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Yazdy GM, Mitchell C, Sobel JD, Tuddenham S. Recurrent Infectious Vaginitis: A Practical Approach for the Primary Care Clinician. Med Clin North Am 2024; 108:373-392. [PMID: 38331486 DOI: 10.1016/j.mcna.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Recurrent infectious vaginitis can lead to significant morbidity, patient frustration, and health care costs. The most common causes are bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC); however, other infectious and noninfectious etiologies should be considered in patients with recurrent symptoms. A detailed history and physical examination with appropriate testing at the time of symptoms is critical to establishing a correct diagnosis. Management options for recurrent BV and VVC are limited. Complex cases including those with atypical symptoms, negative testing for common causes, refractory symptoms despite appropriate therapy or recurrences during suppressive therapy will require referral to specialist care.
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Affiliation(s)
- Golsa M Yazdy
- Department of Gynecology & Obstetrics, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Caroline Mitchell
- Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Jack D Sobel
- Department of Medicine, Division of Infectious Diseases, Wayne State University, 3901 Chrysler Drive Suite 4A, Detroit, MI 48201, USA
| | - Susan Tuddenham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, 5200 Eastern Avenue, MFL Center Tower, Suite 381, Baltimore, MD 21224, USA.
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2
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Blomberg L, Backman K, Kirjavainen PV, Karvonen AM, Harju M, Keski-Nisula L. Vulvovaginal yeast infections, gestational diabetes and pregnancy outcome. BMC Pregnancy Childbirth 2023; 23:70. [PMID: 36703111 PMCID: PMC9878740 DOI: 10.1186/s12884-023-05391-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The primary aim was to evaluate the association between gestational diabetes and blood glucose levels and vulvovaginal yeast infections in pregnancy. Secondly, we clarified the possible associations between maternal and prenatal factors, and birth outcomes and yeast infections. METHODS Three thousand nine hundred sixty-five pregnant women of the Kuopio Birth Cohort Study (KuBiCo) reported vulvovaginal yeast infections during pregnancy, via electronic questionnaires. Maternal and prenatal data, as well as clinical obstetric and early neonatal outcomes were registered during and after birth. The oral glucose tolerance test was performed on 3,079 women during pregnancy. Logistic regression analysis evaluated the possible multivariable associations between yeast infections, gestational diabetes and other prenatal and maternal factors. RESULTS No association was detected between gestational diabetes or blood glucose levels and vulvovaginal yeast infections during pregnancy. In multivariable analysis, women with yeast infections were more often multiparous, with higher education and had used more often antibiotics during pregnancy compared to others. No significant associations were detected in multivariable analysis between infections, the mode of delivery, preterm birth, birth weight or Apgar scores. CONCLUSIONS Women with reported vulvovaginal yeast infections managed generally well during pregnancy. They had no more gestational diabetes or higher blood glucose levels and their newborns managed equally well during early neonatal period.
