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 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The etiology of vaginitis can be difficult to prove. To determine the relationship between clinical criteria (symptoms and signs) and three causes of vaginitis, we prospectively evaluated 22 criteria in 123 unselected symptomatic patients. Diagnoses of Candida albicans and Trichomonas vaginalis infection were based on culture. Bacterial vaginosis was defined by the presence of 3 of 4 clinical criteria. Only 49% of our patients received diagnoses, and itching was the only symptom more frequently noted among those with diagnoses. Symptoms did not differ among the three infections, and lack of vaginal odor in yeast infection was the only significantly different physical sign. Yeast and trichomonads were seen on microscopy in 63% and 75% of culture-positive specimens. Bacterial vaginosis had no significant clinical criteria beyond those that defined the diagnosis. We conclude that presenting symptoms and signs in vaginitis evaluation have limited value, and that half of the women with vaginitis may lack a microbiologic diagnosis.
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PMID:The limited value of symptoms and signs in the diagnosis of vaginal infections. 204 26

Approximately 90 per cent of all the vaginitides are caused by bacterial vaginosis, candidiasis, or trichomoniasis. Bacterial vaginosis is the most frequent, causing approximately 50 per cent of vaginal infections. As described by Amsel and colleagues, three of four findings indicate bacterial vaginosis: amine odor, pH greater than 4.5, clue cells, and a thin homogeneous discharge. Because G. vaginalis colonizes the vagina, treatment should not be instituted in an asymptomatic woman on the basis of a positive culture. For symptomatic patients, oral metronidazole 500 mg twice daily for 7 days is the treatment currently recommended. Vulvovaginal pruritus should be equated with candidiasis until proven otherwise. Mycelia or spores on 10 per cent KOH preparation are diagnostic of candidiasis in the presence of symptoms. Imidazole creams or suppositories are the treatment of choice. Trichomoniasis is characterized by malodor and mild pruritus. Demonstration of trichomonads on saline preparation or a positive culture provides the diagnosis. A single 2 gm dose of oral metronidazole is the initial treatment. Recurrences should provoke inquiry regarding predisposing factors and investigation of sexual partners. Vaginitis can recur, but if approached properly, these recurrences can be minimized, allowing the patient to proceed with daily life in comfort.
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PMID:Vaginitis: a common malady. 305 61

We screened 392 women attending the Laboratory of Microbiology of Toulouse Purpan Hospital for symptoms of lower genital tract infection for six microorganisms. Rates of isolation of Neisseria gonorrhoeae, Chlamydia trachomatis, Candida albicans, Mycoplasma hominis, and Gardnerella vaginalis were 1%, 7.7%, 29.8%, 23.8%, and 37.5%, respectively. Trichomonas vaginalis was detected by direct examination in specimens from 3.1% of patients. Another goal of this study was to determine the relative prevalence of these microorganisms in relation to clinical and epidemiologic findings. C. trachomatis was isolated significantly more often from patients under 25 year old (P less than 0.001), from those who use oral contraceptives (P less than 0.01), from those who have a male sexual partner with symptoms of sexually transmitted disease (P less than 0.001), and from those who present signs of cervicitis (P less than 0.05). Isolation of C. albicans was significantly associated with vulvar pruritus (P less than 0.01), vulvitis (P less than 0.01), and vaginitis (P less than 0.001). G. vaginalis and M. hominis are significantly associated with bacterial vaginosis (P less than 0.001). This syndrome was diagnosed clinically in 27.2% of our study population and was highly correlated with use of an intrauterine device (P less than 0.05).
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PMID:Lower genital tract infections in women: comparison of clinical and epidemiologic findings with microbiology. 313 8

