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Aerobic vaginitis (AV) is a recently defined vaginal recurring infection, which is treated with antibiotics. However, excessive and prolonged use of antibiotics disrupts healthy vaginal microflora and leads to the emergence of antibiotic resistance among pathogens. This situation has directed researchers to explore alternative antimicrobials. The current study describes in vitro and in vivo antimicrobial efficacy and pharmaceutical interactions between plant essential oils (EOs) and five lactic acid bacteria (LABs), isolated from the healthy vagina, against E. faecalis, one of the major etiological agents of AV. In vitro experiments confirm good antimicrobial activity of both plant EOs and cell free supernatant (CFS) from LABs. Based on high antimicrobial efficacy, Moringa essential oil (MO) was selected to determine its nature of interaction with CFS of five LAB strains. Synergism was recorded between MO and CFS of L. reuteri (MT180537). To validate in vitro findings, prophylactic responses of individual and synergistic application of MO and L. reuteri (MT180537) were evaluated in an E. faecalis (MW051601) induced AV murine model. The prophylactic efficacy was evidenced by a reduction in intensity of clinical symptoms, E. faecalis (MW051601) count per vaginal tissue along with a reduction in AV associated changes in histological markers of infection in animals receiving Moringa essential oil and L. reuteri (MT180537) alone or in combination. However, significant synergism between Moringa essential oil and L. reuteri (MT180537) could not be observed. Our data confirms the importance of in vivo experiments in deducing pharmacological interactions.

Vaginite aeróbica (VA) é uma infecção vaginal recorrente definida recentemente, que é tratada com antibióticos. No entanto, o uso excessivo e prolongado de antibióticos perturba a microflora vaginal saudável e leva ao surgimento de resistência aos antibióticos entre os patógenos. Esta situação levou os pesquisadores a explorar antimicrobianos alternativos. O presente estudo descreve a eficácia antimicrobiana in vitro e in vivo e as interações farmacêuticas entre óleos essenciais vegetais (OE) e cinco bactérias lácticas (BAL), isoladas de vagina sã, contra E. faecalis, um dos principais agentes etiológicos da AV. Os experimentos in vitro confirmam a boa atividade antimicrobiana de ambos os EOs de plantas e sobrenadante livre de células (CFS) de LABs. Com base na alta eficácia antimicrobiana, o óleo essencial de Moringa (MO) foi selecionado para determinar sua natureza de interação com o sobrenadante livre de células (CFS) de cinco cepas de LAB. Sinergismo foi registrado entre MO e CFS de L. reuteri (MT180537). Para validar os resultados in vitro, as respostas profiláticas da aplicação individual e sinérgica de MO e L. reuteri (MT180537) foram avaliadas em um modelo murino AV induzido por E. faecalis (MW051601). A eficácia profilática foi evidenciada por uma redução na intensidade dos sintomas clínicos, contagem de E. faecalis (MW051601) por tecido vaginal, juntamente com uma redução nas alterações associadas a AV nos marcadores histológicos de infecção em animais que receberam óleo essencial de Moringa e L. reuteri (MT180537) sozinho ou em combinação. No entanto, não foi possível observar sinergismo significativo entre o óleo essencial de Moringa e L. reuteri (MT180537). Nossos dados confirmam a importância dos experimentos in vivo na dedução de interações farmacológicas.

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Female genital tract infections have a high incidence among different age groups and represent an important impact on public health. Among them, vaginitis refers to inflammation of the vulva and/or vagina due to the presence of pathogens that cause trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. Several discomforts are associated with these infections, as well as pregnancy complications and the facilitation of HIV transmission and acquisition. The increasing resistance of microorganisms to drugs used in therapy is remarkable, since women report the recurrence of these infections and associated comorbidities. Different resistant mechanisms already described for the drugs used in the therapy against Trichomonas vaginalis, Candida spp., and Gardnerella vaginalis, as well as aspects related to pathogenesis and treatment, are discussed in this review. This study aims to contribute to drug design, avoiding therapy ineffectiveness due to drug resistance. Effective alternative therapies to treat vaginitis will reduce the recurrence of infections and, consequently, the high costs generated in the health system, improving women's well-being.

