Are Vaginal Symptoms Ever Normal?

Anderson, Matthew; Karasz, Alison; Friedland, Sarah

doi:10.1201/9781420005318-6

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…Although inclusion and exclusion criteria were aimed at enrolling women with normal VMF, seven out of 17 women had complaints of for instance irritation and pruritus during the study. Although vulvovaginal complaints are quite common among fertile women, they are often limited to transient discomfort [38] , as was the case in this study.…”

Section: Discussionmentioning

confidence: 50%

Longitudinal Study of the Dynamics of Vaginal Microflora during Two Consecutive Menstrual Cycles

et al. 2011

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BackgroundAlthough the vaginal microflora (VMF) has been well studied, information on the fluctuation of the different bacterial species throughout the menstrual cycle and the information on events preceding the presence of disturbed VMF is still very limited. Documenting the dynamics of the VMF during the menstrual cycle might provide better insights. In this study, we assessed the presence of different Lactobacillus species in relation to the BV associated species during the menstrual cycle, assessed the influence of the menstrual cycle on the different categories of vaginal microflora and assessed possible causes, such as menstruation and sexual intercourse, of VMF disturbance. To our knowledge, this is the first longitudinal study in which swabs and Gram stains were available for each day of two consecutive menstrual cycles, whereby 8 grades of VMF were distinguished by Gram stain analysis, and whereby the swabs were cultured every 7th day and identification of the bacterial isolates was carried out with a molecular technique.MethodsSelf-collected vaginal swabs were obtained daily from 17 non pregnant, menarchal volunteers, and used for daily Gram staining and weekly culture. Bacterial isolates were identified with tDNA-PCR and 16 S rRNA gene sequencing.ResultsNine women presented with predominantly normal VMF and the 8 others had predominantly disturbed VMF. The overall VMF of each volunteer was characteristic and rather stable. Menses and antimicrobials were the major disturbing factors of the VMF. Disturbances were always accompanied by a rise in Gram positive cocci, which also appeared to be a significant group within the VMF in general.ConclusionsWe observed a huge interindividual variability of predominantly stable VMF types. The importance of Gram positive cocci in VMF is underestimated. L. crispatus was the species that was most negatively affected by the menses, whereas the presence of the other lactobacilli was less variable.

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Section: Discussionmentioning

confidence: 50%

Longitudinal Study of the Dynamics of Vaginal Microflora during Two Consecutive Menstrual Cycles

et al. 2011

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“…No resistance was found against amphotericin B. Resistance to Ketoconazole, fluconazole, miconazole and voriconazole was 11.6%, while lower resistance was found against itraconazole and nystatin which was 9.3% as shown table(3).…”

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confidence: 77%

“…Candida albicans is the most frequent causative agent in about 80 − 90% of VVC infections even though other non albicans Candida species are increasingly reported (2). VVC is the most common gynecological ruling among women of child-bearing age (3). Among sexually active women, 75% have at least once experienced symptomatic VVC, which usually presents as soreness, burning, itching and abnormal curd-like vaginal discharge (4,5).…”

Section: Introductionmentioning

confidence: 99%

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Antifungal susceptibility pattern of Candida spp. isolated from vaginal discharge of pregnant women

Elmanama

Al-Reefi

Ahmad

et al. 2020

IUGNS

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Vaginal candidiasis is common fungal infections among pregnant women. The aim of this study is to determine antifungal susceptibility pattern of Candida spp. isolated from vaginal discharge and to investigate possible risk factors associated with Candida infection. One hundred high vaginal swabs were collected from pregnant women complaining from abnormal discharge from various clinics in Gaza city, during 2019. Samples were plated on Sabouraud Dextrose Agar supplemented with chloramphenicol. Candida isolates were identified to the Genus level based on cultural and morphological characteristic. The susceptibility to seven antifungals was determined using disc diffusion method. Demographic, environmental, behavioral and other possible risks factors associated with vaginal candidiasis were recorded through an interview with patients before collecting the vaginal swabs and after obtaining a verbal consent. Data analysis was done using the SPSS software. Candida spp. was isolated from 43% of vaginal swabs of pregnant women with discharge. Variations existed in the susceptibilities of the different Candida isolates to antifungals. Amphotericin B the most effective with 0% resistance followed by itraconzaol and nystatin with 9.4% resistance. Resistance to miconazole, ketoconazole, voriconazole and fluconazole was 11.6%. Statistically significant symptoms associated with positive Candida spp. cultures among pregnant women included; redness of vaginal area, secretions, yeast-like smell, urinary urgency, low sexual desire, itching and irritation (p ≤ 0.05). No statistical significance difference with regard to burning urinary sensation and painful intercourse. Candida spp. was isolated from 43% of vaginal swabs from pregnant women. Risks factors should be minimized by patient education and routine testing of pregnant women.