The clinical features, microbiologic investigation, and response to therapy of three patients with Gardnerella vaginalis-associated balanoposthitis were studied. Each man presented with a similar syndrome of diffuse erythema and pruritus of the glans meatus and coronal sulcus, irritation of the prepuce, and minimal urethral discharge. A characteristic fishy odor was present in the urethral discharge of all three patients. G. vaginalis was isolated from the glans of all three, and clue cells were present in two. In all cases, cultures for Candida albicans, herpes simplex virus, Neisseria gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum were negative. All three patients responded to oral therapy with metronidazole and concurrent treatment of the partner. Two patients subsequently relapsed but ultimately responded to clindamycin therapy. These men presented with a distinctive clinical syndrome of balanoposthitis associated with G. vaginalis, which is in many respects similar to the syndrome of bacterial vaginosis in women. Our data indicate that balanoposthitis may have a polymicrobial and synergistic etiology involving G. vaginalis and anaerobic bacteria in the male lower genital tract; such an etiology is analogous to that of bacterial vaginosis.
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PMID:Gardnerella vaginalis-associated balanoposthitis. 349 1

The efficacy of pivampicillin and metronidazole were compared in the treatment of Gardnerella vaginalis associated bacterial vaginosis. In a multicenter trial 86 women were given pivampicillin (P) 700 mg twice daily for 6 days and 86 women received metronidazole (M) 400 mg three times daily for 7 days. At control, 2 weeks from the start of treatment, patients in group P showed the best clinical results, 77.9% in group P vs. 64.0% in group M (p = 0.066). P showed a higher clinical efficacy than M, both in women using intra-uterine device and in patients using other forms of contraception. Negative post-treatment cultures were seen in 43% of women in group P and 64% in group M (p less than 0.002). Bacteriological cure was unrelated to disappearance of discharge, odour and itching, although it correlated significantly with a negative amine test (p less than 0.00005). Pivampicillin in the dosages used in the present investigation is a useful alternative to metronidazole therapy.
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PMID:The treatment of Gardnerella vaginalis vaginosis: a randomized comparison of pivampicillin with metronidazole. 389 76

Nonspecific vaginitis was present in 37% of 40 patients attending the Special Urology (Sexually Transmitted Disease) Clinic at the Victoria General Hospital, in 23% of 75 patients attending the Family Planning Clinic, and in 23% of 13 patients attending the Prenatal Clinic at the Grace Maternity Hospital in Halifax, Nova Scotia. The mean prevalence was 27%. Subjective complaints of vaginal odor were significantly associated with nonspecific vaginitis (P less than .001), but symptoms of vaginal discharge or vulvar irritation and itching were not. No correlations were found between the presence of nonspecific vaginitis and the isolation of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Trichomonas vaginalis, or vaginal yeast species. The organic acid present in vaginal washings that best correlated with the presence of nonspecific vaginitis was succinic acid.
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PMID:Nonspecific vaginitis and other genital infections in three clinic populations. 664 45

Bacterial vaginosis is characterized by an uniform, malodorous, white-grey discharge. The presenting symptom is generally the unpleasant smell of the vaginal discharge, particularly following the menses or intercourse. Other functional signs, such as pruritus, dysuria and dyspareunia are rare. Inflammatory signs are frequent, and can be revealed by colposcopy with the Lugol test: this shows punctuate colpitis with small regular points corresponding histologically to an inflammatory focus in the connective tissue. The term "vaginitis" is avoided because of the absence of polymorphonuclear cells in the vaginal discharge, despite the presence of inflammation. Bacterial vaginosis has been held responsible for prematurity, small birthweight and post-partum infection. Nonetheless, Gardnerella vaginalis and Mobiluncus spp can be recovered from the vaginal flora of women with no signs of inflammation.
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PMID:[Clinical and colposcopic aspects of bacterial vaginosis]. 848 87

