other floroquinolones also have proven clinical benefits in case of aerobic vaginitis although contraindicated in pregnancy [19]. However, Van Schalkwyk et al, in their recent study review several systematic reviews, randomized control trials/controlled clinical trials, and observational studies for screening and management of vulvovaginitis and suggested metronidazole, tinidazole and clindamycin for initial treatment of bacterial vaginosis and tricomoniasis whereas, systemic/ or topical azoles are recommended for the treatment of vulvovaginal candidiasis [5]. Similar recommendation is made by the Center of Disease Dontrol and Prevention, USA in their recent treatment guidelines of sexually transmitted diseases [21].…”

Section: Discussionmentioning

confidence: 99%

“…Generally, bacterial vaginosis are associated with a significantly increased risk of pelvic inflammatory disease, post-abortion uterine infection, breast abscess, cervical intraepithelial neoplasia, and posthysterectomy cuff infection [4]. Similarly, Candida albicans is responsible for most episodes of vulvovaginal candidiasis; a very common condition that affects up to 75% of women at least once in their lifetime [5]. Trichomoniasis is the most common non-viral sexually transmitted disease, caused by the parasitic protozoan Trichomonas vaginalis with an estimated 170 million cases occurring worldwide each year [6].…”

Section: Introductionmentioning

confidence: 99%

“…Various studies have revealed that frequent etiology of vaginitis involves imbalances in the normal flora or pH of the vagina, unhygienic practices, improper care during menstruation, pregnancy, diabetes, broadspectrum antibiotic use, immunodeficiency, frequent douching, diaphragm use, oral contraceptives pill use and occasionally, hormonal and allergic factors [1,3,7,8]. Many studies suggest that oral and topical antibiotics such as metronidazole, tinidazole, clindamycin as the stronghold available therapy for the treatment of bacterial vaginosis and trichomoniasis and antifungals such as fluconazole, clotrimazole, itraconazole are effective in vaginal candidiasis or combined therapy in mixed infection cases [2,4,5]. In Nepal, studies related to infectious genital diseases and their risk factors in females are still lacking.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Risk Factors and Medication Use for Infectious Vaginitis Among Females of Reproductive Age Visiting Maternity Hospital of Pokhara, Nepal

Dahal¹,

Jhendi²,

Pun³

et al. 2017

TOPHJ

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Background:Vaginitis is one of the most common gynecological problems in females especially in their reproductive ages and poses significant clinical consequences if left untreated. The study aims to assess the risk factors and medication used for its management in reproductive-aged females with vaginitis visiting maternity hospital of Pokhara, Nepal. Methods and Materials:A prospective cross-sectional study was carried out on females of age group 15-49 years, diagnosed with infectious vaginitis for the period of two months. Assessment was made based on clinical profile, questionnaire and personnel interview. Descriptive statistics was used for analyzing the results of the study. Results:A total of 130 patients were enrolled in the study. Most patients were literate, married and from rural area. Bacterial and fungal infections were common cause for vaginitis representing 56% and 22% respectively. The study shows that the 70% females with infectious vaginitis had a practice of using plain cloth napkins, during their menstruation period and 35% had previous infection in reproductive organ, also risk factors such as pregnancy, use of oral contraceptive, recent antibiotics/steroid use, sexually transmitted disease (STD) and diabetes were commonly present in females with infectious vaginitis. The most frequently (75%) prescribed drug was topical antibacterial -antifungal agents. Metronidazole, cefpodoxime and ciprofloxacin were mostly prescribed among antibiotics whereas fluconazole and clotrimazole were among antifungals. Conclusion:The study recommends need of awareness and educational programs concerning reproductive health and hygiene for females in these areas. Prescribing trend shows slight discrepancy from standard treatment guidelines for vaginal infections.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of Risk Factors and Medication Use for Infectious Vaginitis Among Females of Reproductive Age Visiting Maternity Hospital of Pokhara, Nepal

Dahal¹,

Jhendi²,

Pun³

et al. 2017

TOPHJ

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“…11,12 This increase mainly occur in insulin targeting cells such as adipocytes, hepatocytes, and skeletal muscle cells. [13][14][15] One of mechanisms which regulate the level of gene expression is DNA methylation.…”

Section: Cycling Condition For Amplification Of Il6mentioning

confidence: 99%

Correlation of methylation of toll-like receptor 4 (TLR4) and interleukin-6 (IL6) promoter with insulin resistance in obese adolescents

