Figure 3 - uploaded by Colin MacNeill
Content may be subject to copyright.
Source publication
Members and non-members of the International Society for the Study of Vulvovaginal Dis- ease (ISSVD), acknowledged as experts in the field of vulvovaginitis, from different countries and backgrounds, were invited to participate in this mission.
Participants were involved in one or more working groups, according to their expertise and interest.
Each...
Citations
... 10,11 Therefore, conjugated equine estrogen remains a recommended treatment option for vulvovaginal atrophy in women. 12 The histological report confirmed exuberant granulation tissue. No foreign body or residual surgical suture was identified in the specimen. ...
... In contrast, topical conjugated equine estrogen vaginal cream is patient-administered, rejuvenates the vaginal tissue amidst the relative hypoestrogenic state that occurs in postpartum and breastfeeding mothers, 7 and this informed the preference for its use after surgical excision. Although topical vaginal estrogen may be safe, 26 it is best administered as a low-or ultralow-dose preparation (such as conjugated equine estrogen, estriol, estradiol, and promestriene [3-propyl 17β -methyl diether estradiol]) 12 to minimize systemic absorption that can increase endometrial thickness. While honey is effective in the treatment of obstetric wounds and shows promise in animal studies as a protective agent for genital atrophy, there are no long-term studies and definitive conclusions about its efficacy in the treatment of urogenital atrophy in humans as in the index patient with atrophic vaginal mucosa. ...
Background
Poor wound healing may limit body functionality and is an indication for clinical intervention. Excessive formation of granulation tissue above the edge of the skin surrounding a wound without re-epithelization is termed exuberant granulation, or proud flesh. It is uncommonly reported as a complication of an episiotomy wound.
Aim
This study aimed to report exuberant granulation that complicates an episiotomy wound with a friable vaginal epithelium and to describe the successful treatment of the lesion with surgical excision and topical conjugated equine estrogen vaginal cream.
Case Report
A 24-year-old para 1 had spontaneous vaginal birth of a normal baby at term in a district hospital. Five months later, she presented to a regional hospital with complaints of pain and incomplete wound healing at the episiotomy site. She had used topical povidone-iodine ointment with no success. Following a physical examination, an exuberant granulation at the episiotomy wound was diagnosed. The lesions were located mostly at 5 to 7 o’clock position in the vagina which had a thin and friable mucosa. The patient was treated with surgical excision and postoperative topical conjugated equine estrogen vaginal cream 0.625 mg per 1 g at a dose of 0.5 g per intravaginal application twice weekly for two weeks, and thereafter once weekly for one week. A review after 6 weeks, 12 weeks, and 6 months confirmed complete wound healing and normal function of the genitalia.
Conclusion
Exuberant granulation that complicates an episiotomy wound with friable vaginal mucosa is amenable to surgical excision and postoperative intermittent intermediate doses of topical conjugated equine estrogen vaginal cream.
... В основную группу вошла 41 пациентка 18-45 лет с жалобами на патологические выделения из половых путей и с установленным диагнозом БВ. Согласно рекомендациям Международного общества по изучению вульвовагинальных заболеваний (International Society for the Study of Vulvovaginal Disease -ISSVD) [7] диагноз БВ устанавливали на основании критериев Амселя [8] при наличии 3 из 4 перечисленных признаков: ...
Aim. To evaluate the effectiveness of treatment of bacterial vaginosis (BV) with the nifuratel+nystatin complex and its effect on the lactobacillus profile (LBP) in the vagina. Materials and methods. A multicenter, prospective, observational study included 41 patients diagnosed with BV (main group) who were treated with vaginal capsules containing 500 mg of nifuratel and 200,000 IU of nystatin (Macmiror® Complex). Efficacy was assessed at 2 weeks and 4–6 weeks after treatment based on clinical data (absence of pathological discharge). The control group for the comparative assessment of LBP included 25 healthy women. Lactobacillus index (LI, the proportion of lactobacilli in the total bacterial mass) and the abundance of Lactobacillus crispatus, L. gasseri, L. jensenii, and L. iners were assessed using a polymerase chain reaction before treatment with BV, at 2 weeks and 4–6 weeks after the end of therapy, as well as in the control group. Additionally, the vaginal pH level was measured. Results. Clinical recovery was achieved in all main group patients and persisted throughout the observation. In all patients in this group, lactobacilli comprised 0.01–100% of the total bacterial mass. The frequency of lactobacilli species in the control group was relatively uniform, with a relatively uniform abundance of lactobacilli and a slight dominance of L. crispatus, with frequent isolation of two species in samples and high LI (70%) in 80% of females. Before treatment in the main group, the majority of vaginal samples contained one species of lactobacilli; 40% had LI70%, and in 62.5%, L. iners was isolated. LBP did not change significantly within 2 weeks after treatment, and after 4–6 weeks, it became comparable to that in the control group. A decrease in pH was associated with LBP recovery. However, there was no strong correlation between LI and individual species of lactobacilli in samples with or without BV. Conclusion. Nifuratel+nystatin complex is highly effective in BV treatment. The treatment had no adverse effect on LBP, which did not differ significantly immediately after treatment compared to the baseline. However, 4–6 weeks after the treatment, LBP recovered spontaneously, reaching comparable indicators with a group of clinically healthy females regarding species composition and LI.
