Comparison of 0.8 percent and 1.6 percent terconazole cream in severe vulvovaginal candidiasis

Article Abstract:

Vulvovaginitis (inflammation of the vulva and vagina, often simply called vaginitis) is a common condition that is treated primarily with topically applied medication. However, the messy and inconvenient nature of these treatments leads to poor compliance with the treatment program for many patients, and drugs that are effective in a short time period are desirable. The effectiveness of a new drug, terconazole, was evaluated in 38 women who received either terconazole or a placebo (inactive) substance for application into the vagina on three consecutive nights. Two dosages of terconazole were used: 0.8 percent (12 women) and 1.6 percent (12 women). Studies to determine the types of organisms present in the vagina were also performed. Results obtained after short-term use of terconazole (1 to 3 days) indicated that three-quarters of the women in the lower-dose group had no symptoms of vaginitis. Analysis of the vaginal flora (microorganisms) indicated that 83.3 percent of these women no longer had vaginal Candida albicans, the fungal species that causes most vaginitis of this type (candidiasis). On longer-term follow-up (30 to 35 days), the same number were asymptomatic and 58.3 percent were negative for the presence of Candida. No side effects were noted, nor were differences detected between the effects of the two dose levels of terconazole. The group of women was not typical, since the most difficult, recurrent cases were referred to the clinic. Thus, the success of terconazole against vaginitis in these subjects is particularly noteworthy. The drug appeared to offer no long-term advantage over other products, all of which are associated with an approximately 50 percent recurrence rate. For this reason, maintenance treatment after the initial therapy is often now recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Candidiasis, Terconazole

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Resolution of resistant vaginal trichomoniasis associated with the use of intravaginal nonoxynol-9

Article Abstract:

Vaginal trichomoniasis, also called vaginitis, is a sexually transmitted disease caused by an infection with the microorganism Trichomonas vaginalis (T. vaginalis). There are several different strains of T. vaginalis, some of which can be killed with the antibiotic metronidazole, while others are metronidazole-resistant. Recently, a contraceptive spermicide containing nonoxynol-9 has been shown to provide protection against certain sexually transmitted diseases, including trichomoniasis. The case report of a 31-year-old woman with vaginitis is presented. The patient had symptoms of vaginitis for 12 months before she sought medical treatment. Laboratory cultures of samples taken from the vagina tested positive for T. vaginalis. Treatment with metronidazole was prescribed for two weeks. At the end of the treatment period, the patient still had vaginitis. Several other treatments were tried, but failed. Metronidazole was tried again, but at a much higher dose. On day 15 of treatment, the patient became light-headed and confused. On day 33, her hands and feet became numb. Treatment with metronidazole was discontinued. It took three months for normal feeling to return to her hands and feet. Treatments with gentian violet, nitrofurantoin, chlorhexidine, clotrimazole, and acetic acid were tried and failed. Even though the vaginitis persisted, the patient resumed normal sexual activity using condoms and a spermicide containing nonoxynol-9. After a second episode of using nonoxynol-9 during coitus, the woman's vaginitis disappeared. Further studies should be performed to evaluate the use of nonoxynol-9 as a treatment for vaginitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Infection, Complications and side effects, Vagina, Trichomoniasis, Spermicides

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Persistent vaginitis caused by metronidazole-resistant trichomonas

Article Abstract:

Vaginitis (vaginal inflammation) is due in many cases to the microorganism Trichomonas vaginalis, which is usually successfully treated by the drug metronidazole. When symptoms do not resolve, however, patients are often regarded as noncompliant with the medication, or as having acquired new infections. The case reports of two patients whose infections did not respond to standard doses of metronidazole are presented. In both cases, culture of T. vaginalis revealed that it was resistant to metronidazole. Effective treatment consisted of a combination of oral metronidazole and metronidazole vaginal suppositories, with vaginal rinsing using a 3 percent solution of acetic acid. While topical use of metronidazole cannot be recommended as an initial approach to vaginitis caused by T. vaginalis, the approach described seems to be effective when infection repeatedly recurs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Drug resistance in microorganisms, Microbial drug resistance

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