Bacterial vaginosis
Shiv Shanker Pareek in The Pictorial Atlas of Common Genito-Urinary Medicine, 2018
Bacterial vaginosis is a common condition affecting the vagina, in which the balance of normally occurring bacteria becomes altered resulting in abnormal discharge. The condition is associated with an increase in vaginal pH, making it more alkaline, which is due to a decrease in lactobacilli – bacteria naturally present in the vagina which produce lactic acid – allowing other bacterial species to overgrow. It is not clear why the bacterial balance of the vagina changes but several factors may be involved, including: sexual activity – sexually active females are more prone to bacterial vaginitis, Smoking and presence of intrauterine device. Many cases of bacterial vaginosis are asymptomatic. Pregnant women may be more likely to miscarry late in the pregnancy or undergo premature delivery, and suffer postpartum endometriosis. Douching with scented and antiseptic soaps or gels should be avoided. Clindamycin 2% cream should be used for women allergic to metronidazole and those breastfeeding.
Vulvovaginitis
Tomasz F. Mroczkowski, Larry E. Millikan, Lawrence Charles Parish MD in Genital and Perianal Diseases, 2014
DEFINITION Vulvovaginitis is defined as inflammation of the vulva and vagina, which may result in vaginal discharge. Itching, vulval soreness, and an offensive smell may also be present. ETIOLOGY AND EPIDEMIOLOGY Vulvovaginitis may be caused by bacterial, fungal, or protozoan infections. The three diseases most commonly associated with vaginal discharge and vulvovaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. These will be looked at separately within each section of the chapter. The National Disease and Therapeutic Index data showed that in 2009 in the USA there were over 3 million initial visits to physicians’ offices with vaginitis, excluding trichomoniasis1. Figure 11.1, from the USA Centers for Disease Control and Prevention (CDC), shows the visits for trichomoniasis and other vaginitis for the years 1966-2009.
Use of Dermatologics during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Dermatologic disorders are frequent among pregnant women, but few conditions are unique to pregnancy. This chapter reviews six major categories of dermatologic preparations: Vitamin A derivatives, antibiotics, antifungals, antiseborrheics, adrenocorticosteroids, and keratolytics, astringents, and defatting agents. Three retinoic acid derivatives, vitamin A analogs, are available to treat cystic acne, acne vulgaris, or psoriasis. Isotretinoin and etretinate are oral preparations, and tretinoin is a topical agent. An active metabolite of etretinate, acitretin has an elimination half-life of approximately 60 hours, compared to 100–120 days for etretinate. Eight cases of acitretin exposure during pregnancy are published. Systemic tretinoin has been used to treat acute promyelocytic leukemia during pregnancy. Antibiotics are used to treat acne and other skin infections, and often include clindamycin, erythromycin, meclocycline, tetracycline, sulfa-drug creams, and lotions. Topical antifungal agents used to treat vaginitis include butoconazole, clotrimazole, econazole, miconazole, nystatin, and terconazole. Systemic preparations used for vaginitis include amphotericin B, griseofulvin, and ketoconazole.
Vaginitis: Diagnosis and Management
Published in Postgraduate Medicine, 2010
Vaginitis is one of the most common ambulatory problems to occur in women. It is a disorder responsible for > 10% of visits made to providers of women's health care. Although vaginal infections are the most common cause, other considerations include cervicitis, a normal vaginal discharge, foreign-body vaginitis, contact vaginitis, atrophic vaginitis, and desquamative inflammatory vaginitis. The medical history and examination are an important source of clues to the underlying diagnosis. However, making a definitive diagnosis requires skillful performance of office laboratory procedures, including the vaginal pool wet mount examination, determination of the vaginal pH, and the whiff test. Vaginal and cervical cultures, nucleic acid tests, and point-of-care tests are available and may be required in selected patients. Once a specific diagnosis is made, effective therapy can be prescribed. Candida vaginitis is generally treated with either the vaginal administration of an imidazole or triazole antifungal agent or the prescription of oral fluconazole. Oral nitroimidazole agents, metronidazole or tinidazole, are the only effective treatments for trichomoniasis in the United States. Bacterial vaginosis, which has been linked to important gynecologic and pregnancy complications, can be treated with an available oral or topical agent containing either a nitroimidazole or clindamycin.
Vaginitis: Its diagnosis and treatment
Published in Health Care for Women International, 1987
Vaginitis is an almost universal problem for women, especially during the reproductive years. In many cases the etiology of the vaginitis is sexually transmitted and this knowledge has an intense impact upon the patient. The three major types of vaginitis are discussed in this article with special attention to the anticipatory counseling and guidance so necessary to optimum management. Information about vaginal physiology and general perineal hygiene is also included. Three common causes of vaginitis are discussed.
Treatment of atrophic vaginitis with topical conjugated equine estrogens in postmenopausal Asian women
Published in Climacteric, 2004
N Raymundo, B Yu-cheng, H Zi-yan, C- Huey Lai, K Leung, R Subramaniam, C Bin-rong, YS Ling, N Nasri, N Calimon
Objective We investigated the effects of 2 months of treatment with topical estrogens on atrophic vaginitis and gynecological health in Asian women. Study design Multicenter, open-label trial of 150 postmenopausal women age < 70 years with atrophic vaginitis. Women applied conjugated equine estrogens (CEE) vaginal cream (0.625 mg/g) once daily on days 1–21 of two 28-day cycles. Changes in the vaginal maturation index (VMI) from baseline to days 21 (month 1) and 49 (month 2) were the primary outcome. Physiological changes were assessed by the Genital Health Clinical Examination (GHCE). Results The VMI was significantly improved (p < 0.001) from baseline at each assessment period. The significant improvement in GHCE from baseline after 1 month (p < 0.001) was maintained at 2 months. Conclusions Vaginal treatment with CEE cream for 21 days of two consecutive 28-day cycles resulted in beneficial changes in the vaginal tissues and induced an overall genital health pattern more characteristic of the premenopausal state.