Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms

Nyirjesy, Paul; Weitz, M.; Grody, Marvin H. Terry; Lorber, Bennett

doi:10.1016/s0029-7844(97)00242-1

Cited by 89 publications

(38 citation statements)

References 5 publications

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“…In 1987, Friedrich [1] demarcated vulvar vestibulitis syndrome as a subset of vulvodynia characterized by severe pain on vestibular touch or attempted vaginal entry, tenderness in response Halperin/Zehavi/Vaknin/Ben-Ami/Pansky/ Schneider to pressure localized within the vulvar vestibule, and physical findings confined to vestibular erythema of various degrees. Although exact data regarding disease prevalence remain scarce, it is seen in as many as 15% of patients referred to tertiary care centers for evaluation of chronic vaginal symptoms [2]. The etiology of vulvar vestibulitis has still not been clarified, and is thought to be multifactorial [3,4].…”

Section: Introductionmentioning

confidence: 99%

The Major Histopathologic Characteristics in the Vulvar Vestibulitis Syndrome

Halperin¹,

Zehavi

Vaknin³

et al. 2005

Gynecol Obstet Invest

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Objective: In order to better understand the etiology of the vulvar vestibulitis syndrome, we examined the histopathologic parameters in vestibular mucosa, and compared the findings in specimens obtained from women with vulvar vestibulitis with those obtained from the control group. Study Design: Specimens of vestibulitis were obtained from 24 patients, undergoing circumferential vestibulectomy under general anesthesia due to the symptoms and signs consistent with vulvar vestibulitis. Control specimens were obtained from 16 women, without symptoms or signs of vulvar vestibulitis, undergoing reconstructive introital surgery due to roomy vagina, rectocele or painful episiotomy. All vestibular tissue specimens were examined for intensity of inflammation, extension of inflammatory cells into the epithelium, vascular proliferation, the presence of mast cells and proliferation of peripheral nerve bundles. Results: No significant difference was found regarding the degree of inflammation, the extension of inflammatory cells into the epithelium, the vascular proliferation and the presence of mast cells while comparing the study and the control groups. The only histopathologic feature, differentiating the patients with vulvar vestibulitis from the control group, was the proliferation of peripheral nerve bundles found in 19 out of 24 (79.1%) specimens expressing vestibulitis and in none of 16 control specimens (p < 0.0001). Conclusion: Our results, therefore, support the existence of peripheral nerve hyperplasia in vestibular tissue obtained from patients with vulvar vestibulitis, and exclude the role of active inflammation or mast cells as probable etiologies for the vulvar vestibulitis syndrome.

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Section: Introductionmentioning

confidence: 99%

The Major Histopathologic Characteristics in the Vulvar Vestibulitis Syndrome

Halperin¹,

Zehavi

Vaknin³

et al. 2005

Gynecol Obstet Invest

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“…Given this, it is not surprising that various efforts are being made to promote the maintenance of normal flora (Hughes & Hillier, 1990;McLean & Rosenstein, 2000;. Unfortunately, these have not proven to be very successful (Nyirjesy et al, 1997). This could be because about 10-42 % of women whose vaginal microbial communities lack appreciable numbers of lactobacilli apparently maintain 'normal' vaginal ecosystems (Hillier, 1998(Hillier, , 1999Larsen & Monif, 2001; Marrazzo et al, 2002; RedondoLopez et al, 1990).…”

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confidence: 99%

Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods

et al. 2004

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The normal microbial flora of the vagina plays an important role in preventing genital and urinary tract infections in women. Thus an accurate understanding of the composition and ecology of the ecosystem is important to understanding the aetiology of these diseases. Common wisdom is that lactobacilli dominate the normal vaginal microflora of post-pubertal women. However, this conclusion is based on methods that require cultivation of microbial populations; an approach that is known to yield a biased and incomplete assessment of microbial community structure. In this study cultivation-independent methods were used to analyse samples collected from the mid-vagina of five normal healthy Caucasian women between the ages of 28 and 44. Total microbial community DNA was isolated following resuspension of microbial cells from vaginal swabs. To identify the constituent numerically dominant populations in each community 16S rRNA gene libraries were prepared following PCR amplification using the 8f and 926r primers. From each library, the DNA sequences of approximately 200 16S rRNA clones were determined and subjected to phylogenetic analyses. The diversity and kinds of organisms that comprise the vaginal microbial community varied among women. Species of Lactobacillus appeared to dominate the communities in four of the five women. However, the community of one woman was dominated by Atopobium sp., whereas a second woman had appreciable numbers of Megasphaera sp., Atopobium sp. and Leptotrichia sp., none of which have previously been shown to be common members of the vaginal ecosystem. Of the women whose communities were dominated by lactobacilli, there were two distinct clusters, each of which consisted of a single species. One class consisted of two women with genetically divergent clones that were related to Lactobacillus crispatus, whereas the second group of two women had clones of Lactobacillus iners that were highly related to a single phylotype. These surprising results suggest that culture-independent methods can provide new insights into the diversity of bacterial species found in the human vagina, and this information could prove to be pivotal in understanding risk factors for various infectious diseases. INTRODUCTIONPrevious studies on the microbial flora of the human vagina indicate that micro-organisms normally present in the human vagina play a key role in preventing successful colonization by 'undesirable' organisms, including those responsible for bacterial vaginosis, yeast infections, sexually transmitted diseases and urinary tract infections (Donders et al., 2000;Gupta et al., 1998;Sobel, 1999;van De Wijgert et al., 2000). Moreover, epidemiologic studies have clearly established that abnormal vaginal microbial communities and lower genital tract infections are significantly associated with an increased risk of HIV infection (Cohen et al., 1995;Martin et al., 1999;Sewankambo et al., 1997). Based on this, researchers have speculated that the normal vaginal microbial ecosystem may play a pivotal role in lo...

