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Fang C, Zhou Z, Li J, Zhou M, Chen X. Short-term nitrogen dioxide exposure is associated with the spread of S. pyogenes-induced vulvovaginitis in prepubertal girls in Hangzhou, China. Environ Sci Pollut Res Int 2021; 28:35790-35797. [PMID: 33677663 DOI: 10.1007/s11356-021-13268-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
As a cause of vulvovaginitis in prepubertal girls, Streptococcus pyogenes (S. pyogenes) is commonly isolated from vaginal introitus swabs. Studies have identified several risk factors, but have not focused on the correlation between ambient air pollutants and S. pyogenes-induced vulvovaginitis in prepubertal girls. This study was conducted to determine whether ambient air pollutants were associated with S. pyogenes-induced vulvovaginitis in prepubertal girls. Daily data about S. pyogenes-induced vulvovaginitis in prepubertal girls from the outpatient department of Children's Hospital at the Zhejiang University School of Medicine in Hangzhou City between January 1, 2015, and December 31, 2018, were retrospectively reviewed. Ambient air pollutants in Hangzhou were measured daily. A generalized additive model (GAM) was utilized to assess the associations between daily air pollutants and S. pyogenes isolates obtained from vaginal introitus swabs of prepubertal girls. The mean daily concentration of nitrogen dioxide (NO2) in Hangzhou City during the study period was 44.6 μg/m3 (25th-75th percentiles, 32.0-56.0 μg/m3). The GAM showed that the largest estimate effects in S. pyogenes-induced vulvovaginitis in prepubertal girls were found in NO2 with a moving (accumulative) average on day 3. The excess risk of NO2 in terms of the daily number of S. pyogenes isolates obtained from the vaginal introitus swabs was 14.91% (95% confidence interval [CI]: 4.85-25.94%) in the single-pollutant model. The multipollutant model revealed that an increase of 10 μg/m3 in NO2 exposure was associated with an 18.33% increased risk for acquiring S. pyogenes-induced vulvovaginitis in prepubertal girls (95% CI: 1.21-38.35%; P < 0.05). In conclusion, short-term NO2 exposure was strongly associated with the spread of S. pyogenes-induced vulvovaginitis in prepubertal girls.
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Affiliation(s)
- Chao Fang
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Road, Hangzhou, 3333, Zhejiang Province, China.
| | - Zheng Zhou
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Road, Hangzhou, 3333, Zhejiang Province, China
| | - Jianping Li
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Road, Hangzhou, 3333, Zhejiang Province, China
| | - Mingming Zhou
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Road, Hangzhou, 3333, Zhejiang Province, China
| | - Xuejun Chen
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Road, Hangzhou, 3333, Zhejiang Province, China
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Bruins MJ, Dos Santos CO, Damoiseaux RAMJ, Ruijs GJHM. Bacterial agents in vulvovaginitis and vaginal discharge: a 10-year retrospective study in the Netherlands. Eur J Clin Microbiol Infect Dis 2021; 40:2123-2128. [PMID: 33942163 DOI: 10.1007/s10096-021-04265-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022]
Abstract
Vulvovaginitis is a common problem in the GP's practice. Causes are bacterial vaginosis (BV), Candida infection and sexually transmitted infections (STIs). Only if empirical treatment fails, a vaginal swab is sent in for culture and BV detection. However, without culture essential, bacterial pathogens may escape diagnosis. Many molecular BV assays have recently appeared on the marketplace, all quite differing in price and targets. However, for years, the Nugent score has been the gold standard for BV detection. We analysed retrospectively 10 years of microbiology results of vulvovaginal swabs, focusing on less frequently reported bacterial pathogens, and assessed the characteristics of BV diagnostics. Vulvovaginal swabs sent in between 2010 and 2020 from > 11,000 GP patients with vulvovaginitis associated symptoms, but negative STI tests, were analysed. First cultures and repeat cultures after at least 6 months were included in four age groups: < 12, 12-17, 18-51 and > 51 years. Candida species and BV were most frequently found, with the highest prevalence in premenopausal women. Haemophilus influenzae, beta-haemolytic streptococci, Streptococcus pneumoniae and Staphylococcus aureus were isolated in 5.6% of all cultures, with the highest percentages in children and postmenopausal women. If empirical treatment of vulvovaginitis fails, bacterial culture should be performed to detect all potentially pathogenic microorganisms to obtain a higher rate of successful diagnosis and treatment, avoiding unnecessary antimicrobial use and costs. For BV detection, molecular testing may seem attractive, but Nugent scoring still remains the low-cost gold standard. We recommend incorporating the above in the appropriate guidelines.
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Affiliation(s)
- Marjan J Bruins
- Laboratory of Clinical Microbiology and Infectious Diseases, Isala Hospital, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - Claudy Oliveira Dos Santos
- Laboratory of Clinical Microbiology and Infectious Diseases, Isala Hospital, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Roger A M J Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gijs J H M Ruijs
- Laboratory of Clinical Microbiology and Infectious Diseases, Isala Hospital, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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Sachs A, Guglielminotti J, Miller R, Landau R, Smiley R, Li G. Risk Factors and Risk Stratification for Adverse Obstetrical Outcomes After Appendectomy or Cholecystectomy During Pregnancy. JAMA Surg 2017; 152:436-441. [PMID: 28114513 PMCID: PMC5831452 DOI: 10.1001/jamasurg.2016.5045] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/16/2016] [Indexed: 11/14/2022]
Abstract
Importance Identification of risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy is necessary for evidence-based risk reduction and adequate patient counseling. Objectives To identify risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy and stratify the risk of such outcomes. Design, Setting, and Participants A cohort study was conducted using the Nationwide Inpatient Sample, a nationally representative sample of patients discharged from community hospitals in the United States, from January 1, 2003, to December 31, 2012. Multivariable analysis of risk factors for adverse obstetric outcomes was performed for 19 926 women undergoing appendectomy or cholecystectomy during pregnancy and a scoring system for such risk factors was developed. Data analysis was conducted from January 1, 2015, to July 31, 2016. Main Outcomes and Measures A composite measure including 7 adverse obstetrical outcomes throughout pregnancy and occurring before hospital discharge. Results Of the 19 926 women (mean [SD] age, 26 [6] years) in the study, 1018 adverse obstetrical events were recorded in 953 pregnant women (4.8%). The 3 most frequent adverse events were preterm delivery (360 [35.4%]), preterm labor without preterm delivery (269 [26.4%]), and miscarriage (262 [25.7%]). The risk factors associated most strongly with an adverse obstetrical outcome included cervical incompetence (adjusted odds ratio, 24.29; 95% CI, 7.48-78.81), preterm labor during current pregnancy (adjusted odds ratio, 18.34; 95% CI, 4.95-67.96), vaginitis or vulvovaginitis (adjusted odds ratio, 5.17; 95% CI, 2.19-12.23), and sepsis (adjusted odds ratio, 3.39; 95% CI, 2.08-5.51). A scoring system based on statistically significant variables classified the study sample into 3 risk groups corresponding to predicted probabilities of adverse obstetrical outcomes of 2.5% (≤4 points), 8.2% (5-8 points), and 21.8% (≥9 points). Conclusions and Relevance Approximately 5% of women experience adverse obstetrical outcomes after appendectomy or cholecystectomy during pregnancy. The major risk factors for such outcomes are cervical incompetence, preterm labor during current pregnancy, vaginitis or vulvovaginitis, and sepsis.