... BV and AV pose significant risks, including obstetrical complications and an increased risk of sexually transmitted infection acquisition (e.g., human papilloma virus, human immunodeficiency virus, Trichomonas vaginalis, and Chlamydia trachomatis). Therefore, it is crucial to treat these infections promptly [28]. ...
... The aim of BV and AV treatment is to restore the balance of the vaginal flora and thereby limit the excessive growth of harmful microorganisms. Current international guidelines recommend the use of antibiotics, in particular, metronidazole or clindamycin, topically in the first instance and then, depending on disease evolution, systemically [28][29][30][31][32][33][34]. Local treatments are generally preferred as a first-line treatment because oral options can result in systemic side effects such as headache and gastro-intestinal disorders. ...
... Local treatments are generally preferred as a first-line treatment because oral options can result in systemic side effects such as headache and gastro-intestinal disorders. In contrast, vaginal applications can reach local concentrations up to 30 times higher, resulting in comparable or slightly improved cure rates with fewer side effects [28]. As clindamycin is active against both staphylococci and streptococci, as well as anaerobes, the International Union Against Sexually Transmitted Infections states that the best treatment for uncomplicated AV is currently vaginally administered clindamycin, whereas metronidazole if advocated for the treatment of persistent and recurrent BV [3,28,29]. ...
Background/Objectives: Aerobic vaginitis (AV) and bacterial vaginosis (BV) are vaginal infections requiring the fast elimination of pathogens. The frequent confusion of these infections may justify the use of a rapidly acting broad-spectrum antibiotic treatment. Methods: This study investigated the bactericidal kinetics of the neomycin-polymyxin B-nystatin (NPN) combination compared to those of two reference antibiotics (clindamycin and metronidazole) against 22 bacteria commonly implicated in AV and BV. Results: NPN exhibited bactericidal activity against the aerobic Gram-positive bacteria, with particularly high bactericidal activity being observed against streptococci, S. aureus, and C. amycolatum after 1 h at low dilutions and after 4 h for all dilutions. Enterococci were less sensitive to NPN. Clindamycin demonstrated poor rapid bactericidal activity against all Gram-positive bacteria tested. NPN manifested high bactericidal activity against all aerobic Gram-negative bacteria tested, whereas clindamycin showed bactericidal activity only after 4 h at a 1/2 dilution. With respect to the four anaerobic strains tested, NPN demonstrated high bactericidal activity at all tested dilutions with concentration-dependent effects. Metronidazole exhibited lower or no rapid bactericidal activity. Conclusions: These results suggest that NPN has very fast bactericidal action against the main bacteria involved in AV and BV compared to clindamycin and metronidazole, highlighting its potential in managing bacterial vaginal infections.
... Кроме того, это состояние связано с неблагоприятными последствиями для беременности и плода, включая внутриутробные инфекции, преждевременный разрыв плодных оболочек, поздний самопроизвольный выкидыш, преждевременные роды, а также послеродовые и послеабортные гнойно-септические осложнения [3,4]. В настоящее время первой линией лечения БВ остаются антибактериальные препараты, такие как пероральный метронидазол по 500 мг дважды в день в течение семи дней, интравагинальный метронидазол по 5 г один раз в день в течение пяти дней, а также интравагинальный клиндамицин по 5 г один раз в день в течение семи дней [5]. Однако известно, что рецидивы БВ после стандартной антибактериальной терапии возникают у 43% женщин в течение трёх месяцев и у 58% -в течение 12 месяцев, что может быть связано с устойчивостью к антимикробной терапии, формированием биоплёнок и последующей персистенцией микроорганизмов, а также реинфекцией [6]. ...