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“…A possible explanation for more frequent isolation of nonalbicans species from vulvovaginitis patients may be the increased use of topical azole agents-available as over-thecounter preparations in the United States since 1992 (14,24). Patients who see a physician usually receive empirical therapy; vaginal cultures are not routinely obtained, and susceptibility testing is rarely performed.…”

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confidence: 99%

Antifungal Susceptibilities of Candida Species Causing Vulvovaginitis and Epidemiology of Recurrent Cases

Richter¹,

Galask

Messer³

et al. 2005

J Clin Microbiol

389

281

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There are limited data regarding the antifungal susceptibility of yeast causing vulvovaginal candidiasis, since cultures are rarely performed. Susceptibility testing was performed on vaginal yeast isolates collected from January 1998 to March 2001 from 429 patients with suspected vulvovaginal candidiasis. The charts of 84 patients with multiple positive cultures were reviewed. The 593 yeast isolates were Candida albicans (n ‫؍‬ 420), Candida glabrata (n ‫؍‬ 112), Candida parapsilosis (n ‫؍‬ 30), Candida krusei (n ‫؍‬ 12), Saccharomyces cerevisiae (n ‫؍‬ 9), Candida tropicalis (n ‫؍‬ 8), Candida lusitaniae (n ‫؍‬ 1), and Trichosporon sp. (n ‫؍‬ 1). Multiple species suggesting mixed infection were isolated from 27 cultures. Resistance to fluconazole and flucytosine was observed infrequently (3.7% and 3.0%); 16.2% of isolates were resistant to itraconazole (MIC > 1 g/ml). The four imidazoles (econazole, clotrimazole, miconazole, and ketoconazole) were active: 94.3 to 98.5% were susceptible at <1 g/ml. Among different species, elevated fluconazole MICs (>16 g/ml) were only observed in C. glabrata (15.2% resistant [R], 51.8% susceptible-dose dependent [S-DD]), C. parapsilosis (3.3% S-DD), S. cerevisiae (11.1% S-DD), and C. krusei (50% S-DD, 41.7% R, considered intrinsically fluconazole resistant). Resistance to itraconazole was observed among C. glabrata (74.1%), C. krusei (58.3%), S. cerevisiae (55.6%), and C. parapsilosis (3.4%). Among 84 patients with recurrent episodes, non-albicans species were more common (42% versus 20%). A >4-fold rise in fluconazole MIC was observed in only one patient with C. parapsilosis. These results support the use of azoles for empirical therapy of uncomplicated candidal vulvovaginitis. Recurrent episodes are more often caused by non-albicans species, for which azole agents are less likely to be effective.Limited data addressing the incidence of vulvovaginal candidiasis suggest approximately two-thirds of women experience at least one episode during their lifetime and nearly 50% of women have multiple episodes (3, 12). The majority of cases of vulvovaginal candidiasis are caused by Candida albicans; however, episodes due to non-albicans species of Candida appear to be increasing (15,22,29). Most non-albicans Candida species have higher azole MICs, and infections they cause are often difficult to treat (10,20,21,26).A possible explanation for more frequent isolation of nonalbicans species from vulvovaginitis patients may be the increased use of topical azole agents-available as over-thecounter preparations in the United States since 1992 (14, 24). Patients who see a physician usually receive empirical therapy; vaginal cultures are not routinely obtained, and susceptibility testing is rarely performed.Surveillance programs for candidemia have demonstrated that fluconazole resistance among C. albicans bloodstream isolates is rare (Յ1%) (16). The majority of studies analyzing yeast isolates from vulvovaginitis patients have also shown the recovery of fluconazole-resistant C. albicans isola...

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Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms

Abstract: Women with chronic vaginal symptoms often use over-the-counter and alternative medicines that add to health care costs and are unlikely to be of benefit.

Cited by 89 publications

References 5 publications

The Major Histopathologic Characteristics in the Vulvar Vestibulitis Syndrome

The Major Histopathologic Characteristics in the Vulvar Vestibulitis Syndrome

Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods

Antifungal Susceptibilities of Candida Species Causing Vulvovaginitis and Epidemiology of Recurrent Cases

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