et al. 2016

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Chronic inflammation can lead to insulin resistance in obesity. Increased mRNA expression of inflammatory markers such as toll-like receptor 4 (TLR4) and interleukin 6 (IL6) were reported both in the tissue and the peripheral blood of obese adolescent and correlated with insulin resistance. DNA methylation surrounding TSS region is known to regulate the level of a gene expression. The aim of the study was to investigate the methylation status of TLR4 and IL6 promoter in peripheral blood of obese adolescent and its correlation to insulin resistance. This was a cross sectional study with observational analytic approached. Fifty adolescents with obesity from Yogyakarta Special Region, aged 15-18 years, z-score value >2 SD, no experience of any acute infections within 2 weeks and signed in informed consent, were selected in this study. Subjects with diabetic mellitus, incomplete data and DNA concentration of <20 µg/mL were excluded. DNA samples were extracted from peripheral blood of the subjects. The bisulfite converted DNA was analyzed for methylation level with direct sequencing. Correlation analysis using Spearman test was performed with significance value was set at p<0.05. No methylation in TLR4 promoter was detected in all subjects. The methylation level of IL6 was transformed to categorical variable. Four (8%) subjects with insulin resistance and 2 (4%) without insulin resistance had methylation on a CpG site. Methylation of IL6 was not statisticaly different between insulin resistance and non-resistance adolescent (p=0.635). The significant correlation was not found between methylation level in IL6 promoter with insulin resistance (HOMA-IR) (r=0.051). Cell specific of methylation mechanism, characteristic of subjects and types of samples were suspected causing those results. In conclusion, no correlation between methylation levels of TLR4 promoter and IL6 with insulin resistance in obese adolescent was observed in this study.Keywords: obesity -methylation -TLR4 -IL6 -direct sequencing J Med Sci, Volume 48, No. 1, 2016 January: 11-25 12 ABSTRAKInflamasi kronis dapat menyebabkan resistensi insulin pada obesitas. Peningkatan ekspresi mRNA pada penanda inflamasi seperti toll-like receptor 4 (TLR4) dan interleukin 6 (IL6) dilaporkan terjadi di jaringan dan darah tepi pada remaja obes dan berhubungan dengan resistensi insulin. Metilasi DNA di sekitar regio Transcriptional Start Site (TSS) berperan pada pengaturan ekspresi gen. Penelitian ini bertujuan untuk mengkaji status promoter TLR4 dan IL6 darah tepi remaja obes dan hubungannya dengan resistensi insulin. Rancangan studi potong lintang dengan pendekatan analitik observasional digunakan pada penelitian ini. Penelitian melibatkan 50 remaja obes di Daerah Istimewa Yogyakarta (DIY), berumur 15-18 tahun, mengalami obesitas dengan skor z >2 SD, tidak memiliki riwayat infeksi akut selama 2 minggu terakhir dan menandatangani surat pernyataan persetujuan keikut sertaan dalam penelitian. Kriteria eksklusi adalah subjek dengan diabetes mellitus, data tidak l...

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“…According to a recently performed literature review BV should be diagnosed using either clinical (Amsel's) or laboratory (Gram stain with objective scoring system) criteria [42]. Amsel's criteria has been presented in section Methods [8].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

A New Effective, User-friendly Bacterial Vaginosis Treatment: A Randomized Multicenter Open-label Parallel-group Two-part Study with a Novel Sustained-release Pessary Containing Oligomeric Lactic Acid

Robertsson¹

2015

INID

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Introduction: Bacterial Vaginosis (BV) is an imbalance in the naturally occurring vaginal bacterial flora resulting in lack of vaginal acidity, inhibition of the normal lactobacilli growth and overgrowth by mixed anaerobic bacterial flora including Gardnerella vaginalis. The prevalence of BV is estimated at approximately 15-30% among fertile women and frequent recurrences several times a year are common. BV has a negative effect on many women's lives, in particular due to the odorous vaginal discharge. First line treatment with antibiotics is associated with adverse events, high relapse rates, and an emerging risk of bacterial drug resistance development. New antibiotic-free treatments with high efficacy and less frequent administration in combination with high patient acceptance are needed.The aim of the present study was to investigate a new sustained release treatment, an Oligomeric Lactic Acid (OMLA) pessary in patients with confirmed BV, and to evaluate BV clearance, pH decrease, adverse events, and patient treatment satisfaction. Methods:The study was a randomized parallel-group open-label two-part study at ten gynecological clinics. Part A: A two-week proof-of-concept evaluation, and Part B: A one-week efficacy evaluation. In Parts A and B, the OMLA pessary was administrated either Once (OW) or Twice (TW) a week and in Part B was also compared to an untreated Control Group (CG). Non-pregnant fertile women with confirmed BV could participate. The main outcome measures were Amsel's criteria to confirm BV, vaginal pH, adverse events, and patient treatment satisfaction.Results: Part A (n=21) showed high safety and treatment efficacy already after one week. In the pooled treatment group, the one week BV clearance ratio was 19/20 (95%). In Part B (n=105) the one week BV clearance ratios were 70.6% in the OW group (p<0.001 vs. CG), 80.0% in the TW group (p<0.001 vs. CG), and 10.0% in the CG. Pooled data from Parts A and B showed a one week BV clearance of 78% in each treatment group. The vaginal pH decreased (p<0.05) in both treatment groups. The results demonstrated high patient treatment satisfaction. Most adverse events were mild and of short duration. Conclusion:The novel OMLA pessary showed a BV treatment efficacy of 78% after one week of single-dose administration. Along with a good safety profile, user-friendliness, and no risk of bacterial antibiotic resistance development, this represents a significant improvement in BV treatment.

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Vulvovaginitis: Screening for and Management of Trichomoniasis, Vulvovaginal Candidiasis, and Bacterial Vaginosis

Cited by 136 publications

References 56 publications

Assessment of Risk Factors and Medication Use for Infectious Vaginitis Among Females of Reproductive Age Visiting Maternity Hospital of Pokhara, Nepal

Assessment of Risk Factors and Medication Use for Infectious Vaginitis Among Females of Reproductive Age Visiting Maternity Hospital of Pokhara, Nepal

Correlation of methylation of toll-like receptor 4 (TLR4) and interleukin-6 (IL6) promoter with insulin resistance in obese adolescents

A New Effective, User-friendly Bacterial Vaginosis Treatment: A Randomized Multicenter Open-label Parallel-group Two-part Study with a Novel Sustained-release Pessary Containing Oligomeric Lactic Acid

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