BACKGROUND. Bacterial vaginosis is a common infectious non-inflammatory vaginal disease that increases the likelihood of contracting sexually transmitted infections, which has a negative impact on perinatal outcomes and generally reduces the quality of life. Given the low long-term efficacy of antibiotic therapy, as well as the high recurrence rate and side effects associated with antibiotic use, there is a need to find alternative approaches to its treatment. AIM. To evaluate the efficacy and tolerability of a comprehensive two-stage treatment of BV including clindamycin or dequalinium chloride and lactic acid in women of reproductive age. METHODS. An open randomized clinical study was carried out, which involved 54 women aged 18 to 45 years with a diagnosis of bacterial vaginosis confirmed by Amsel's criteria. The participants were randomly assigned into three groups: 17 women from the first group used lactic acid, 20 women from the second group used a combination of clindamycin and lactic acid, and 17 women from the third group used dequalinium chloride with lactic acid. Treatment efficacy was evaluated after 14 days using Amsel's criteria. Three months after the completion of treatment, complaints were assessed and vaginal pH was measured. RESULTS. During the study, it was noted that two weeks after the completion of treatment, whitish-gray vaginal discharge ceased in all women from the second and third groups. In the first group, where only lactic acid was used, discharge continued in three patients. Positive dynamics in the pH change of vaginal secretions were observed in all groups both two weeks and three months after the end of treatment, with the most noticeable effect in women using dequalinium chloride together with lactic acid. Three months after the end of treatment, complaints of vaginal discharge persisted in two women from the first group and two from the second group. CONCLUSION. The conducted study confirmed the high effectiveness of two-stage treatment. However, the combination of dequalinium chloride and lactic acid demonstrated more stable results in both the short and long term, making this method of non-antibacterial therapy the most preferable in the context of the growing problem of antibiotic resistance.
... Another possible explanation for this decrease in consumption may be a lower prevalence of infections due to reduced opportunities for human contact due to the implementation of non-pharmaceutical interventions, such as lockdowns where gatherings and meetings were banned and public spaces were closed. This reduction in infection rates could have led to an overall decrease in consumption of broad-spectrum antibiotics, which is a main risk factor associated with recurrent Vulvovaginal Candidosis [11]. ...
... We wonder if this reflects a medical preference or if there is another reason for this decrease. The International Society for the Study of Vulvovaginal Disease indicates isoconazole vaginal suppository as one of the available treatment options for patients with uncomplicated Vulvovaginal Candidosis (mild symptoms); however, it does not mention vaginal cream [11]. ...
Background/Objectives: Excessive or inadequate use of antimicrobial drugs may lead to the emergence of resistant strains. For this reason, it is important to monitor consumption indicators to assess drugs’ utilization over time. This study aimed to analyze the consumption of medically prescribed azole antifungal drugs in mainland Portugal from 2014 to 2023, focusing on those directed to genital infections: fluconazole, isoconazole, itraconazole, and sertaconazole. Methods: For each drug, the evaluated parameters were the total number of packages, number of packages per 1000 inhabitants, defined daily dose (DDD) per 1000 inhabitants per day, and total costs. For this purpose, we used data from community pharmacies’ sales, which are available through INFARMED (the Portuguese national authority on medicines and health products). Results: Several trends emerged from data analysis. The COVID-19 pandemic negatively affected the consumption of all azole antifungal drugs included in this study. However, after 2020, fluconazole and sertaconazole consumption has been increasing. In the specific case of fluconazole, there was an increase in expenditure, although the total number of packages suffered a decrease over the 10-year study period. Additionally, the defined daily dose (DDD) per 1000 inhabitants per day for fluconazole and itraconazole was lower compared to estimates from the last available survey (2009). Conclusions: Although our findings represent a lesser pressure on fungi, further monitoring is needed to better understand the evolution of fluconazole and itraconazole consumption over time, particularly due to the trends observed in this study.
... Moreover, a substantial proportion (5-8%) suffer from recurrent VC (RVC), experiencing four or more episodes per year [2]. The symptoms of VC extend beyond physical manifestations such as vaginal discharge, itching, and burning; they also significantly affect mental, sexual, and social health [3][4][5]. Epidemiological data indicate that RVC poses a significant global public health challenge, impacting over 130 million women annually [1]. Additionally, the diagnosis and treatment of VC, particularly RVC, impose significant economic burdens due to social withdrawal and workforce loss [1,6]. ...