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BACKGROUND: Vaginal candidiasis (VC) is a disease that affects thousands of women of childbearing age, mainly caused by Candida albicans fungus. Photodynamic therapy (PDT) uses photosensitizing substances that are nontoxic in the dark, but able to produce reactive oxygen species when they are subjected to a light source. In this work our purpose was to investigate PDT effects on fungal burden and inflammatory cells in a murine model of C. albicans-induced vaginal candidiasis. METHODS: Female BALB/c mice 6-10 weeks were estrogenized and maintained in this state during all experiment. After 72h, mices were inoculated intravaginally (IV) with 20µL of 2×10(5)C. albicans cells suspension. Mice were separated into 5 groups after five days: H (healthy), PBS (control), laser, MB (methylene blue) and PDT. PDT and MB groups received IV 20µL solution with 1mM of MB, others received PBS. PDT and laser groups were irradiated with a red laser (100mW, 660nm) in one (36J, 6min) or two sessions (18J, 3min). After the end of treatment, mice were submitted to microbiological and histomorphometric analysis with ImageJ software. Data were plotted by mean values and standard deviations of CFU/mL and percentage of inflammatory cells area. ANOVA and Bonferroni post-test were used and data were considered significant when p<0.05. RESULTS: PDT significantly reduced C. albicans after the two tested protocols, however, percentage area of inflammatory cells was significantly reduced just with two sessions of PDT. CONCLUSIONS: PDT with MB and red laser is a promising therapy for VC. It is able to reduce fungal infection in biofilm and inflammatory signals associated with VC in a murine model of vaginitis.

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A case of enterobiasis in pregnancy that presented as copious nocturnal vaginal discharge is reported. Enterobius vermicularis is the most common parasite infecting humans. Transmission can be fecal-oral or via fomites, and recently arrived immigrants from developing countries and individuals who live in households with young children are particularly at risk. Pinworms are most frequently found in the gastrointestinal tract but can also enter the vagina and bladder. Patients typically present with nocturnal anal itching, and diagnosis can be made by clinical history. Treatment includes an antihelminthic agent for the patient and members of the household as well as home hygiene measures to prevent transmission.

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The frequency of mucosal infections caused by Candida glabrata has increased significantly. Candida glabrata infections are often resistant to many azole antifungal agents, especially fluconazole. The purpose of this study was to compare the efficacies of posaconazole (PSC) and fluconazole (FLC) in the treatment of experimental C. glabrata vaginitis caused by isolates with different FLC susceptibilities. A battery of 36 vaginal isolates of C. glabrata was tested against PSC and FLC to determine their in vitro susceptibilities. The 48-h geometric mean MICs for all isolates tested were 0.156 and 4.238 µg ml(-1) for PSC and FLC respectively. Two strains of C. glabrata for which FLC MICs were different were selected for in vivo study. The treatment regimens for the vaginal murine infection model were PSC or FLC at 10 or 20 mg kg(-1) of body weight/day and 20 mg kg(-1) twice a day. Regimens with PSC at 20 mg kg(-1) once or twice a day were effective in reducing the load of both the FLC-susceptible and -resistant isolates of C. glabrata. FLC at 20 mg kg(-1) twice a day was effective in reducing the load of both the isolates of C. glabrata. PSC displayed a more effective in vivo activity than FLC in the treatment of murine C. glabrata vaginitis.

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BACKGROUND: Vaginitis is an inflammatory process in vaginal mucosa that affects millions of woman worldwide. OBJECTIVE: To evaluate prevalence perception and prescription preference among Latin-American gyneco-obstetricians in mixed vaginitis, and to identify attributes of various active principles. MATERIAL AND METHODS: multicentric and transversal study during January 2008. Close Up was used to poll gyneco-obstetricians prescribing clyndamicin plus ketoconazole. 1,198 gyneco-obstetricians were selected to answer a poll (scales and measuring attributes) to identify differences among various therapeutic schemes to mixed vaginitis. RESULTS: 34% of gyneco-obstetricians consider that 30 to 50% of them patients had mixed vaginitis, 38% consider a 50 to 70% of its prevalence, and 20% a 70% or higher figure. In a bad to excellent scale, 97% had very good to excellent results with antimycotic and antibacterial mix, 73% had a bad to good result with antimycotics alone and 79% with antibacterial alone. Clyndamicin plus ketoconazole had a meaningful difference from mean results (standard), and from the second best mix (metronidazole plus nystatin), with a rapid itch healing, efficacy, and relapse decrease. Metronidazole plus nystatin had the highest score in tolerance and treatment period. CONCLUSION: 90% of polled Latin-American obstetricians prescribe clyndamicin plus ketoconazole as the best available treatment to mixed vaginitis.