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Affiliation(s)
- Adam Sachs
- Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut
- Department of Anesthesiology, University of Connecticut School of Medicine, Farmington
| | - Jean Guglielminotti
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France
| | - Russell Miller
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ruth Landau
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Richard Smiley
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Yanikkerem E, Yasayan A. Vaginal douching practice: Frequency, associated factors and relationship with vulvovaginal symptoms. J PAK MED ASSOC 2016; 66:387-392. [PMID: 27122262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determine the frequency, associated factors and relationship with vulvovaginal symptoms and vaginal douching among Turkish women. METHODS The cross-sectional, analytical study was conducted at Merkez Efendi Hospital, Manisa, Turkey, from January to June 2014 using a questionnaire. Statistical analysis was carried out using SPSS 17. RESULTS Of the total 343 women in the study, 91(26.5%) had reported vaginal douching in the preceding year. Statistically significant relationship was determined between the vaginal douching behaviour and couples who had low educationand low income levels, having unplanned pregnancy and had someone in their neighbourhood who douched (p< 0.05 each). The most common reason for using vaginal douching was reported to be cleanliness by 85(93.4%) women, prevention of genital infections 75(82.4%), cleaning after/before sexual intercourse 72(79%), during menstruation 49(54%), prevention of vaginal discharge 69(76%), decreasing of unpleasant odours 65(71.4%) and religious beliefs 46(50.5%). Self-reported history of vaginal infection was significantly more common for women who douched compared those who did not (p< 0.05). CONCLUSIONS Healthcare providers should determine the reason and risky groups of women and educate the women to stop the vaginal douching behaviour and harmful effects of vaginal douching.
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Affiliation(s)
- Emre Yanikkerem
- Celal Bayar University, School of Health, Istasyonmevki, Uncubozkoykampusu, Manisa, Turkey
| | - Aysegul Yasayan
- Celal Bayar University, Hafsa Sultan Hospital, Uncubozkoykampusu, Manisa, Turkey
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Clegg HW, Giftos PM, Anderson WE, Kaplan EL, Johnson DR. Clinical Perineal Streptococcal Infection in Children: Epidemiologic Features, Low Symptomatic Recurrence Rate after Treatment, and Risk Factors for Recurrence. J Pediatr 2015; 167:687-93.e1-2. [PMID: 26095284 DOI: 10.1016/j.jpeds.2015.05.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/16/2015] [Accepted: 05/19/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the epidemiology of perineal streptococcal infection and recurrence rates following amoxicillin treatment. STUDY DESIGN We used laboratory logs in a single pediatric practice to identify patients 0-18 years of age with perineal cultures positive for group A Streptococcus (GAS) and reviewed their medical charts. We described epidemiologic features, determined recurrence rates following antibiotic treatment, and performed a case-control study to identify possible risk factors for recurrence in patients treated with amoxicillin. RESULTS We found a perineal streptococcal infection rate of 4.6 per 10,000 patient encounters and a recurrence rate in 157 patients with perineal streptococcal infection of 12.4% after amoxicillin. In male patients, the predominant site of involvement was the perianal region (86%), and for female patients, the perivaginal area (62%). Nearly 80% of patients were 2-7 years of age (range 18 days-12.5 years). Perineal streptococcal infection and GAS pharyngitis followed a similar seasonal pattern of occurrence with 65% of perineal streptococcal infection occurring October through March. In patients with perineal streptococcal infection, 95% had a concomitant pharyngeal culture positive for GAS. Best predictive factors for recurrence after amoxicillin were longer duration of symptoms prior to diagnosis and having a sibling with perineal streptococcal infection at some time before or after the initial episode. CONCLUSIONS Following treatment with amoxicillin, we found a low recurrence rate of 12.4%. Amoxicillin can be expected to be reliable first-line therapy for perineal streptococcal infection.
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Johnsson KM, Ptaszynska A, Schmitz B, Sugg J, Parikh SJ, List JF. Vulvovaginitis and balanitis in patients with diabetes treated with dapagliflozin. J Diabetes Complications 2013; 27:479-84. [PMID: 23806570 DOI: 10.1016/j.jdiacomp.2013.04.012] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/29/2013] [Accepted: 04/29/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Vulvovaginitis, balanitis, and related genital infections are common in patients with type 2 diabetes. Glucosuria, which is an outcome of treatment with sodium glucose cotransporter 2 (SGLT2) inhibitors, is among the possible causes. Dapagliflozin, an SGLT2 inhibitor with demonstrated glycemic benefits in patients with diabetes, has been studied across a broad spectrum of patients. Analysis of multi-trial safety data may better define the relationship between glucosuria and genital infection. METHODS Safety data were pooled from 12 randomized, placebo-controlled Phase 2b/3 trials to analyze the association of glucosuria with genital infection in patients with suboptimally controlled diabetes (HbA1c >6.5%-12%). Patients were randomized to receive dapagliflozin (2.5mg, 5mg, or 10mg) or placebo once daily, either as monotherapy or add-on to metformin, insulin, sulfonylurea, or thiazolidinedione for 12-24weeks. The incidence of clinical diagnoses and of events suggestive of genital infection was evaluated. RESULTS The pooled safety data included 4545 patients: 3152 who received once-daily dapagliflozin (2.5mg [n=814], 5mg [n=1145], or 10mg [n=1193]) as monotherapy or add-on treatment, and 1393 placebo-treated patients. For dapagliflozin 2.5mg, 5mg, 10mg, and placebo, diagnosed infections were reported in 4.1%, 5.7%, 4.8%, and 0.9%, respectively. Most infections were mild or moderate and responded to standard antimicrobial treatment. Discontinuation due to these events was rare. No clear dose-response relationship between dapagliflozin and genital infection was demonstrated. CONCLUSIONS Treatment with dapagliflozin 2.5mg, 5mg, or 10mg once daily is accompanied by an increased risk of vulvovaginitis or balanitis, related to the induction of glucosuria. Events were generally mild to moderate, clinically manageable, and rarely led to discontinuation of treatment.
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Abstract
Vulvovaginitis, labial adhesions, and other vulvar disorders occur commonly in children and can provoke high anxiety in both the parent and child. Performed correctly, the pediatric gynecologic examination can diagnose and treat, educate and reassure both parent and child. This examination requires patience, sensitivity, direct communication with the child as well as with the parent, and an open manner that inspires trust in both parties to manage a potentially anxiety-provoking situation. This chapter will review common vulvar disorders, including vulvovaginitis, lichen sclerosis et atrophicus, bubble bath vaginitis, labial adhesions, urethral prolapse, and other common problems. A discussion of childhood sexual abuse is beyond the scope of this chapter, with appropriate references available elsewhere. Practical pearls will be offered to make this exam easy for the primary care clinician and/or subspecialist.