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Affiliation(s)
- Leeni Blomberg
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Katri Backman
- grid.410705.70000 0004 0628 207XDepartment of Pediatrics, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Pirkka V. Kirjavainen
- grid.14758.3f0000 0001 1013 0499Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland ,grid.9668.10000 0001 0726 2490Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Anne M. Karvonen
- grid.14758.3f0000 0001 1013 0499Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Maijakaisa Harju
- grid.416155.20000 0004 0628 2117Department of Obstetrics and Gynecology, South Karelia Central Hospital, 53130 Lappeenranta, Finland
| | - Leea Keski-Nisula
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XDepartment of Obstetrics and Gynecology, Kuopio University Hospital, PL 100, 70029 Kuopio, Finland
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3
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McLellan J, Heneghan C, Roberts N, Pluddemann A. Accuracy of self-diagnosis in conditions commonly managed in primary care: diagnostic accuracy systematic review and meta-analysis. BMJ Open 2023; 13:e065748. [PMID: 36627158 PMCID: PMC9835960 DOI: 10.1136/bmjopen-2022-065748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of self-diagnosis compared with a clinical diagnosis for common conditions in primary care. DESIGN Systematic review. DATA SOURCES Medline, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews and CINAHL from inception to 25 January 2021. STUDY SELECTION Eligible studies were prospective or retrospective studies comparing the results of self-diagnosis of common conditions in primary care to a relevant clinical diagnosis or laboratory reference standard test performed by a healthcare service provider. Studies that considered self-testing only were excluded. DATA EXTRACTION Two authors independently extracted data using a predefined data extraction form and assessed risk of bias using Quality Assessment of Diagnostic Accuracy Studies-2. METHODS AND RESULTS 5047 records identified 18 studies for inclusion covering the self-diagnosis of three common conditions: vaginal infection (five studies), common skin conditions (four studies) and HIV (nine studies). No studies were found for any other condition. For self-diagnosis of vaginal infection and common skin conditions, meta-analysis was not appropriate and data were reported narratively. Nine studies, using point-of-care oral fluid tests, reported on the accuracy of self-diagnosis of HIV and data were pooled using bivariate meta-analysis methods. For these nine studies, the pooled sensitivity was 92.8% (95% CI, 86% to 96.5%) and specificity was 99.8% (95% CI, 99.1% to 99.9%). Post hoc, the robustness of the pooled findings was tested in a sensitivity analysis only including four studies using laboratory testing as the reference standard. The pooled sensitivity reduced to 87.7% (95% CI, 81.4% to 92.2%) and the specificity remained the same. The quality of all 18 included studies was assessed as mixed and overall study methodology was not always well described. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Overall, there was a paucity of evidence. The current evidence does not support routine self-diagnosis for vaginal infections, common skin conditions and HIV in primary care. PROSPERO REGISTRATION NUMBER CRD42018110288.
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Affiliation(s)
- Julie McLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, Oxfordshire, UK
| | - Annette Pluddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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4
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Thomas-White K, Navarro P, Wever F, King L, Dillard LR, Krapf J. Psychosocial impact of recurrent urogenital infections: a review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231216537. [PMID: 38099456 PMCID: PMC10725120 DOI: 10.1177/17455057231216537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/12/2023] [Accepted: 08/18/2023] [Indexed: 12/18/2023]
Abstract
Recurrent urogenital infections such as bacterial vaginosis, vulvovaginal candidiasis, and urinary tract infections have a high prevalence and pronounced psychosocial impact. However, no review has compared the psychosocial impacts across infection types. This narrative review discusses the impact of common recurrent urogenital infections on psychosocial aspects, including quality of life, stress, mental health, sexual health, work productivity, race and ethnicity, and satisfaction of medical care. Validated questionnaires show that women with recurrent vulvovaginal candidiasis and urinary tract infections have decreased scores on all aspects of quality of life. Those with recurrent vulvovaginal candidiasis and urinary tract infections show lower mental health scores compared to the general population, with increased risk of anxiety and depression. Recurrent urogenital infections affect sexual relationships and intimacy, including avoidance due to symptoms or as a method of prevention. Recurrent infections also increase medical cost and negatively affect work productivity, leading to a combined estimated cost of over US$13 billion per year. There are clear effects of racial inequality involving minority populations that affect diagnosis, treatment, prevalence, and reporting of recurrent urogenital infections. Satisfactory medical treatment improves quality of life and mental health in those suffering from these conditions. Research evaluating psychosocial aspects of recurrent urogenital infections is variable and is not comparable across vulvovaginal conditions. Even so, psychosocial factors are important in understanding contribution and consequence of urogenital infections. Education, awareness, normalization, community support, and access to care can help to alleviate the negative implications of recurrent urogenital infections.
