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Infections and treatment guidelines
Published in Sarah Bekaert, Alison White, Integrated Contraceptive and Sexual Healthcare, 2018
Sarah Bekaert, Alison White, Kathy French, Kevin Miles
NB: Stat doses of metronidazole contraindicated in pregnancy.Symptoms in early pregnancy - clotrimazole pessary 100 mg od seven days or Aci-Jel can be used.
Management of sexually transmitted diseases
Published in Hilary Curtis, Tony Hoolaghan, Carey Jewitt, Sexual Health Promotion in General Practice, 2018
Hilary Curtis, Tony Hoolaghan, Carey Jewitt
Typically there is a fishy odour, and often a yellowy discharge. Anaerobic vaginosis may be implicated in premature labour. Women often mistake this condition for thrush, but the diagnosis is easy to make in general practice because the vaginal secretions lose their usual acidity. Placing some discharge on pH paper will quickly confirm the diagnosis - the normal pH of the vagina is about 4, whereas in anaerobic vaginosis it rises to 6 or 7. A high vaginal swab may reveal clue cells. This condition is not necessarily sexually transmitted, and is best described to women as an imbalance of the normal flora in the vagina. The ‘good’ bacteria that maintain the acidity of the vagina have been replaced with ‘bad’ ones, which prevent the ‘good’ ones growing. Oral metronidazole 2 g as a single dose kills the anaerobes, which usually allows the lactobacilli to reestablish. Occasionally, Aci-Jel is useful to maintain the vaginal pH while the normal flora re-establishes itself.
Lactic acid, citric acid, and potassium bitartrate non-hormonal prescription vaginal pH modulator (VPM) gel for the prevention of pregnancy
Published in Expert Review of Clinical Pharmacology, 2022
There have been several studies comparing the microbicidal effects of VPM to both Buffergel and Aci-jel. Buffergel is an aqueous gel with a pH of 3.9; the active ingredient is the hydrogen ions released by carbopol 1974P, a polyacrylic acid [51]. Designed to protect against HIV infection by maintaining the normal acidity of the vagina in the presence of sperm [51,52], it is not considered to be a direct competitor to VPM as it is not currently available or in active development. The effectiveness of Buffergel as a vaginal contraceptive with the use of a diaphragm was evaluated in a phase III trial, and was determined to have comparable efficacy to N-9 plus diaphragm [53]. Aci-jel, a vagina gel containing 0.94% glacial acetic acid, is used to maintain the acidity in the vagina. In a clinical study, it showed promise in reducing episodes of recurrent bacterial vaginosis (BV) [54].
An overview of properties of Amphora (Acidform) contraceptive vaginal gel
Published in Expert Opinion on Drug Safety, 2018
Amphora has strong acid-buffering abilities [42]. Starting with a baseline pH of 3.5–3.55, it is more acidic than any other currently available vaginal compound. Amphora has been tested against the only other product (acetic acid and oxyquinoline sulfate in a buffered vaginal jelly [AciJel]) that was marketed at the time in the US as a vaginal acid-buffering agent. Aci-Jel was used only to treat ‘nonspecific vaginitis,’ not to prevent pregnancy [42]. The object of the experiment was to compare the volume of dilution that would be needed to be added to a fixed volume of each product to raise its pH to 5.0 (the upper limit of pH needed for spermicidal activity). One gram of each gel was first diluted to 10 mL with 0.9% NaCl (normal saline 1:10 w/v). The pH of normal saline is 5.5 slightly more alkalotic than the pH of the healthy vagina. Since both compounds were equally diluted, the pH of the dilatant itself would not alter the outcome being studied – the relative buffing capacities of the two compounds. Sodium hydroxide (1.0 N) was added to each diluted specimen in 20 µl increments. Thirty seconds after every addition, the pH was measured with a standard electrode. Amphora had four-time greater acid-buffering capacity than Aci-Jel [42]. It was calculated that 0.320 microequilalents (meg) NaOH was required to raise the pH of 1 g Amphora to 5.0 from its initial pH of 3.57. On the other hand, Aci-Jel had a higher baseline pH (4.07), and required only 0.076 meg NaOH to raise the pH of 1 g of it to 5.0. The pKa values for Amphora were lower (3.7, 4.0, and 4.7) than those of Aci-Jel (4.4 and 5.5) [42].