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Affiliation(s)
- Ellen S Rome
- Section of Adolescent Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine at Case, Cleveland, Ohio, USA
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Nomelini RS, Carrijo APB, Adad SJ, Nunes AA, Murta EFC. Relationship between infectious agents for vulvovaginitis and skin color. SAO PAULO MED J 2010; 128:348-53. [PMID: 21308158 PMCID: PMC10948073 DOI: 10.1590/s1516-31802010000600007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 10/13/2010] [Accepted: 10/13/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Many factors influence occurrences of vulvovaginitis. The aims here were to assess skin color and age-related differences in the vaginal flora and occurrences of vulvovaginitis. DESIGN AND SETTING Cross-sectional study; tertiary referral hospital (Universidade Federal do Triângulo Mineiro, Uberaba). METHODS Healthy women who underwent routine outpatient gynecological assessments were assessed for vulvovaginitis and vaginal flora and then divided into whites (n = 13,881) and nonwhites (n = 5,295). Statistical analysis was performed using the X² test, logistic regression and odds ratios. RESULTS The vaginal microflora was skin-color dependent, with greater occurrence of clue cells, Trichomonas vaginalis and coccobacilli in nonwhite women (p < 0.0001). Döderlein bacilli and cytolytic flora were more prevalent in white women (p < 0.0001 and p < 0.05, respectively). The vaginal microflora was age-dependent within the skin color groups. Among the nonwhite women, clue cells were more prevalent in women aged 21 to 50 years; Trichomonas in women up to 40 years and coccobacili in women between 21 and 40 years (P < 0.05). During the proliferative and secretory phases, the nonwhite women were more likely to present clue cells, Trichomonas, Candida and coccobacilli (OR, proliferative phase: 1.31, 1.79, 1.6 and 1.25 respectively; secretory phase: 1.31, 2.88, 1.74 and 1.21 respectively), while less likely to present Döderlein flora (OR, proliferative phase: 0.76; secretory phase: 0.66), compared with white women, irrespective of age. CONCLUSIONS There are differences in vulvovaginitis occurrence relating to skin color, which may be associated with variations in vaginal flora.
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Affiliation(s)
- Rosekeila Simoes Nomelini
- Instituto de Pesquisa em Oncologia, Discipline of Gynecology and Obstetrics, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
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Olejek A, Kellas-Sleczka S, Kozak-Darmas I, Bilska A, Zamłyński J, Horak S, Nowak L. [Vulvovaginitis in young girls]. Ginekol Pol 2009; 80:931-934. [PMID: 20120939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Vulvovaginitis is the most common cause of gynecological complaints in young girls. Factors which cause vulvovaginitis include, among other things, low level of sexual hormones (hypoestrogenism), the anatomical proximity of the rectum and delicate vulvar skin and vaginal mucosa. Usually vulvovaginitis in young girls is caused by non-specific factors. The aim of the study was to present the most frequent causes of vulvovaginitis in young girls.
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Affiliation(s)
- Anita Olejek
- Katedra i Oddział Kliniczny Ginekologii, Połoznictwa i Ginekologii Onkologicznej w Bytomiu, Slaski Uniwersytet Medyczny w Katowicach.
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Blum S, Brenner J, Friedgut O, Stram Y, Koren O, Dagoni I, Munbaz A, Elad D. Isolation of Porphyromonas levii from vaginal samples from cows in herds negative for bovine necrotic vulvovaginitis. Vet Rec 2008; 163:745-747. [PMID: 19103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- S Blum
- Department of Clinical Bacteriology and Mycology, Kimron Veterinary Institute, PO Box 12, 50250 Bet Dagan, Israel
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Campos ACC, Freitas-Junior R, Ribeiro LFJ, Paulinelli RR, Reis C. Prevalence of vulvovaginitis and bacterial vaginosis in patients with koilocytosis. SAO PAULO MED J 2008; 126:333-6. [PMID: 19274321 DOI: 10.1590/s1516-31802008000600008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Accepted: 11/03/2008] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Empirical discussion regarding an association between koilocytosis and vulvovaginitis often occurs. Thus, the objective of this study was to assess the prevalence of microorganisms associated with bacterial vaginosis and vulvovaginitis in women with and without koilocytosis. DESIGN AND SETTING Analytical cross-sectional study including two cohorts of women (with and without koilocytosis) who attended a cancer hospital in the city of Goiânia, state of Goiás. METHODS A total of 102 patients entered the study. The whiff test, Gram and Papanicolaou staining and bacterial and fungal culturing were performed. The results were observed using univariate analysis. The odds ratio and confidence interval (CI) of the variables were calculated; P-values < 0.05 were considered significant. RESULTS The prevalence of bacterial colonization was similar in patients with and without koilocytosis. The odds ratio for candidiasis was 1.43 (CI 1.05-1.95) and the odds ratio for trichomoniasis was 1.78 (CI 1.49-2.12), in patients with koilocytosis. CONCLUSIONS The prevalence of candidiasis and trichomoniasis seems to be higher in patients with koilocytosis.
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Affiliation(s)
- Ana Claudia Camargo Campos
- Breast and Gynecology Service, Hospital Araújo Jorge, Associação de Combate ao Câncer em Goiás, Goiânia, Goiás, Brazil
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Blum S, Mazuz M, Brenner J, Friedgut O, Koren O, Goshen T, Elad D. Effects of bovine necrotic vulvovaginitis on productivity in a dairy herd in Israel. Vet J 2008; 176:245-7. [PMID: 17433735 DOI: 10.1016/j.tvjl.2007.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 01/16/2007] [Accepted: 02/24/2007] [Indexed: 10/23/2022]
Abstract
Bovine necrotic vulvovaginitis (BNVV) is characterized by the development of a necrotic vulvovaginal lesion, almost exclusively in post-parturient first-lactation cows, associated with Porphyromonas levii. The scope of this survey was to evaluate the impact of BNVV on herd productivity as a means to rationally evaluate the resources that should be allocated in dealing with the syndrome. During an outbreak of BNVV in a dairy herd, following the introduction of a large number of cows from another farm, the impact of the animals' origin (local or transferred) and BNVV (positive or negative) upon involuntary culling rate, milk yield and days between pregnancies were assessed. The results indicated that the number of days between pregnancies was significantly higher in first-lactation cows with BNVV but was not influenced by the other independent variables. None of the other variables included in this survey had any effect on the involuntary culling rate and milk yield.
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Affiliation(s)
- S Blum
- Department of Clinical Bacteriology and Mycology, The Kimron Veterinary Institute, P.O. Box 12, 50250 Bet Dagan, Israel
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Mohanty S, Xess I, Hasan F, Kapil A, Mittal S, Tolosa JE. Prevalence & susceptibility to fluconazole of Candida species causing vulvovaginitis. Indian J Med Res 2007; 126:216-219. [PMID: 18037716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND & OBJECTIVE Vulvovaginal candidiasis is an important cause of morbidity in women of reproductive age. This study was carried out to determine the species prevalence and susceptibility pattern to fluconazole of yeasts isolated from the vagina of symptomatic women. METHODS This prospective study was conducted in a rural primary health care center of north India from May 2003 to April 2004 and included 601 married, sexually active women (18-49 yr) with the self reported symptoms of vaginal discharge and/or genital itching and/or genital burning. Specific aetiology of the genitourinary symptoms including candidal infection were determined. Specimens from the lateral wall of vagina were subjected to direct wet mount microscopy and fungal culture on Sabouraud's dextrose agar. Susceptibility testing to fluconazole was carried out using broth microdilution method. RESULTS Yeasts were isolated in 111 (18.5%) women and these consisted of Candida glabrata (56, 50.4%), C. albicans (39, 35.1%), C. tropicalis (12, 10.8%), C. krusei (3, 2.7%) and C. parapsilosis (1, 0.9%). Susceptibility testing carried out on 30 representative isolates (15 C. glabrata, 10 C. albicans, 4 C. tropicalis and 1 C. parapsilosis) revealed that 21 isolates (70%) were susceptible (MIC, < or = 8 microg/ml) to fluconazole while 9 (30%) were susceptible-dose dependent (S-DD, MIC 16-32 microg/ml). INTERPRETATION & CONCLUSION Our findings suggest a low prevalence of fluconazole resistance in vaginal candida isolates in our population. However, a high prevalence of non-albicans candida species and increased dose-dependent resistance in these isolates necessitates vigilance since this may warrant a change in the optimal therapy of non-albicans candida vaginitis.