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Affiliation(s)
| | | | | | | | - Lillian R Dillard
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Jill Krapf
- The Centers for Vulvovaginal Disorders, Washington, DC, USA
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5
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Hopkins D, Wilson C, Allard R. Sexually Transmitted Infections in U.S. Military Women: A Scoping Review 2000-2018. Womens Health Issues 2021; 31 Suppl 1:S43-S52. [PMID: 34454703 DOI: 10.1016/j.whi.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/28/2020] [Accepted: 01/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE High rates of sexually transmitted infections (STIs) have been documented among U.S. military servicemembers. The purpose of this scoping review is to evaluate the literature to determine what is known about the risk factors, preventive measures, and health outcomes regarding STIs among active duty servicewomen. METHODS A search of six bibliographic databases and the grey literature identified articles published from January 1, 2000, to December 31, 2018. A two-level review process was used to evaluate the inclusion of articles. RESULTS Fifty-six articles were included. The majority of studies (n = 47) were descriptive (95%). The primary STIs of focus were chlamydia (66%) and gonorrhea (38%), with a lesser focus on herpes simplex virus 1 and 2 (17%) and syphilis (11%). There were no studies on chancroid or pubic lice. Chlamydia and gonorrhea were highly prevalent. Age, race, and gender were nonmodifiable risk factors, whereas behaviors, beliefs, socioeconomic level, marital status, and concomitant or repeat infections were modifiable risk factors. Educational programs and studies evaluating efficacious STI prevention methods were lacking. STI diagnoses occurred in servicewomen at their home stations as well as in deployed settings. CONCLUSION STIs remain an ongoing public health challenge with insufficient research to guide military and health care leaders. Future research should focus on prospective designs that leverage identified risk factors and at-risk populations where the most impact can be made to promote reproductive health.
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Affiliation(s)
- Dawnkimberly Hopkins
- David Grant Medical Center, Clinical Investigation Facility, Travis AFB, Fairfield, California.
| | - Candy Wilson
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland
| | - Rhonda Allard
- Uniformed Services University of the Health Sciences, James A. Zimble Learning Resources Center, Bethesda, Maryland
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6
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Abstract
BACKGROUND An increased incidence in hygiene-related urogenital infections (bacterial vaginitis, vulvovaginal candidiasis, and urinary tract) has been reported in female warfighters serving in austere environments with decreased availability of water and sanitation resources, and when personal safety outweighs concerns for hygiene. Knowledge and access to an innovative kit designed for the female warfighter to self-test, self-identify, and self-treat common urogenital symptoms is critical to force health. PURPOSE The purpose of this descriptive, cross-sectional, exploratory qualitative study was to explore female warfighters': 1) confidence in seeking sex-specific health care in field and deployment environments and 2) acceptance and willingness to self-test, self-identify, and self-treat urogenital symptoms and infections. METHODOLOGICAL ORIENTATION Qualitative data for this thematic analysis were collected during administration of the Military Women's Readiness Urogenital Health Questionnaire. Participants provided open-ended comments associated with three survey questions. Braun and Clarke's inductive thematic analysis method guided the narrative analysis. SAMPLE Our sample included a diverse group of US Army women (USAW; n = 152) from a large, military installation. RESULTS Narratives and themes demonstrate USAW's desire and need for the availability of a self-test and self-treatment kit. Access, time, mission, and prevention of self-harm by quicker resolve of symptoms are cited as key reasons in support of such a kit. CONCLUSIONS AND PRACTICE IMPLICATIONS Nurse practitioners (NPs) are ideally positioned to provide sex-specific educational interventions and anticipatory guidance that supports physical health, to include urogenital conditions. As urogenital self-testing becomes available for female warfighters, NPs are the model healthcare provider for educating women on their use.