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OBJECTIVE: To evaluate the effectiveness of the combination of ketoconazol 400 mg + clindamycin 100 mg for 6 days compared to ketoconazol 800 mg + clindamycin 100 mg in Candida vaginitis and bacterial vaginosis. MATERIAL AND METHODS: Patients aged 18-60 years, with clinical diagnosis of Candida vaginitis and vaginosis confirmed by culture of genital secretions were included. Patients were assigned at random to one of two treatment groups: group 1 was given ketoconazol 400 mg + clindamycin 100 mg during six days (K/C6D); group 2 received ketoconazol 800 mg + clindamycin 100 mg for three days + placebo during three days (K/C3D). Patients were evaluated at days 7 and 11 after initiating treatment, at day 11 culture of vaginal secretion was repeated; along with treatment and follow up period patients were asked to report presence of adverse events. RESULTS: Eighty-two patients were included, 41 in K/C6D group and 40 in K/C3D group. C. albicans was found at baseline in 19 patients in K/C6D group and in 15 in K/C3D group; at day 11 was cultured in 2/19 patients (10.52%) and in 2/15 (13.33%) (p = 0.626) respectively; G. vaginalis was cultured at baseline in 25 patients of each group, at day 11 was cultured in 1/25 patients (4.0%) of K/C6D group and in 4/ 25 (16.0%) of K/C3D group (p = 0.174). Clinical cure was found in 36/41 cases (87.8%) of K/C6D group and in 34/40 cases (85.00%) of K/C3D (p = 0.965) group. Only five patients presented adverse events, of which three were related to the treatment. CONCLUSION: Treatment of vaginitis and bacterial vaginosis with anyone of both formulations has the same clinical and microbiological effectiveness, and is well tolerated by the patient. The fact that K/C3D formulation is as effective as K/C6D has the advantage of shortening the treatment time of vaginal infections, and allows a better patient compliance.

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Las enfermedades infecciosas inflamatorias del cérvix uterino, vagina y vulva se encuentran entre las patologías con mayor frecuencia en la práctica clínica cotidiana; forman parte de los 12 motivos principales de demanda de consulta en medicina familiar en el Instituto Mexicano del Seguro Social (IMSS). La cérvico-vaginitis de origen infeccioso se asocia con incremento en la frecuencia de parto pretérmino secundario a ruptura prematura de membranas amnióticas durante el embarazo y con enfermedad inflamatoria pélvica crónica, esterilidad de origen tubario y carcinoma cérvico-uterino. Todas estas patologías impactan en forma desfavorable la salud de las mujeres en edad reproductiva y dan lugar a secuelas de alto costo social y económico. En virtud de lo anterior, en el presente trabajo se efectúa la revisión y síntesis de los factores de riesgo, las medidas preventivas y los criterios más aceptados para el diagnóstico y tratamiento de los tipos más frecuentes de cérvico-vaginitis infecciosas, con el fin de contribuir a su difusión y a la utilización de protocolos actualizados y uniformes por parte del personal médico familiar y ginecoobstetra de nuestra institución

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La asociación de bacteria y hongos en las vulvovaginitis motiva un tratamiento combinado para evitar la recaída de la paciente. En este estudio se incluyeron 36 pacientes con vaginitis o vaginosis y se les practico exámenes bacteriológicos para determinar el organismo causante del cuadro clínico. La recurrencia del padecimiento se relacionó directamente con más de seis infecciones al año (39 por ciento). Los síntomas más severos se relacionaron con virus del papiloma humano (VPH) o Eschericha coli. La combinación de itraconazol/secnidazol fue efectiva tanto clínica como bacteriológicamente. Los casos resistentes al tratamiento fueron por VPH o gérmenes gramnegativos. La combinación es inocua y tuvo leves efectos secundarios sólo en 4.41 por ciento de los casos sin necesidad de suspender el tratamiento

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