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Affiliation(s)
- Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Blum S, Mazuz M, Brenner J, Friedgut O, Stram Y, Koren O, Goshen T, Elad D. Sample-based assessment of the microbial etiology of bovine necrotic vulvovaginitis. Theriogenology 2007; 68:290-3. [PMID: 17553557 DOI: 10.1016/j.theriogenology.2007.05.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Revised: 03/19/2007] [Accepted: 05/05/2007] [Indexed: 11/23/2022]
Abstract
A semiquantitative evaluation of potential bacterial pathogens was correlated to the severity of lesions during an outbreak of bovine necrotic vulvovaginitis (BNVV) on an Israeli dairy herd. Bacteriologic examination of 287 vaginal swabs from 104 post-calving heifers showed a highly significant correlation between Porphyromonas levii colony forming unit numbers and the clinical scores of the lesions, when assessed by an ordinal regression statistical model. No such correlation was found for the other bacteria included in the study. Nineteen samples taken for virological examinations resulted negative for bovine herpes viruses 1, 2, 4 and 5. Thus the results of this study substantiate the essential role of P. levii in the etiology of BNVV and indicate that BHV4 is not required as a predisposing factor to the syndrome.
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Affiliation(s)
- S Blum
- Department of Clinical Bacteriology and Mycology, The Kimron Veterinary Institute, P.O. Box 12, 50250 Bet Dagan, Israel
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Affiliation(s)
- I Yeruham
- 'Hachaklait' Gedera and the Koret School of Veterinary Medicine, the Hebrew University of Jerusalem, po Box 12, Rehovot 76100, Israel
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Buitrón García R, Bonifaz A, Amancio Chassin O, Basurto Kuba E, Araiza J, Romero Cabello R. [Correlation between clinical characteristics and mycological tests in the vulvovaginitis by Candida]. Ginecol Obstet Mex 2007; 75:68-72. [PMID: 17542254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Vulvovaginitis caused by Candida sp is one of the most frequent infections. OBJECTIVES To culture and to identify the fungi related to clinical manifestations of patients based on a suspected diagnosis of vulvovaginal candidiasis. PATIENTS AND METHODS A prospective, transversal and comparative study was performed on 181 women older than 18 years with vulvovaginitis by Candida sp. A correlation was made between the clinical characteristics of this entity and mycological tests such as direct examination and cultures. RESULTS The direct exam or fresh vaginal exam and cervical sample was positive for the different microscopic forms of Candida (blastoconidia, pseudohyphye or pseudomycelia) in 60.8% (110 women); at the same time that cultures were positive for Candida sp in 51.9% (94 patients). CONCLUSIONS The direct examination and the cultures of vaginal and cervical exudate are mandatory tests for diagnosis of Candida sp in women with vulvovaginitis.
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Fosch S, Fogolín N, Azzaroni E, Pairetti N, Dana L, Minacori H, Tita I, Redona M, Gribaudo G. [Vulvovaginitis: correlation with predisposing factors, clinical manifestations and microbiological studies]. Rev Argent Microbiol 2006; 38:202-5. [PMID: 17370572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Vaginitis (V) and bacterial vaginosis (BV) are one of the most common reasons the middle class patient has to consult a gynaecologist. The purpose of this work is to analyse samples of vaginal fluid targeting the infection etiology and its relationship to related factors: (intrauterine devices, contraceptive pills, condoms, use of antibiotics), symptoms and signs. From November 1, 2001 to October 30, 2003, a cross-section study was carried out of 400 nonpregnant, sexually active women in an age range of 15 to 55. Vaginal secretions were analysed by Gram and Giemsa stains and culturing was used. Interpreting: (1) normal--no observable changes, absence of the infecting agents studied here; (2) infected--changes observed: bacterial vaginosis, vaginal candidiasis (CV) and trichomoniasis (TC) and (3) imbalance in vagina ecology, with medium alterations (D). Results obtained: (1) normal: 209 (52.2%); infected: 115 (28.8%) including 13.5% VB, 12.5% CV, 2.8% TC, and (3) 76 (19%) with imbalance of vagina ecology. Bacterial vaginosis and flora imbalance were related to the use of intrauterine devices, and candidiasis to contraceptive pills and previous antibiotic use. The number of symptoms increased in patients with vaginal candidiasis and trichomoniasis.
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Affiliation(s)
- S Fosch
- Division Bacteriología, Laboratorio CEDIBI, Sanatorio NOSTI, Avda. Mitre 325 (2300) Rafaela, Pcia. de Santa Fe, Argentina.
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Jackson ST, Mullings AM, Rainford L, Miller A. The epidemiology of mycotic vulvovaginitis and the use of antifungal agents in suspected mycotic vulvovaginitis and its implications for clinical practice. W INDIAN MED J 2005; 54:192-5. [PMID: 16209225 DOI: 10.1590/s0043-31442005000300007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Data in the Caribbean documenting the speciation of yeast associated with vulvovaginitis are lacking. The widespread use of antibiotics and increased availability of antimycotic agents, both prescribed and over-the-counter, predisposes both to a change in the epidemiologic patterns and the possible development of secondary resistance among previously susceptible yeast. This study was conducted to evaluate the aetiologic agents associated with mycotic vulvovaginitis and to review the appropriateness of prescribed antifungal therapy. Of 134 positive isolates, the most frequent yeast isolate was C. albicans accounting for 78%, C. tropicalis 10%, Prototheca wickerhamii (P. wickerhamii) 5%, C. glabrata 4%, Cryptococcus albidus (C. albidus) 2% and C. lusitaniae (1%) were also isolated. Of the positive cases, 75% were treated with antifungals, 17% with antibiotics and 8% were not treated. The azole group was the most frequently prescribed antifungal (71%). Of cases with negative yeast cultures, 83% were treated with antifungals. The presence of non-albicans Candida species and other opportunistic fungi is an important finding and combined with the pattern of therapy, represents a major challenge for future empirical therapeutic and prophylactic strategies in the treatment of mycotic vulvovaginitis.
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Affiliation(s)
- S T Jackson
- Department of Microbiology, The University of the West Indies, Kingston 7, Jamaica West Indies.
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Buscemi L, Arechavala A, Negroni R. [Study of acute vulvovaginitis in sexually active adult women, with special reference to candidosis, in patients of the Francisco J. Muñiz Infectious Diseases Hospital]. Rev Iberoam Micol 2004; 21:177-81. [PMID: 15709796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
The results of microbiological vaginal secretions samples obtained from 749 women (from July 2001 to July 2002) were studied in the Bacteriology Unit of the Francisco Javier Muñiz Hospital from Buenos Aires. All patients suffered acute vulvovaginitis were child bearing and sexually active women, 334 of them were HIV-positive. The following are the results of the microbiological studies: Lactobacillus spp 50.6%, Gardnerella vaginalis 25.6%, Candida spp 17.4%, Trichomonas vaginalis 5.3%, Neisseria gonorrhoeae 0.3% and B group Streptococcus 0.8%. Candida vaginitis was significantly more frequent in HIV-positive patients, (21.6% vs 14%; p = 0.0086); meanwhile, trichomoniasis was less common although the difference was not statistically significant (3.6 vs 6.7%, p = 0.0810). The following Candida species were isolated in this study: Candida albicans 76.8%, Candida glabrata 15.6%, Candida parapsilosis 2.9%, Candida tropicalis 1.5% and Candida krusei 0.7%. Eight cases (6.2%) of vaginitis were produced by two Candida species (C. albicans and C. glabrata), and in three cases (2.17%) Saccharomyces cerevisiae were isolated. Five women suffering acute vaginitis with Candida spp presented another etiologic agent of vaginal infection, three cases T. vaginalis and two cases G. vaginalis. The following are some of the most important findings of this study: 1) Half of the patients presented a normal microbial biota; 2) Candida spp vaginitis was significantly more frequent among HIV-positive women; 3) we observed a high incidence of Candida glabrata infections (15.9%), 4) 6.2% of vaginal candidiasis were caused by more than one Candida species and, 5) the susceptibility pattern of C. albicans and C. glabrata isolates against fluconazole was similar to the one observed in other studies. The majority of C. albicans isolates were susceptible to fluconazole (MIC90 = 0.5 microg/ml) meanwhile C. glabrata strains were much less susceptible to this drug (MIC50 and MIC90 = 32 microg/ml).