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Otsuki K, Kawabata I, Matsuda Y, Nakai A, Shinozuka N, Makino Y, Kamei Y, Iwashita M, Okai T. Randomized trial of the efficacy of intravaginal ulinastatin administration for the prevention of preterm birth in women with a singleton pregnancy and both cervical shortening and inflammation of lower genital tract. J Obstet Gynaecol Res 2018; 45:86-95. [PMID: 30277627 DOI: 10.1111/jog.13796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/01/2018] [Indexed: 01/28/2023]
Abstract
AIM To assess the preventive effect on preterm birth of intravaginal ulinastatin (urinary trypsin inhibitor; UTI) administration during the mid-trimester in women with singleton pregnancy and both cervical shortening and lower genital infections. METHODS Pregnant women with a short cervical length < 25 mm between 16 and 26 weeks of gestation and who had been diagnosed with a lower genital infection were randomly assigned for intravaginal UTI administration or placebo. All of the women were screened for infection or inflammation of the lower genital tract, and women with negative results were excluded. RESULTS Of the 92 patients with a short cervical length who were assessed for eligibility for this study, 86 singleton patients were enrolled. All patients were randomized to one of two treatment groups: patients administered UTI (n = 35) and placebo (n = 35). There were no differences between the two groups in the incidence of preterm delivery before 28, 30, 32, 34 and 37 weeks of gestation and in perinatal outcomes. CONCLUSION For women diagnosed with a short cervical length < 25 mm) between 16 and 26 weeks of gestation and lower genital infection, who were at risk of preterm birth, administration of transvaginal UTI with vaginal irrigation showed no apparent benefit. Future research on the efficacy of UTI should evaluate modified modes of UTI application.
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Affiliation(s)
- Katsufumi Otsuki
- Japanese Organization of Prevention of Preterm Delivery (JOPP) Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ikuno Kawabata
- Japanese Organization of Prevention of Preterm Delivery (JOPP) Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, International University of Health and Welfare, Tochigi, Japan
| | - Yoshio Matsuda
- Japanese Organization of Prevention of Preterm Delivery (JOPP) Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Nippon Medical School, Tama-nagayama Hospital, Tokyo, Japan
| | - Akihito Nakai
- Japanese Organization of Prevention of Preterm Delivery (JOPP) Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, International University of Health and Welfare, Tochigi, Japan
| | - Norio Shinozuka
- Japanese Organization of Prevention of Preterm Delivery (JOPP) Tokyo, Tokyo, Japan.,Fetal Medicine Research Unit, Kanagawa, Hiratsuka, Kanagawa, Japan
| | - Yasuo Makino
- Japanese Organization of Prevention of Preterm Delivery (JOPP) Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshimasa Kamei
- Japanese Organization of Prevention of Preterm Delivery (JOPP) Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Tokyo University, Tokyo, Japan
| | - Mitsutoshi Iwashita
- Japanese Organization of Prevention of Preterm Delivery (JOPP) Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Kyorin University, Tokyo, Japan
| | - Takashi Okai
- Japanese Organization of Prevention of Preterm Delivery (JOPP) Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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8
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Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. THE LANCET. INFECTIOUS DISEASES 2018; 18:e339-e347. [PMID: 30078662 DOI: 10.1016/s1473-3099(18)30103-8] [Citation(s) in RCA: 284] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/28/2017] [Accepted: 12/19/2017] [Indexed: 01/10/2023]
Abstract
Recurrent vulvovaginal candidiasis is a debilitating, long-term condition that can severely affect the quality of life of affected women. No estimates of the global prevalence or lifetime incidence of this disease have been reported. For this systematic review, we searched PubMed, Embase, and Web of Science databases for population-based studies published between 1985 and 2016 that reported on the prevalence of recurrent vulvovaginal candidiasis, defined as four or more episodes of the infection every year. We identified 489 unique articles, of which eight were included, consisting of 17 365 patients from 11 countries. We generated estimates of annual global prevalence, estimated lifetime incidence and economic loss due to recurrent vulvovaginal candidiasis, and predicted the number of women at risk to 2030. Worldwide, recurrent vulvovaginal candidiasis affects about 138 million women annually (range 103-172 million), with a global annual prevalence of 3871 per 100 000 women; 372 million women are affected by recurrent vulvovaginal candidiasis over their lifetime. The 25-34 year age group has the highest prevalence (9%). By 2030, the population of women with recurrent vulvovaginal candidiasis each year is estimated to increase to almost 158 million, resulting in 20 240 664 extra cases with current trends using base case estimates in parallel with an estimated growth in females from 3·34 billion to 4·181 billion. In high-income countries, the economic burden from lost productivity could be up to US$14·39 billion annually. The high prevalence, substantial morbidity, and economic losses of recurrent vulvovaginal candidiasis require better solutions and improved quality of care for affected women.