... Despite their impact, Candida species are typically a low-abundance component of the vaginal flora and may be present at an increased abundance in 20-30% of reproductive-aged women without symptoms (Candida colonization) [7]. Historically, the primary pathogen in both acute and recurrent VC (AVC and RVC, respectively) is C. albicans (85-95%) [3,8,9]. However, misdiagnosis and improper treatment, including the use of over-the-counter antifungals, have contributed to the rise in treatment-refractory C. albicans and non-albicans VC [10][11][12]. ...
... Azole antifungals, such as fluconazole, show decreased activity at pH 4 [17,18]. Therefore, conducting AFST at pH 4, reflecting vaginal acidity, provides a more realistic assessment of antifungal efficacy [3,9,14]. ...
Vaginal candidiasis (VC) is a prevalent condition among women of reproductive age and poses a significant global public health challenge. However, the disease is often diagnosed and treated without mycological information. We investigated the epidemiology, laboratory diagnostics, and antifungal susceptibility of VC. We included 300 women from Çukurova University Obstetrics and Gynecology outpatient clinic in Adana, Türkiye. Participants underwent a health survey and provided vaginal swab samples for microscopic examination and fungal culture. The microscopic analysis involved wet-mount and gram-stained slides, whereas fungal identification involved CHROMAgar Candida, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and real-time polymerase chain reaction high-resolution melting analysis (RT-PCR HRMA). Antifungal susceptibility tests were conducted at pH 7 and 4 using the CLSI document M44-A2. Of the 106 women with positive fungal cultures, 86.8% were diagnosed with VC, whereas 13.2% showed Candida colonization. Among those with VC, 55.4% had acute and 44.6% had recurrent VC; a family history of allergies increased the risk for both types. We recovered 115 yeast isolates, predominantly C. albicans, C. glabrata, and C. krusei. Diagnostic accuracy of CHROMAgar Candida was 91.3% for the most common isolates, and HRMA was consistent in differential diagnosis. Antifungal resistance varied with pH; susceptibility to fluconazole, itraconazole, and ketoconazole decreased at pH 4, whereas susceptibility to miconazole increased. Our findings underscore the need for a diagnostic algorithm and enhanced collaboration between clinicians and microbiologists to improve VC management. Recommendations include using Gram staining, CHROMAgar Candida, MALDI-TOF MS, and antifungal susceptibility tests at both pH levels.
... В заключение необходимо отметить рекомендации Международного общества по изучению вульвовагинальных заболеваний (ISSVD, 2023), согласно которым в основе диагностики ГУМС также лежит оценка клинико-анамнестических данных с дополнительной оценкой микроскопии мазка и определением уровня вагинального pH [14]. ...
... В настоящее время, по данным отечественных и международных клинических рекомендаций, «золотым стандартом» лечения ГУМС является локальная гормональная терапия [10,13]. При этом, согласно рекомендациям ISSVD (2023), имеется несколько вариантов локальной гормональной терапии, представленных в табл. 2 [14]. ...
Genitourinary syndrome of menopause still represents one of the most pressing unresolved issues of modern gynecology. High prevalence and the data suggesting a marked decline in the quality of life in general and sexual life in particular in patients of this cohort demonstrate the need to develop effective clinical management programs. The review provided considers the key aspects of genitourinary syndrome of menopause as a medical and social problem, reports modern approaches to clinical management in the wake of new international guidelines.
... Vaginitis remains poorly understood [22], and symptoms can often be the result of mixed infections [6]. A co-occurrence analysis showed that different Candida species were found to rarely co-occur together. ...
Vaginitis is a widespread issue for women worldwide, yet current diagnostic tools are lacking. Bacterial vaginosis (BV) is the most prevalent type of vaginitis, found in 10–50% of reproductive-aged women. Current diagnostic methods for BV rely on clinical criteria, microscopy, or the detection of a few microbes by qPCR. However, many vaginal infections lack a single etiological agent and are characterized by changes in the vaginal microbiome community structure (e.g., BV is defined as a loss of protective lactobacilli resulting in an overgrowth of anaerobic bacteria). Shotgun metagenomic sequencing provides a comprehensive view of all the organisms present in the vaginal microbiome (VMB), allowing for a better understanding of all potential etiologies. Here, we describe a robust VMB metagenomics sequencing test with a sensitivity of 93.1%, a specificity of 90%, a negative predictive value of 93.4%, and a positive predictive value of 89.6% certified by Clinical Laboratory Improvement Amendments (CLIA), the College of American Pathologist (CAP), and the Clinical Laboratory Evaluation Program (CLEP). We sequenced over 7000 human vaginal samples with this pipeline and described general findings and comparisons to US census data.