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Affiliation(s)
- Luis Buscemi
- Unidad Bacteriología, Hospital de Infeccionsas Francisco Javier Muñiz, Buenos Aires, Argentina
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20
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Elad D, Friedgut O, Alpert N, Stram Y, Lahav D, Tiomkin D, Avramson M, Grinberg K, Bernstein M. Bovine necrotic vulvovaginitis associated with Porphyromonas levii. Emerg Infect Dis 2004; 10:505-7. [PMID: 15109423 PMCID: PMC3322791 DOI: 10.3201/eid1003.020592] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An outbreak of bovine necrotic vulvovaginitis associated with Porphyromonas levii, an emerging animal and human pathogen, affected 32 cows on a dairy farm in the northeast of Israel. Five animals had to be culled. This report appears to be the first that associates P. levii with bovine necrotic vulvovagnitis.
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Affiliation(s)
- Daniel Elad
- Department of Clinical Bacteriology and Mycology, Kimron Veterinary Institute, PO Box 12, Bet Dagan 50250, Israel.
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Boselli F, Chiossi G, Garutti P, Matteelli A, Montagna MT, Spinillo A. [Preliminary results of the Italian epidemiological study on vulvo-vaginitis]. Minerva Ginecol 2004; 56:149-53. [PMID: 15258544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM The aim of this work was to evaluate the prevalence of symptomatic vulvo-vaginal infections among the Italian female population and the diagnostic approach of 158 Italian gynaecologists. METHODS A total of 1644 patients were enrolled in this survey. A presumed diagnosis of vulvovaginal infection was made according to specific clinical and laboratory criteria (pH e sniff test) in 902 (55.4%) cases, whereas a definitive diagnosis was made in 1439 (87.5%) cases. The definitive diagnoses were as follows: 844 (51.3%) vulvovaginal mycosis, 327 (19.9%) bacterial vaginosis, 110 (6.7%) trichomonal infection, 100 (6.1%) aspecific bacterial vaginitis, 58 (3.5%) non-infectious vaginitis. As assessed by typing, mycosis were mainly due to Candida albicans infections in 459 cases (78%). CONCLUSION From the survey it is possible to infer that: 1) only thanks to the employed microbiological diagnostic tests a definitive diagnosis was made in 702 patients without a previous presumed diagnosis; 2) mycotic infections were underestimated; 3) Candida albicans was the most common species causing female low genital tract mycotic infections. In conclusion, these data underline the importance of laboratory examinations in the diagnosis of low genital tract infections for the ambulatory gynaecological practice.
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Affiliation(s)
- F Boselli
- Dipartimento di Ostetricia e Ginecologia Università degli Studi di Modena e Reggio Emilia, Modena, Italy.
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22
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Goldblum H, Munoz C. [Sexual transmissible diseases and "returning leukorrhea"]. Rev Med Suisse Romande 2002; 122:553-5. [PMID: 12522941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
White discharges and sexual transmissive diseases are now increasing. Confronted to this symptom, the general practician can easily diagnose and treat his patient. Therefore he must keep in his mind that behind this common symptom, a much more serious disease can be hidden.
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Affiliation(s)
- Henri Goldblum
- Service de Gynécologie Hôpital régional, 2900 Porrentruy.
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Acosta M, Cazorla D, Garvett M. [Enterobiasis among schoolchildren in a rural population from Estado Falcón, Venezuela, and its relation with socioeconomic level]. Invest Clin 2002; 43:173-81. [PMID: 12229279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Between may and july 2001, a survey was conducted in order to investigate the prevalence and symptoms of Enterobius vermicularis infection and its relationship with the socio-economic status and household crowding of 154 schoolchildren aged 6-12 years from a rural village in Falcon State, Venezuela. The Graham technique (perianal swabs with an adhesive cellulose tape) was used to perform the parasitological diagnosis. The overall prevalence was high (57.79%). There was no difference in the prevalence between sexes (X2 = 0.005; d.f. = 1) or ages (X2 = 3.63; d.f. = 6) (p > 0.05), suggesting similar risk conditions for all individuals. Anal pruritus was the most common clinical finding (53.9%). Other less frequent manifestations were the following: perianal lesions (34.8%) and vulvovaginitis (32.6%). Graffar analysis revealed that the majority of schoolchildren belong to the poorer socioeconomic strata: IV (55.9%) and V (29.87%), with overcrowded living conditions. The correlation between E. vermicularis infection and crowding rates was found to be statistically significant (r = 0.98; p < 0.001). In the light on these results, it can be concluded that poverty, overcrowding, anal pruritus, scarcity of water, inadequate personal and community hygiene play a relevant role on the transmission dynamics and endemic maintenance of enterobiasis among schoolchildren from Sabaneta.
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Affiliation(s)
- María Acosta
- Laboratorio de Entomología Médica, UNIMETROPA, Centro de Investigaciones Biomédicas, Universidad Nacional Experimental Francisco de Miranda, Coro, Venezuela
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Abstract
OBJECTIVES This is a pilot study to test the validity of using one research assistant to train and support reception staff at five clinics to obtain waiting room data in general practice surveys. DESIGN A research assistant trained reception staff at five randomly chosen general practices to administer a survey to all eligible women over a two-week period. Practices were audited daily by their appointment books and where possible by billing records to check total numbers of eligible women to determine the denominator of the sample. SETTING Five metropolitan general practices in one divisional area. PARTICIPANTS Twenty-five receptionists distributed surveys to 1,298 women. MAIN OUTCOME MEASURES Number of eligible women missed at each clinic. RESULTS The number of potential subjects missed by the reception staff ranged from nil to 18% with the appointment book audit. A second audit using billing records at three clinics revealed inaccuracies of up to 50%. The ability to accurately capture eligible patients for waiting room surveys depends on good administrative systems within the practice and motivated staff. CONCLUSIONS It is important for general practice researchers to consider and account for eligible participants who are missed from the denominator with a waiting room survey method. Valid sampling using this method can be achieved in certain practices, however this may limit the generalisability of the findings.
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Affiliation(s)
- Marie Pirotta
- Department of General Practice, University of Melbourne, Victoria, Carlton.