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Affiliation(s)
- David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland; University of Manchester and National Aspergillosis Centre, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Matthew Kneale
- University of Manchester and National Aspergillosis Centre, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jack D Sobel
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Riina Rautemaa-Richardson
- University of Manchester and National Aspergillosis Centre, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Mycology Reference Centre Manchester, Wythenshawe Hospital, Manchester, UK
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Chekiri-Talbi M, Denning DW. [The burden of fungal infections in Algeria]. J Mycol Med 2017; 27:139-145. [PMID: 28342778 DOI: 10.1016/j.mycmed.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
Abstract
In Algeria, superficial mycoses are very commonly diagnosed. Deep fungal infections are less often observed. Few data from Algeria are found in the literature. We report for the first time the main causes of these diseases in our country and provide burden estimates. We searched for existing data and estimated the incidence and prevalence of fungal diseases based on the population at risk and available epidemiological data. Demographic data were derived from the Service (Office) of the Statistics (ONES), World Health Organization (WHO), The Joint Nations Programme on HIV/AIDS (UNAIDS) and national published reports. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology. Algeria has 40.4 million inhabitants and probably at least 568,900 (1.41 %) of Algerians have a serious fungal infection each year. Recurrent vulvovaginal candidiasis (485,000) and fungal asthma (72,000) are probably the commonest problems as there are over 1 million adult asthmatics. Candidaemia is estimated in 2020, invasive aspergillosis in 2865, intra-abdominal candidiasis in 303 people and are the most common life-threatening problems. AIDS is uncommon, but cancer is not (45,000 new cases of cancer among including 1500 in children) and nor is COPD (an estimated 317,762 patients of whom 20.3 % are admitted to hospital each year). A focus on improving the diagnosis and epidemiological data related to fungal infection is necessary in Algeria.
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Affiliation(s)
- M Chekiri-Talbi
- Pharmacy department, university Saad Dahlab, Blida, Algérie.
| | - D W Denning
- National Aspergillosis Centre, Manchester Academic Health Science Centre, The University of Manchester, University Hospital of South Manchester, Manchester, Royaume-Uni
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10
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Chekiri-Talbi M, Denning DW. Burden of fungal infections in Algeria. Eur J Clin Microbiol Infect Dis 2017; 36:999-1004. [PMID: 28220323 DOI: 10.1007/s10096-017-2917-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022]
Abstract
We report for the first time in Algeria and provide burden estimates. We searched for existing data and estimated the incidence and prevalence of fungal diseases based on the population at risk and available epidemiological data. Demographic data were derived from the National Office of Statistics (Office National des Statistiques: ONS), World Health Organization (WHO), The Joint Nations Programme on HIV/AIDS (UNAIDS) and national published reports. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology. Algeria has 40.4 million inhabitants, and probably at least 568,900 (1.41%) of Algerians have a serious fungal infection each year. Recurrent vulvovaginal candidiasis (485,000) and fungal asthma (72,000) are probably the commonest problems, as there are over 1 million adult asthmatics. Candidaemia is estimated in 2,020 people, invasive aspergillosis in 2,865 people, and intra-abdominal candidiasis in 303 people; these are the most common life-threatening problems. AIDS is uncommon, but cancer is not (45,000 new cases of cancer including 1,500 in children), nor is COPD (an estimated 317,762 patients, of whom 20.3% are admitted to hospital each year). A focus on improving the diagnosis and epidemiological data related to fungal infection is necessary in Algeria.
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Affiliation(s)
- M Chekiri-Talbi
- Pharmacy Department, Université Saad Dahlab de Blida, Blida, 09000, Algeria.
