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Objective Antimycotics effectively treat sporadic and recurrent vulvovaginal candidiasis (RVVC). Classic homeopathy (CH) is also used to treat this condition. We compared the efficacy of CH and itraconazole in reducing the frequency of RVVC episodes.Design Single-centre, prospective, randomised trial.Sample One hundred-and-fifty patients with a history of RVVC and an acute episode of VVC.Methods Women were randomised into 3 groups: itraconazole with lactobacilli (group 1), itraconazole without lactobacilli (group 2) and CH (group 3). Itraconazole treatment of acute infection was followed by a 6-month maintenance regimen with monthly single-day itraconazole (200 mg bid). Women in group 1 were given additional vaginal lactobacilli for 6 days per month throughout the maintenance regimen Thereafter, patients were followed without treatment for 6 months. CH treatment was performed for 12 months.Results Women in groups 1 and 2 reached a culture-free status significantly earlier than women in group 3 (log-rank test; P < 0.0001). Specifically, before the start of the maintenance regimen, 44 of 49 women (89.8%) in group 1 and 40 of 47 women (85%) in group 2 were free of Candida detectable by culture, 22 of 46 (47%) women in group 3 reached a culture-free status after the first visit, but had a recurrence significantly earlier compared with women in groups 1 and 2 (log-rank test; P = 0.002). After 12 months, 19 of 25 (76%) women in group 1, 18 of 23 (78%) women in group 2 and 9 of 23 (39%) women in group 3 were free of culture-detectable Candida. Assessment of RVVC-associated complaints by VAS score showed that women in group 3 had a significantly higher level of discomfort (36.8, 25.1 and 27.7 respectively; P < 0.001) and were significantly less satisfied (59.2, 68.2 and 71.7 respectively; P < 0.001) than patients in groups 1 and 2.Conclusions Monthly cycle-dependent itraconazole is more effective than CH in the treatment of RVVC. Lactobacilli do not confer an added benefit.

This prospective comparative study evaluated a DNA hybridization test (Affirm VPIII) as an alternative to Gram stain for the diagnosis of bacterial vaginosis. We examined vaginal smears from 1,725 pregnant women between the 12th and 36th weeks of gestation with clinical signs of vaginal infection. The DNA hybridization test compared well with Gram stain and can be used as a rapid diagnostic tool to exclude bacterial vaginosis.Common reproductive tract infections and associated inflammatory responses are the most frequent gynecological complaints, representing a central problem in modern clinical care. Vaginitis is usually characterized by vaginal discharge, vulvar itching and irritation, or odor. Even though the causative microorganisms are manifold, the three diseases most frequently associated with vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis (3). The complications of bacterial vaginosis can be especially substantial in pregnant women, increasing the risk of an adverse pregnancy outcome, including histological chorioamnionitis (5), amniotic fluid infection (12), preterm labor, and preterm delivery (8, 9). Laboratory methods for the identification of bacterial vaginosis include wet mount, Gram stain, the "gold standard" of diagnosis, and microbiological culture. Because microscopic evaluation by wet mount or Gram stain requires special diagnostic skills not available to all practitioners, overdiagnosis is common and therapy is frequently empirical. Although cultures for Gardnerella vaginalis constitute a highly sensitive method, they are not recommended for the diagnosis of bacterial vaginosis due to the high number of women positive for G. vaginalis who do not have clinical symptoms of bacterial vaginosis (2, 6). Furthermore, determination of G. vaginalis by culture is rarely useful because of the relatively long period between the examination and the time the results are finally available. Because the different forms of vaginitis call for different treatment regimens, there is a need for a rapid and highly selective tool to help the care provider diagnose bacterial vaginosis and distinguish it from other types of infection. The aim of this study was to evaluate a DNA hybridization test (Affirm VPIII) as an alternative to Gram-stained microscopic slides, currently considered the most reliable diagnostic tool.This study on the prospective comparison of two diagnostic tools included 1,725 pregnant women between the 12th and 36th weeks of gestation attending the outpatient clinic of the Department of Obstetrics and Gynecology at the University of Vienna, Vienna, Austria. If clinical symptoms such as increased vaginal discharge combined with pruritus and/or burning, cervical incompetence, lower abdominal pain, preterm labor, or preterm rupture of the membranes were present, two vaginal specimens were obtained with the Affirm VPIII sample collection set on Dacron tipped swabs for both Gram stain and nucleic acid hybridization. The samples were immediately transported to the labora...

As with hepatitis B vaccines, the recently developed hepatitis A vaccine is suitable not only for individual protection, but also for public health control measures. For introduction into routine immunisation programmes, however, hepatitis A vaccine should preferably be combined with other already established vaccines. In particular, a combination of hepatitis A and hepatitis B vaccines would be appropriate. We investigated a new combined hepatitis A/hepatitis B vaccine comparing its tolerability and immunogenicity with that obtained after separate or mixed simultaneous administration of the two components. Three groups of healthy volunteers, each of approximately 50 persons, were included. All were negative for hepatitis A and hepatitis B markers and had normal liver enzyme values. They received hepatitis A (720 ELISA units) and hepatitis B (20 micrograms) vaccines in the deltoid muscle, combined, mixed or separately, according to a 0, 1, 6-month schedule. Blood samples for determination of antibodies to hepatitis A virus (anti-HAV) and hepatitis B virus (anti-HBs) and of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were drawn at months 0, 1, 2, 6, and 7. Local and systemic reactions were monitored by means of questionnaires. The results of our study demonstrate that the combined hepatitis A and B vaccine is well tolerated and highly immunogenic. The seropositivity and seroprotection rates were 100% for both antigens in all groups. Surprisingly, anti-HAV and anti-HBs antibody titres after the combined and mixed vaccines were significantly higher compared with the respective monovalent vaccines injected separately.

The objective of our study was to evaluate the correlation of the cervical length at 20–25 weeks of gestation with the incidence of spontaneous preterm delivery in twins in a country with a high incidence of preterm delivery compared to other European countries. Cervical length was measured in 262 consecutive patients. Previous preterm delivery before 34 weeks of gestation, chorionicity, maternal age, body-mass-index, smoking habit and parity were recorded as risk factors for preterm delivery. Women who were symptomatic at 20–25 weeks and who delivered because of other reasons than spontaneous labour and preterm rupture of membranes or at term were excluded. The primary outcome was incidence of preterm birth before 34 weeks. Two hundred and twenty-three patients were analyzed. Thirty-two (14%) delivered before 34 weeks. There was a significant correlation between cervical length of less than 25 mm and spontaneous delivery before 34 weeks (50% vs. 13%,p= .007). In addition, logistic regression analysis found cervical length to be the only significant predictor of spontaneous delivery before 34 weeks (OR 1.084; 95% CI 1.015; 1.159;p= .017). We conclude that the risk of severe preterm delivery in twins is high. Cervical length at mid-gestation was the only predictor of delivery before 34 weeks.