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25
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Azzam-W M, Cermeño-Vivas JR, Orellán-García Y, Penna SJ. [Vulvovaginitis caused by Candida spp. and Trichomonas vaginalis in sexually active women]. Invest Clin 2002; 43:3-13. [PMID: 11921745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Vulvovaginitis accounts for 20 to 30% of gynecological diseases and it is observed in women from 20 to 30 years of age. It has a higher frequency in women using oral contraceptives and during the third trimester of pregnancy. The aim of this research was to assess the prevalence of Candida spp and Trichomonas vaginalis in patients with the diagnosis of vulvovaginitis from the Gynecology Service in Hospital Universitario "Ruiz y Páez" in Ciudad Bolívar and Hospital "Raúl Leoni" in San Félix (Bolívar State, Venezuela). Two hundred women with symptoms of vulvovaginitis were examined, and samples were taken from the uterocervical cul-de-sac. Each patient was asked to fill a questionnaire. The following studies were made in each sample: a) fresh wet mount examination, b) orange acridine and Giemsa stains for Trichomonas and c) culture for the identification of yeasts. The latter were identified by means of the germinal tube assay, resistance to actidione and the presence of clamidospores in rice-cream agar and sugar utilization test, using the commercial kit ID32C (BioMérieux). Only in 57 women of 200 patients with vulvovaginitis the causative agent was demonstrated; Candida spp was present in 84.2% (n = 48) and Trichomonas vaginalis in 14% (n = 8). A single case of Zygosaccharomyces spp (1.8%) was detected. The age group mainly affected was that of 25-35 years old, the 38.6% of the studied population. Candida species detected were: C. albicans in 87% of cases (n = 42), C. glabrata, in 10.42% (n = 5), and C. guillermondii, in 2.08 (n = 1). Vaginal flux, vulvar pruritus and leucorrhoea were observed in significant number of patients with vulvovaginal candidiasis. The use of antibiotics was considered predisposing factor for Trichomonas vaginalis infection. The relationship between age and the etiological agent was not statistically significant. Due to the low specificity of clinical manifestations of infections caused by Candida spp and Trichomonas vaginalis, we conclude that performing the etiologic diagnosis of vulvovaginitis is necessary in order to take the appropriate therapeutic and preventive measures, specially in those patients with a recurrent disease.
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Affiliation(s)
- Maha Azzam-W
- Departamento de Parasitología y Microbiología, Escuela de Medicina, Universidad de Oriente, Núcleo Bolívar, Ciudad Bolívar, Venezuela
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Abstract
Vaginal specimens for culture were obtained from two hundred and five immunocompetent, non-hospitalized patients selected among all women attending the Gynecology and Obstetric Ambulatory Clinic of the University of Espírito Santo, Brazil, during a 2-year period (From 1998 to 1999). Patients were checked for signs and symptoms of vulvovaginitis and previous use of topical and systemic antifungal drugs. Yeast isolates were identified by classical methods and the antifungal susceptibility profile was determined according to NCCLS microbroth assay. The prevalence of vaginal yeast isolates from asymptomatic women was 25% (30/121) and 60% (50/84) among patients with symptoms of vulvovaginitis. Candida albicans was the most frequently isolated species in both groups (46% and 90%, respectively), followed by C. glabrata (13% and 6%, respectively). All isolates were susceptible to amphotericin B. Only ten isolates had dose dependent susceptibility (DDS) or resistance to azoles; and seven of these were non-albicans species. Based on our results we suggest that species identification and antifungal susceptibility testing need not be routinely performed in immunocompetent women, and may be reasonable only for the minority of patients with complicated vulvovaginal candidiasis that fail to respond to therapy.
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Affiliation(s)
- M A Ribeiro
- Universidade Federal do Espírito Santo, Brazil
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Abstract
OBJECTIVE This study was designed to document the frequency and define the clinical, epidemiologic, and microbiologic characteristics of perineal disease caused by group A beta-hemolytic streptococci (GAS) in a pediatric practice in which increased numbers of cases had been observed. METHODS Clinical, epidemiologic, and microbiologic data were collected on all culture-confirmed cases of perineal GAS disease during the calendar year 1997. GAS isolates from clinical cases and a comparison group of children with GAS pharyngitis were analyzed by T typing, emm gene analysis, and pulsed-field gel electrophoresis (PFGE). RESULTS Twenty-three cases of GAS perineal disease were diagnosed during 4530 office visits in 1997. Thirteen cases had perianal disease, 8 had vulvovaginal infection, and 2 were infected at both sites. No cases of penile disease were identified. Infections peaked in late winter and early spring and affected children with an average age of 5 years with a range of perineal, gastrointestinal, and genitourinary symptoms. Analysis of T and emm types showed the majority (82%) of perineal isolates to be T 28 emm 28, showing 2 closely related PFGE patterns. In contrast, the pharyngeal isolates were distributed among 6 different T and emm types. CONCLUSION Perineal infection caused by GAS may be a relatively common diagnosis in a pediatric or family practice setting. There may be specific GAS types that have a tropism for perineal tissues but the mechanism of infection is yet to be established.
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Affiliation(s)
- N P Mogielnicki
- Department of Pediatrics and Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire, USA.
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Bergonier D, Berthelot X, Poumarat F. Contagious agalactia of small ruminants: current knowledge concerning epidemiology, diagnosis and control. REV SCI TECH OIE 1997; 16:848-73. [PMID: 9567311 DOI: 10.20506/rst.16.3.1062] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Contagious agalactia of small ruminants is a syndrome which principally affects the mammary glands, joints and eyes. The main causal agents are Mycoplasma agalactiae in sheep, and M. agalactiae, M. mycoides subsp. mycoides large colony type and M. capricolum subsp. capricolum in goats. In addition, M. putrefaciens can produce a similar clinical picture, particularly in goats. Contagious agalactia occurs on all five continents and is often enzootic. The evolution of the infection tends to be chronic in affected animals and herds. Symptomless shedding of mycoplasmas, mainly in the milk, may persist for a long time. These insidious infections, associated with carriage in the ears of healthy animals, are difficult to diagnose and to control. The main mode of transmission between flocks is related to the sale of carrier animals and contact during transhumance, whereas transmission within a flock occurs through contact, suckling and milking. This review discusses the clinical features, epidemiology, treatment, prevention and control of the disease.
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Affiliation(s)
- D Bergonier
- Ecole Nationale Vétérinaire, Département Elevage et Produits, Toulouse, France
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Pritchard G, Cook N, Banks M. Infectious pustular vulvovaginitis/infectious pustular balanoposthitis in cattle. Vet Rec 1997; 140:587. [PMID: 9194305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
STUDY OBJECTIVE To evaluate cases of vulvovaginitis treated in our institutions. DESIGN Follow-up of 1,778 cases of vulvovaginitis to investigate the prevalence of various pathogens involved in the disease. SETTING Divisions of pediatric and adolescent gynecology, university hospitals of Crete and Athens, Greece. PARTICIPANTS Girls 1-18 years old seen at the clinics of the above institutions. INTERVENTIONS None. MAIN OUTCOME MEASURES Vaginal culture, cytology, and vaginoscopy. RESULTS Vulvovaginitis was encountered in 61.8% of the gynecological problems seen during childhood and adolescence. Infections were usually located in both the vulva and the vagina (56.9%). The main symptoms were vaginal discharge (53%), erythema (33%), and pruritus (27%). Candida spp (23.0%), beta-hemolytic Streptococci group B (15.0%), and Enterococci spp (10.0%) were the most frequent pathogens involved in the disease. CONCLUSIONS Vulvovaginitis is a common disease during childhood and adolescence. Effective treatment, reassurance, and appropriate consultation based on the prevention of relapses are the most important steps for the management of the disease.