| | - D W Denning
- The University of Manchester, National Aspergillosis Centre, University Hospital of South Manchester and Manchester Academic Health Science Centre, Manchester, UK
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Abstract
PURPOSE OF REVIEW This review aims to determine the effectiveness of the use of syndrome diagnosis in the evaluation of vaginitis and to make suggestions based on the review findings. RECENT FINDINGS Vaginal discharge as the main symptom of vaginitis is unspecific. A randomized study of symptom-based diagnosis and treatment of vaginitis in the USA favored symptoms used for treatment; however, this was only a pilot study. Hence, a population-based study is necessary to validate these findings. Most of the study that assessed treatment of vaginitis in pregnancy reported low diagnostic sensitivity and specificity for bacterial vaginosis and vaginal candidiasis and a wide range for trichomonas vaginalis reflecting ineffectiveness of syndrome-based treatment in pregnancy. A systematic review of the web for relevant literature was made, and appropriate articles were extracted and reviewed. Sensitivity, specificity, and positive values were used, where applicable to determine effectiveness. Forty-three full articles and abstracts were reviewed. Studies that validated or applied WHO algorithm for treatment of vaginitis reported high sensitivity (91.5-100%) but moderate to low specificity (0-27.5%) among women with vaginal symptoms. Studies that focused on symptoms for diagnosis of the three main etiologic agents of vaginitis reported low sensitivity and specificity, while such studies in pregnancy reported sensitivity and specificity ranging from 35.4 to 54% for TV, 11 to 100% for BV, and 0 to 56.2% for trichomonas vaginalis, bacterial vaginosis, and vaginal candidiasis, respectively. Studies that added point of care test reported higher sensitivity and specificity and positive predictive value. The use of WHO syndrome-based algorithm or its modification for treatment of vaginitis though moderately effective has the potential for overtreatment and physician error. Point of care testing and laboratory investigation are essential for productive intervention especially in pregnancy.
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12
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Otsuki K, Nakai A, Matsuda Y, Shinozuka N, Kawabata I, Makino Y, Kamei Y, Iwashita M, Okai T. Randomized trial of ultrasound-indicated cerclage in singleton women without lower genital tract inflammation. J Obstet Gynaecol Res 2015; 42:148-57. [DOI: 10.1111/jog.12880] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 08/11/2015] [Accepted: 08/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Katsufumi Otsuki
- Japanese Organization of Prevention of Preterm Delivery; Tokyo Japan
- Department of Obstetrics and Gynecology; Showa University Koto Toyosu Hospital; Tokyo Japan
| | - Akihito Nakai
- Japanese Organization of Prevention of Preterm Delivery; Tokyo Japan
- Department of Obstetrics and Gynecology; Nippon Medical School, Tama-Nagayama Hospital; Tokyo Japan
| | - Yoshio Matsuda
- Japanese Organization of Prevention of Preterm Delivery; Tokyo Japan
- Department of Obstetrics and Gynecology; International University of Health and Welfare; Tochigi Japan
| | - Norio Shinozuka
- Japanese Organization of Prevention of Preterm Delivery; Tokyo Japan
- Fetal Medicine Research Unit; Kanagawa Japan
| | - Ikuno Kawabata
- Japanese Organization of Prevention of Preterm Delivery; Tokyo Japan
- Department of Obstetrics and Gynecology; Nippon Medical School, Musashi-Kosugi Hospital; Tokyo Japan
| | - Yasuo Makino
- Japanese Organization of Prevention of Preterm Delivery; Tokyo Japan
- Department of Obstetrics and Gynecology; Tokyo Women's Medical University; Tokyo Japan
| | - Yoshimasa Kamei
- Japanese Organization of Prevention of Preterm Delivery; Tokyo Japan
- Department of Obstetrics and Gynecology; Tokyo University; Tokyo Japan
| | - Mitsutoshi Iwashita
- Japanese Organization of Prevention of Preterm Delivery; Tokyo Japan
- Department of Obstetrics and Gynecology; Kyorin University; Tokyo Japan
| | - Takashi Okai
- Japanese Organization of Prevention of Preterm Delivery; Tokyo Japan
- Department of Obstetrics and Gynecology; Showa University School of Medicine; Tokyo Japan
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Abstract
INTRODUCTION Bacterial vaginosis (BV) has been associated with pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. Diagnosis of BV should be rapid, reliable and safe. This is especially vital in pregnant women where intervention may be necessary for the well-being of both the mother and the foetus. AREAS COVERED This paper consulted PUBMED, LISTA and Web of Science for point-of-care and laboratory-based tests commonly used for the diagnosis and management of BV in pregnant women. An overview of strengths and weaknesses of the methods used may partially explain why treatment plans have failed. Differences in sampling and detection methods, time of gestation, inter-examiner variability and interpretation of data, and the use of different reference tests, amongst many other factors, complicated a meta-analysis of the data. EXPERT OPINION Inconsistencies found in clinical and laboratory detection methods used for the monitoring of treatment have a direct impact on success rates. With current advances in technology, the diagnosis of BV is taking on a new perspective. New information implicating specific vaginal biofilms in adverse pregnancy outcomes through the application of advanced technology promises to change the way we view the aetiology, diagnosis and management of BV.