... Vaginitis remains poorly understood [24] and symptoms can often be the result of mixed infections [6]. A co-occurrence analysis showed that different Candida species were found to rarely 8 co-occur together. ...
Vaginitis is a widespread issue for women worldwide, yet current diagnostic tools are lacking. Bacterial vaginosis (BV) is the most prevalent type of vaginitis, found in 10-50% of reproductive aged women. Current diagnostic methods for BV rely on clinical criteria, microscopy, or detection of a few microbes by qPCR. However, many vaginal infections lack a single etiological agent and are characterized by changes in the vaginal microbiome community structure (e.g. BV is defined as a loss of protective lactobacilli resulting in an overgrowth of anaerobic bacteria). Shotgun metagenomic sequencing provides a comprehensive view of all the organisms present in the vaginal microbiome (VMB) allowing for a better understanding of all potential etiologies. Here, we describe a robust VMB metagenomics sequencing test with a sensitivity of 93.1%, specificity of 90%, a negative predictive value of 93.4%, and a positive predictive value of 89.6% certified by Clinical Laboratory Improvement Amendments (CLIA), the College of American Pathologist (CAP) and the Clinical Laboratory Evaluation Program (CLEP). We sequenced over 7,000 human vaginal samples with this pipeline and described general findings and comparison to US census data.
... Видовий склад лактобактерій у здорових жінок різний [9,13,14], із вагінальних зразків виділяють такі види Lactobacillus: L. plantarum, L. fermentum, L. acidophilus, L. jensenii, L. casei, L. gasseri, L. crispatus, L. cellobiosus, L. brevis та L. Salivarius [15,16,18]. Найчастіше виявляють мікроаерофільні види лактобактерій, що продукують пероксид водню, рідшеанаеробні [16,19]. ...
The article presents literary data on the morphology and types of vaginal lactobacilli, pathological changes in the vaginal environment, as well as modern possibilities of restoring the vaginal microflora of a woman’s organism. Certain regularities regarding the connection of bacterial vaginosis with intestinal dysbiosis have been observed, which indicates a single dysbiotic process in the organism with a dominant manifestation either in the sexual or digestive system.A review of scientific publications of recent years shows the significant influence of intestinal dysbiosis, infectious and inflammatory diseases of the stomach and intestines, as well as the oral use of antibacterial drugs on the quantitative and qualitative composition of the vaginal microflora in women. It was found that an increased number of opportunistic microorganisms (85%) and a decreased number of lactobacilli and bifidobacteria (less than 70%) in the intestine are associated with a rise in the content of opportunistic microorganisms in the vaginal biota in women with infectious and inflammatory diseases of the reproductive system. This is explained by the ability of saprophytes and opportunistic microorganisms to penetrate into the reproductive organs of women by increasing the permeability of the mucous membrane of the intestinal wall, as well as into the vascular bed, which can be observed, for example, on the background of antibiotic use. The antibiotic use in a number of cases leads to a closed circle, when the need for antibacterial therapy to eliminate one infection leads to a deepening of dysbiosis and an increased number of other pathogens.Numerous studies have demonstrated the effectiveness of selective decontamination (selective elimination of pathogens) in combination with a probiotic, prebiotic or synbiotic to restore vaginal microbiocenosis.Our experience of using an oral synbiotic (1 capsule contains 5 billion colony-forming units of Lactobacillus plantarum lyophilizate pcs. 8Р-AZ, Lactobacillus fermentum pcs. 90Т-С4 and prebiotic inulin, once a day 30 minutes before meal for 7–10 days) in a complex therapy of bacterial vaginosis in non-pregnant women of reproductive age indicates faster elimination of systemic dysbiosis and restoration of normal intravaginal flora. Thus, regression of complaintsand normalization of objective data was determined on average for 2.9 days versus 4.7 days in women who were not administered the drug.The obtained data show that a systemic synbiotic containing a lyophilized microbial mass of probiotic lactobacteria, products of their metabolism and inulin (prebiotic) creates an additional effect in restoring normal biocenosis and the immune mechanism of ensuring colonization resistance of the body’s mucous membranes.