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Affiliation(s)
- E E Koumantakis
- Department of Obstetrics and Gynecology, University of Crete, Greece
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31
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Pena MJ, Campos-Herrero MI, Ruiz MC, Rodríguez H, Lafarga B. [Microbiological study of vulvovaginitis in premenarcheal girls]. Enferm Infecc Microbiol Clin 1996; 14:311-3. [PMID: 8744372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A prospective microbiological study of the vaginal swab specimens from premenarcheal girls with clinical diagnosis of vulvovaginitis was done from the 1st of September 1991 to the 31st of August 1994. PATIENTS AND METHODS Vaginal secretions from premenarcheal girls with clinical findings were examined. Most important pathogenic agents were investigated and if there was an inflammatory reaction in the Gram stain and a heavy growth on culture, other potentially pathogenic agents were considered also. RESULTS In 70 (28.7%) of the 262 patients a potentially pathogenic microorganism was found: eight cases (3.0%) due to Streptococcus pyogenes, four cases (1.5%) due to Candida albicans. Only in one case Neisseria gonorrhoeae was isolated. Among the uncertain etiologic agents, Haemophilus influenzae was the most frequently isolated (7.6%). In 25 (12.6%) of the 198 patients Enterobius vermicularis ova were visualized. CONCLUSIONS Streptococcus pyogenes was the most frequently related organism with the vulvovaginitis syndrome among the traditionally established pathogens. The role of Haemophilus influenzae should be considered due to the high prevalence of isolation in this group of patients. We consider that differential diagnosis with Enterobius vermicularis infestation should be done in all cases.
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Affiliation(s)
- M J Pena
- Unidad de Microbiología, Complejo Hospitalario Las Palmas Norte, Las Palmas de Gran Canaria
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Abstract
Clinical features, diagnosis and treatment of 286 women whose high vaginal swabs (HVS) submitted by their general practitioners showed pure, heavy growth of Staphylococcus aureus, beta haemolytic streptococci groups A, C or G, Streptococcus milleri, Streptococcus pneumoniae or Haemophilus influenzae were analysed. Women with group A, C and G streptococci frequently had clinical vulvovaginitis and although the numbers were too small for statistical confirmation, S. pneumoniae and H. influenzae appeared to cause clinical disease as well. The association of S. aureus or S. milleri with clinical vulvovaginitis was much less convincing. It seems relevant for laboratories to report sensitivities for group A, C and G streptococci. Further research is needed to determine the pathogenicity of S. pneumoniae and H. influenzae.
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Krasnikov DG, Semenova TB, Antipina NN. [Genital herpes in girls]. Akush Ginekol (Mosk) 1995:47-48. [PMID: 8779356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Rylander E, Larsson PG, Frankman O. [Vulvodynia. An increasing problem among young women]. Lakartidningen 1994; 91:618-20. [PMID: 8114599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- E Rylander
- Kvinnokliniken, Akademiska sjukhuset, Uppsala
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Colman G, Tanna A, Efstratiou A, Gaworzewska ET. The serotypes of Streptococcus pyogenes present in Britain during 1980-1990 and their association with disease. J Med Microbiol 1993; 39:165-78. [PMID: 8366514 DOI: 10.1099/00222615-39-3-165] [Citation(s) in RCA: 162] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A total of 16,909 cultures of Streptococcus pyogenes (Lancefield group A) isolated in Britain during 1980-90 were examined for T- and M-protein antigens. One or other M antigen was detected in 92.6% of the strains. The numbers of isolates of some serotypes, such as M3 and M12, did not show great variation from year-to-year, whereas there were nationwide epidemics, extending over several years, caused by strains of serotypes M1 and M49. Isolates of serotypes M1 and M3 were associated particularly with invasive disease and fatal infections. Representatives of serotypes M80, M81 and the provisional types PT180, PT1658 and PT5757 were isolated most often from cases of pyoderma. Erythromycin resistance was detected in 30 serotypes but one half of all of the resistant isolates belonged to serotype M4.
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Affiliation(s)
- G Colman
- Division of Hospital Infection, Central Public Health Laboratory, London
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Affiliation(s)
- A M Vandeven
- Comprehensive Child Health Program, Children's Hospital, Boston, MA
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37
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Affiliation(s)
- C Sullivan
- Saint Barnabas Medical Center, Livingston, NJ 07039
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38
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Röpke-Brandt B, Gerhard I. [Clinical results of pediatric gynecologic consultation at the Heidelberg University Gynecologic Clinic]. Zentralbl Gynakol 1993; 115:68-76. [PMID: 8451893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
During the research period from January 1984 through June 1991 649 patients between the age of 0 and 16 were examined. Divided into 13 diagnostic groups the vulvovaginitis occurred most frequently with 30.6%. The predominant causal agents were E. coli (18.1%) and streptococci B (11.5%). Almost 24% did not show any agents. Aside from malformations of the genitals (6%), the genital bleedings (8.3%), genital tumours (2.7%), the search for anticonceptives (7.5%), examinations by specialists (8.1%) and borderline surgical problems, cycle disorders (14.7%) were most frequent. Among the cycle disorders dysmenorrhea and oligomenorrhea were predominant. The hormonal inhibition of growth was also checked very carefully. Thus the necessity of well-aimed training of children's gynaecology becomes dear. Our results stress the importance of an intensive disciplinary contact between gynaecologists who are interested in pediatrics and pediatricians.
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Affiliation(s)
- B Röpke-Brandt
- Abteilung für Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitäts-Frauenklinik Heidelberg
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Bogaerts J, Lepage P, De Clercq A, Mukeshimana M, Serufilira S, Piot P, Verhaegen J. Shigella and gonococcal vulvovaginitis in prepubertal central African girls. Pediatr Infect Dis J 1992; 11:890-2. [PMID: 1408494 DOI: 10.1097/00006454-199210000-00018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- J Bogaerts
- Department of Bacteriology, Centre Hospitalier de Kigali, Rwanda
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40
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Jiménez Fernández F, Cermeño PC, Pescador Abad FJ, Ruano Gil M, Mora Guio F, Martín Pérez C. [Vulvovaginitis in premenarche girls. A preliminary study]. An Esp Pediatr 1991; 35:319-21. [PMID: 1785745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The study population consisted of 832 premenarcheal girls. Vaginal cultures are performed on 40 premenarcheal girls suffering from vulvovaginitis. All were less than 7 years old. This patients were seen in primary cares. In 23 cases (57.5%) E. coli was isolated, Enterococcus (30%), mixed flora (10%) and G. vaginalis (2.5%). Common clinical characteristics were pruritus (97.5%), vaginal discharge (67.5%). Dysuria and abdominal pain constituted accompanying symptoms. Only in one case masturbation was observed.
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41
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Abstract
Isolates of Streptococcus pyogenes from vaginal swabs of children with vulvovaginitis received at Nottingham Public Health Laboratory during 1986-9 were studied. A total of 159 isolates was made during the 4 years, increasing from 17 in 1986 to 64 in 1989 and accounting for 11% of all vaginal swabs received from children. The numbers of throat swabs yielding S. pyogenes also showed an increase from 974 in 1986 to 1519 in 1989. A winter peak of isolates was noted for both vaginal swabs and throat swabs. A total of 98 strains from vaginal swabs were serotyped: 22 different types were identified, 61% of which were the common types M4, M6, R28 and M12. Erythromycin sensitivity was done on 89 strains; 84% were highly sensitive (MIC less than 0.03 mg/l). There are no other reports of such large numbers in the literature; the reason for seeing this increase in Nottingham is unclear.
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Affiliation(s)
- F E Donald
- Department of Microbiology, University Hospital, Queen's Medical Centre, Nottingham
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42
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Ackermann M, Bélak S, Bitsch V, Edwards S, Moussa A, Rockborn G, Thiry E. Round table on infectious bovine rhinotracheitis/infectious pustular vulvovaginitis virus infection diagnosis and control. Vet Microbiol 1990; 23:361-3. [PMID: 2402878 DOI: 10.1016/0378-1135(90)90167-t] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The current situation of infectious bovine rhinotracheitis/infectious pustular vulvovaginitis infection in various European countries is reviewed. Whilst some have a high serological prevalence and use live virus vaccines to control the disease, others have a low prevalence and two countries (Denmark and Switzerland) have national eradication schemes which are almost complete. Serology remains important for diagnosis although other tests such as delayed cutaneous hypersensitivity may have a role to play. New tests such as polymerase chain reaction may find increasing application where high sensitivity is required, such as the detection of virus in semen.