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“…Finally, both patients and clinicians would benefit from a better understanding of vaginal physiology and what constitutes a meaningful departure from the "normal." 27 Dr. Clyde Schechter suggested the initial study design and provided valuable statistical consultation. All data provided as n. *Two women were lost to follow-up.…”

Section: Discussionmentioning

confidence: 99%

Are a Speculum Examination and Wet Mount Always Necessary for Patients With Vaginal Symptoms? A Pilot Randomized Controlled Trial

Anderson¹,

Cohrssen²,

Klink³

et al. 2009

The Journal of the American Board of Family Medicine

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Purpose:The suggested evaluation of vaginal symptoms is based on the wet mount diagnosis of candidiasis, trichomoniasis, and bacterial vaginosis. We wondered if patients with vaginal symptoms could be managed initially based solely on symptoms.Methods: This pilot randomized controlled trial was conducted in 2 urban family practice clinics and enrolled 46 premenopausal, nonpregnant women with acute vaginal symptoms. In the control arm, women were managed based on a speculum examination and wet mount. In the intervention arm, women were managed based on symptoms. Women were tested for gonorrhea, chlamydia, and trichomoniasis and called 2 weeks later to assess symptom resolution, adverse medication effects, need for revisit, and satisfaction with care.Results: Forty-one of 44 women (93%) felt better 2 weeks after the visit; 28 (64%) had complete resolution of symptoms. The intervention arm had slightly better resolution of symptoms (P ‫؍‬ .046); there were other no differences between the 2 arms. Three women were diagnosed with sexually transmitted diseases (trichomoniasis, chlamydia, and gonorrhea).Conclusions: Our pilot study suggests that in selected women it may be reasonable to initially manage vaginal complaints based on symptoms. These results should be confirmed in other larger trials. Vaginal symptoms are extremely common in women presenting to primary care settings and are considered among the most common reasons women consult with physicians.1,2 The current standard of care for vaginal symptoms focuses on diagnosing bacterial vaginosis, trichomoniasis, and vaginal candidiasis using evaluation of the discharge with microscopy, pH testing, and the whiff test.3-5 Although theoretically it makes sense to diagnose before treatment, the actual benefit of following this approach has not been demonstrated in a clinical trial. There are both theoretical and practical problems with an approach to vaginal symptoms that focuses on identifying bacterial vaginosis, trichomoniasis, and candidiasis. First, the differential diagnosis of vaginal complaints is broad, including not only other microbial causes (herpes simplex, cervicitis, urinary tract infection) but also dermatologic conditions (desquamative inflammatory vaginitis, lichen simplex); vulvodynia; and concerns about sexual dysfunction and abuse. Secondly, studies in a wide variety of clinical settings show that no cause is identified in 25% to 50% of women with vaginal symptoms. 6 -8 This suggests that at least some women may present because of excessive physiologic discharge. Further complicating the picture, candida and trichomonas are often isolated from asymptomatic women, 9,10 so it is difficult to distinguish symptomatic infection from mere colo-

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Are Vaginal Symptoms Ever Normal?

Cited by 4 publications

References 14 publications

Longitudinal Study of the Dynamics of Vaginal Microflora during Two Consecutive Menstrual Cycles

Longitudinal Study of the Dynamics of Vaginal Microflora during Two Consecutive Menstrual Cycles

Antifungal susceptibility pattern of Candida spp. isolated from vaginal discharge of pregnant women

Are a Speculum Examination and Wet Mount Always Necessary for Patients With Vaginal Symptoms? A Pilot Randomized Controlled Trial

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