This was a cross-sectional study meant to determine the prevalence of vaginitis and bacterial vaginosis among open population females from Cuernavaca City. The relationship between clinical manifestations, laboratory diagnosis and response to therapy were evaluated as well. A group of 405 sexually active women were enrolled between January and July, 1994. The patients were attending the City Hospital for a regular gynecological consultation, upon their informed consent, they answered a specifically designed questionnaire and had a vaginal secretion sampling. Cotton swabs containing such secretions were employed to measure pH, estimate amines production (fishy odor) and perform both direct microscopic examination and Gram stained smears, which allowed the recognition of yeasts, Trichomonas vaginalis, "clue" cells and normal microflora. Treatments were clotrimazole for candidiasis and metronidazole for trichomoniasis and bacterial vaginosis. Data obtained were analyzed with statistical programs SPSS/PC and EGRET. Overall, 193 out of 405 women (47.7%) had some genital infection; most frequent was candidiasis with a prevalence of 105/405 (26%), bacterial vaginosis and trichomoniasis were present in 67/405 (16.5%) and 7/405 (1.7%) of the population, respectively. Clinical features associated to candidiasis were vulvar itching, dyspareunia, vulvar and cervical erythema, cervical inflammation and vaginal secretion. The only sign consistently observed in bacterial vaginosis patients was a yellow secretion. Women with T. vaginalis showed cervical lesions, friability, microhemorragic zones and vaginal secretion. One important factor linked to bacterial vaginosis was to have had premature labor. Therapeutic responses, with clinical and microbiological cure, were 92% for candidiasis; 93% for bacterial vaginosis; and 100% for trichomoniasis. In conclusion, it is of relevance to stimulate sexually active women to care for their genital health to medically diagnose, avoid and control the very common infections assessed in this paper.
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PMID:[Prevalence of bacterial vaginitis and vaginosis: association with clinical and laboratory features, and treatment]. 894 21

An assessment of gynecological morbidity among 385 married mothers of children 6-12 months of age from a district in South India's Karnataka State revealed a high burden of reproductive tract infections. Research methods included clinical examination, laboratory tests, and self-reports. A total of 152 women reported 226 gynecological complaints to a social worker, primarily vaginal discharge with bad odor and itching or irritation (22%), lower abdominal pain or vaginal discharge with fever (16%), and menstrual bleeding disorders or pain (15%). Under more extensive probing by a gynecologist, the proportion of women reporting menstrual problems rose to 62%. At medical examination, 36% of women had at least one clinically diagnosed reproductive tract infection, including pelvic inflammatory disease (11%), cervical ectopy (10%), and genital prolapse (3%). More than half had endogenous infections. The two most common infections, identified by laboratory tests, were bacterial vaginosis (18%) and mucopurulent cervicitis (37%). Sexually transmitted diseases, primarily trichomonal vaginalis, were diagnosed in 10%. Women residing in town, those with 6 or more years of schooling, and women with 4 or more pregnancies were significantly more likely to report menstrual problems. Laboratory-detected vaginosis was significantly higher among urban and sterilized women. There were no significant associations between demographic/socioeconomic status variables and the other reproductive health problems analyzed. Finally, severe anemia was present in 17% and chronic energy deficiency in 12%. The combination of widespread undernutrition/malnutrition and reproductive tract infections revealed in this study indicates an urgent need to take steps to implement the reproductive health strategy outlined at the 1994 Cairo Conference in South India.
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PMID:Levels and determinants of gynecological morbidity in a district of south India. 921 30

This is a study of 189 women attending a family planning clinic in rural South Africa to determine the prevalence of asymptomatic and unrecognized genital tract infections. Genital samples were taken from these women to diagnose infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, Treponema pallidum, and HIV, and to diagnose bacterial vaginosis. Among the 189 women, 41 (22%) reported having had an STD treated in the preceding 12 months. By direct questioning, 74 women stated the following symptoms: genital itch -- 38 (20%); vaginal discharge -- 56 (30%); dysuria -- 33 (18%); dyspareunia -- 22 (12%); and genital ulcers -- 4 (2%). 45 (24%) women had more than one symptom. 119 (63%) women had at least one genital infection, and 49 (26%) had multiple infections. Most of the infections were asymptomatic; while those that were symptomatic, were unrecognized or not reported. Results showed a high prevalence of genital tract infection among the participating women, with most of their infections remaining asymptomatic or unrecognized. Thus, strategies to detect and treat genital tract infections in rural South Africa need to be developed.
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PMID:Family planning services in developing countries: an opportunity to treat asymptomatic and unrecognised genital tract infections? 958 84


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