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Affiliation(s)
- M Ackermann
- Institut für Viruskrankheiten und Immunprophylaxe, Basel, Switzerland
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43
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Crum CP, Burkett BJ. Papillomavirus and vulvovaginal neoplasia. J Reprod Med 1989; 34:566-71. [PMID: 2552110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cumulative evidence strongly implicates human papillomavirus (HPV) in the genesis of squamous neoplasia of the lower female genital tract, including the vulva. The association of HPV with neoplasms at that site includes the relationship of specific HPV types with neoplasms and evidence that those HPV DNA types can transform epithelial cells in vitro. The capacity for in vitro transformation has been isolated to specific regions of the HPV genome. That may be unique in cancer-associated viruses. Nevertheless, epidemiologic evidence points to additional factors, including immunologic, habitual and environmental, that may play an important role in the development of lower genital tract carcinomas. In particular, the marked differences in mean age and other variables between women with vulvar precancers and invasive cancer suggest that the evolution of invasive cancer involves more than HPV infection alone. Hence, the prevention of invasive vulvar cancer in older age groups will require an understanding of the unique host factors that render a small group of women susceptible to the disease in the face of an epidemic of HPV infection in the population at large.
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Affiliation(s)
- C P Crum
- Department of Pathology, University of Virginia Health Sciences Center, Charlottesville
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Thomason JL. Clinical evaluation of terconazole. United states experience. J Reprod Med 1989; 34:597-601. [PMID: 2677365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Terconazole is the first of a new class of antifungal agents, the triazoles. The results of numerous European studies have demonstrated the efficacy and safety of this agent in both cream and suppository form in the treatment of vulvovaginal candidiasis. Recently, results of short- and long-term analyses in the United States confirmed the efficacy and safety of 0.4% terconazole cream and 80-mg terconazole suppositories. In short-term evaluations (eight to ten days after therapy), 0.4% terconazole cream was as effective as 2.0% miconazole nitrate cream and significantly superior microbiologically in one study. The clinical cure rates with terconazole cream ranged from 87.3% to 95.5% and the microbiologic cure rates, from 76.9% to 91.1%. Thirty- to 35-day microbiologic relapse rates with terconazole cream ranged from 10.4% to 22.2%. In the short-term evaluations of vaginal suppositories the cure rates of 80-mg terconazole suppositories for three days were comparable to those of 100-mg miconazole nitrate suppositories for seven days. The clinical cure rates with 80-mg terconazole suppositories ranged from 90.0% to 92.2% and the microbiologic cure rates, from 80.4% to 85.0%. The 30- to 35-day microbiologic relapse rates of the 80-mg terconazole suppositories ranged from 20.0% to 28.1%. Terconazole cream and suppositories demonstrated an excellent safety profile in all the studies; no life-threatening side effects occurred with any of the regimens. The frequency of common side effects was similar with terconazole and miconazole nitrate formulations.
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Affiliation(s)
- J L Thomason
- Department of Obstetrics and Gynecology, University of Wisconsin Medical Center, Milwaukee
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Chungue E, Cartel JL, Tourneux M, Mahé A, Pérolat P, Flye Sainte Marie F, Roux J. Chlamydia trachomatis genital infections in Tahiti. Eur J Clin Microbiol Infect Dis 1988; 7:635-8. [PMID: 3143573 DOI: 10.1007/bf01964241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The rate of Chlamydia trachomatis infection was determined in three populations in Tahiti by means of a direct immunofluorescence test performed in specimens, tissue culture and detection of chlamydial antibody in serum specimens using a single-serotype indirect immunofluorescence test. Chlamydia trachomatis was recovered in 53% of 53 bar girls, 24% of 75 women attending a public maternity clinic for routine care, and 37% of 71 men attending a sexually transmitted disease clinic with acute or subacute urethritis. The presence of chlamydial antibody in a high proportion of the groups studied confirmed the high frequency of chlamydial infections (62.3%, 66.6% and 83.1% respectively). Neisseria gonorrhoeae infection was often associated with chlamydial infection in both bar girls and men with urethritis (11.4% and 18.3% respectively). With regard to clinical manifestations, 58.3% (7/12) of bar girls and 23.2% (10/43) women at the maternity clinic without clinical complaints were found to be Chlamydia trachomatis-positive. The presence of Chlamydia trachomatis in these asymptomatic persons highlights their important role in spread of this organism in Tahiti. The findings indicate that routine testing for Chlamydia trachomatis is warranted in patients attending the sexually transmitted disease and public maternity clinics in Tahiti.
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Affiliation(s)
- E Chungue
- Institut Territorial de Recherches Médicales Louis Malardé, Papeete, Tahiti
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Cappa F, Facchini D, Di Stefano L, De Paulis AL, Pitoni L, Luciani S, Nusiner MP, Pozzi V. [Vulvovaginal pathology in the prepuberal age]. Minerva Ginecol 1988; 40:83-8. [PMID: 3399123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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47
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Wachter I, Weissenbacher ER, Terruhn V. The incidence of gonorrhoea in young girls. Acta Eur Fertil 1987; 18:125. [PMID: 3630574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Two concurrent outbreaks of genital disease in goats were associated with infection by a herpesvirus that was isolated from vulval and vaginal lesions of affected does. Serum neutralising antibody to the virus was present both in goats with the clinical disease and some unaffected goats. Of 19 goat herds examined only 4 had serum neutralising antibody positive goats with low (5%) to high (60%) incidence of infection. The virus isolate was characterised as a herpesvirus on its physico-chemical and morphological features. It contained DNA and was inactivated at low pH and by treatment with lipid solvents and trypsin. The virus particles were icosahedral, consisting of a nucleocapsid surrounded by an envelope membrane and measured approximately 150 nm in diameter. The virus was serologically related to a New Zealand isolate of caprine herpesvirus (NZ-CpHV), associated with similar genital disease, and was distinct from bovine herpes virus-1 (BHV-1) showing a one way neutralisation pattern.
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Abstract
In this retrospective review of 16 children with vulvovaginitis due to Neisseria gonorrhoeae, the authors attempt to estimate the incidence of this infection and to ascertain the routes of transmission. From January 1977 to December 1982, 422 cases of gonococcal vulvovaginitis in women of all age groups were encountered at the University Hospital, Kuala Lumpur, Malaysia. Of these, 406 cases (96.2%) occurred in adults, and 16 cases (3.8%) occurred in children younger than 12 years of age. Penicillinase-producing N. gonorrhoeae (PPNG) strains were isolated from five (31%) of the 16 girls; all five cases were subsequently treated with cefuroxime and probenecid. The rest responded to intramuscular procaine penicillin. Although all patients appeared to be cured, only ten of 11 (two with PPNG) had test-of-cure cultures performed after treatment. Although interviewing the parents revealed no history of sexual contact in these children, nine of the girls were linked to culture-positive adult(s).
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Abstract
All the women working in a Sydney house of prostitution were surveyed for one year for the presence of sexually transmitted diseases (STDs) and other medical problems, and for the contraceptive methods they used. Considerable potential morbidity from STD was noted, particularly pelvic inflammatory disease (23 episodes). Contraception was an area of unsatisfactory practice. Suggestions are made for the clinical management of these women, with the intention of diminishing the impact of STDs on them and, as a direct result, rendering them less infectious, to the benefit of the community. It is hoped that greater knowledge will improve the standard of current debate about prostitution.
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