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Affiliation(s)
- Charlene W J Africa
- University of the Western Cape, Department of Medical Biosciences, Life Sciences Building, Cape Town, South Africa.
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14
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Lowe NK, Ryan-Wenger NA. Uncomplicated UTIs in women. Nurse Pract 2012; 37:41-48. [PMID: 22543881 DOI: 10.1097/01.npr.0000413483.52003.f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Empirical diagnosis and treatment of lower urinary tract infection (UTI) in women is the most common clinical approach due to the urgency of symptoms and cost. This study examines the importance of recognizing common symptoms and accurately diagnosing UTIs in the primary care setting.
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Affiliation(s)
- Nancy K Lowe
- University of Colorado College of Nursing, Aurora, CO, USA
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Bruner S, Corbett C, Gates B, Dupler A. Clinical significance as it relates to evidence-based practice. Int J Nurs Knowl 2012; 23:62-74. [PMID: 23281882 DOI: 10.1111/j.2047-3095.2012.01205.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE This paper analyzes the concept of clinical significance (CS) in relation to evidence-based practice (EBP). The purpose is to show that CS terminology is inconsistent in the nursing literature. It is argued that nursing outcomes and interventions that include findings of CS are difficult to interpret due to lack of an operational definition. It is further argued that the absence of a consistent operational definition is incompatible with EBPs which require standardization of terminology. DATA SOURCES The current literature and research studies, particularly from the electronic databases Cumulative Index to Nursing and Allied Health Literature, ISI Web of Knowledge, PubMed, and Cochrane Database of Systematic Reviews. DATA SYNTHESIS The disparate uses of CS negatively impact standardizing and quantifying research outcomes to discern EBPs. The authors propose a definition of CS inclusive of the multifarious uses that were revealed in the literature, and conclude that there is a need for professional nursing consensus to define the term. A standard operational definition of CS would enable consistency as clinicians interpret research findings and facilitate translating research to practice. CONCLUSIONS Given the centrality of CS to interpreting research findings and applying them to practice, there is a need to solidify the terminology of and measurements for CS in nursing. National nursing agencies, including The National Institute for Nursing Research and Sigma Theta Tau International, should make standardizing CS a high priority for targeted funding. One method of doing so would be to support a consensus convergence to review and select the optimal measures of CS for nursing research. Research to increase knowledge about what constitutes measurement and change, or CS from the patient perspective is needed. Editors and peer reviewers should encourage authors to include a discussion of CS. Discussions of CS should receive greater emphasis in research journals. It is hoped that the preliminary findings from the concept analysis presented in this article will facilitate the work of such a consensus forum. IMPLICATIONS FOR NURSING PRACTICE The most immediate and tangible advantages to a common conceptual definition and meaning of CS terminologies by nursing, regardless of which definition is selected, are less confusion and more clarity. Ultimately, the most enduring benefit of a common conceptual definition and measurement for CS is the bridge it provides between research and practice, and the facility with which it promotes the integration of research into EBP.
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Affiliation(s)
- Susan Bruner
- Spokane Resource Group, PLLC, Spokane, Washington, USA.
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Trego LL. Prevention is the Key to Maintaining Gynecologic Health during Deployment. J Obstet Gynecol Neonatal Nurs 2012; 41:283-292. [DOI: 10.1111/j.1552-6909.2011.01337.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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