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Leukorrhea is one of the most common reasons for consultation in gynecology. A distinction must be made between physiological leukorrhea, the variations of which are linked to hormonal changes or specific conditions such as pregnancy or menopause, and pathological leukorrhea. Among the latter, infections are the most common, bacterial or candidal vaginosis accompanied by abnormal vaginal discharge, vulvar and vaginal pruritus and burning sensations. They are a source of discomfort for women with a risk of transmission to sexual partners. How can they be distinguished? What appropriate management is needed to preserve women's well-being and prevent complications? [ABSTRACT FROM AUTHOR]

BackgroundLasers and energy-based technologies have been developed for genitourinary applications over the past several decades.AimsThis consensus article aims to categorize the published articles and clinical trial data that culminated in protocol development of technology for genitourinary applications, and to develop consistent parameters in future clinical trials.Materials and methodsThe published articles and clinical trials data on lasers and energy-based devices applied to genitourinary conditions were categorized according to device and condition and consensus developed on protocols and parameters.ResultsThe devices in genitourinary applications were classified as fractional lasers, radiofrequency and high-intensity focused electromagnetic field therapy. The consensus of the protocols and parameters based upon the published clinical trials of their application to the vaginal and urologic conditions associated with genitourinary syndrome of menopause was developed and organized according to device and condition.DiscussionThe status of FDA clearances and future pathways are discussed.ConclusionsThis consensus article categorizes and presents the protocols and practices for the main classes of lasers and energy-based devices for genitourinary applications in future clinical trials.

Objective: To investigate the relationship between enolase (Eno) content, vaginal microecology and pregnancy outcomes in patients with vulvovaginal candidiasis (VVC) during pregnancy. Methods: A retrospective study was conducted on 77 pregnant VVC patients who were hospitalized and delivered in the obstetrics department of the 980th Hospital of PLA Joint Logistics Support Forces from April 2021 to April 2022. The pregnancy outcomes of pregnant VVC patients were observed and statistically analyzed, and they were divided into 49 cases with adverse pregnancy outcomes and 28 cases with normal pregnancy outcomes. The general data, vaginal microecological indicators, (1,3)-β-D-glucan and Eno levels were compared between the two groups. Logistic regression was applied to analyze the influencing factors of adverse pregnancy outcomes in VVC patients during pregnancy. Receiver operating characteristic curve was applied to analyze the diagnostic value of (1,3)-β-D-glucan and Eno for adverse pregnancy outcomes in patients with VVC during pregnancy. Results: The proportion of patients treated with anti-infection treatment in the adverse pregnancy outcome group was lower than that in the normal pregnancy outcome group, and the difference was statistically significant (χ2 =4.270, P=0.039). The proportions of vaginal flora density of grade II-III, flora diversity of grade II-III, cleanliness of grade I-II, pH value 3.8-4.5, hydrogen peroxide positivity, and leukocyte esterase negativity in the adverse pregnancy outcome group were lower than those in the normal pregnancy outcome group, the differences were statistically significant (all P < 0.05). The levels of (1,3)-β-D-glucan and Eno in the adverse pregnancy outcome group were higher than those in the normal pregnancy outcome group, the differences were statistically significant (all P < 0.001). (1,3)-β-D-glucan and Eno were independent risk factors for adverse pregnancy outcomes in patients with VVC during pregnancy (P < 0.05), the vaginal flora density of grade II-III was protective factor (P < 0.05). The AUC of (1,3)-β-Dglucan and Eno in the combined to diagnosis adverse pregnancy outcomes in patients with VVC during pregnancy was higher than that of a single index, with a sensitivity of 95.92% and a specificity of 82.14%. The combination of the two methods was better than that of (1,3)-β-D-glucan (Z=2.092, P=0.036) and Eno (Z=2.703, P=0.007). Conclusions: Elevated levels of (1,3)- β-D-glucan and Eno, and abnormalities in vaginal microecology can increase the risk of adverse pregnancy outcomes in VVC patients during pregnancy, and (1,3)-β-D-glucan combined with Eno can be used to screen the risk of adverse pregnancy outcomes in patients with VVC during pregnancy. [ABSTRACT FROM AUTHOR]

ObjectiveTo compare the performance of vaginitis diagnosis based on clinical assessment to molecular detection of organisms associated with bacterial vaginosis, vulvovaginal candidiasis, and Trichomonas vaginalis using a vaginal panel assay.MethodsThis cross-sectional diagnostic accuracy study included 489 enrolled participants from five collection sites where those with vaginitis symptoms had a vaginal assay swab collected during their visit and a clinical diagnosis made. The swab was later sent to a separate testing site to perform the vaginal panel assay. Outcome measures include positive, negative, and overall percent agreement (and accompanying 95% CIs) of clinical assessment with the vaginal panel assay. P

Background: Recurrent vulvovaginal candidiasis [RVVC] is a common condition affecting millions of women worldwide. It is associated with significant morbidity. Vulvovaginal candidiasis affects up to 75% of women of childbearing age once in their life, and up to 9% of women in different populations experience more than three episodes per year, which is defined as recurrent vulvovaginal candidiasis [RVVC].The Aim of the work was to test efficacy of povidone iodine vaginal swabs in treatment of recurrent vaginal candidiasis.Patients and Methods: This study included 210 women, who suffered from symptomatic acute episode of RVVC, and attended Obstetrics and Gynecology Department, Al-Azhar university hospital Damietta. They were divided into three groups: Group A [70 women] who were treated with povidone iodine vaginal swabs. Group B [70 patients] who were treated with oral fluconazole and topical azole therapy. Group C [70 patients] who were treated with a combination of povidone iodine swabs and fluconazole. The overall clinical cure rate and improvement were assessed and compared between groups.Results: There was no significant difference between study groups, regarding overall clinical cure rate, which was higher in group C. As the clinical cure, improvement and no improvement percentage were in group A, 62.8%, 27.2%, 10% respectively. In group B, the values were 60.0%, 28.5%, and 11.5%, respectively. The values in group C were 65.7%, 31.3% and 3.2% with the same order. However, the recurrence rate 6 months after treatment was significantly different between groups [it was 7.9%, 3.2% and 1.47% in groups A, B and C, respectively].Conclusion: Povidone iodine swabs were effective in treatment of RVVC as medical treatment almost with lower cost and lower side effects with good compliance.

BACKGROUND: Vulvovaginal candidiasis is one of the most common vaginal infections worldwide. We conducted this systematic review and meta-analysis to determine the effect of probiotics in the treatment of vulvovaginal candidiasis. METHODS: A comprehensive search of databases including PubMed, Scopus, Cochrane, Scientific Information Database (SID), IranMedex, and Google Scholar search engine was performed. The search was conducted from inception to 1 October 2022, to identify published English or Persian language randomized control trials (RCTs) of women with vulvovaginal candidiasis who received probiotics as medical treatment. The quality of the included studies was assessed using the Oxford Center for Evidence Based Medicine checklist. All statistical analyses were performed using Comprehensive Meta-analysis (CMA) version 2. RESULTS: Six RCTs were included in this review. The results showed that treatment with probiotic was not different from placebo regarding the rate of positive culture (OR: 1.12; 95% CI: 0.390 to 3.26, P=0.825); treatment with probiotic was more effective compared to placebo regarding the rate of recurrence. (OR: 0.14; P= 0.01; 95 % CI: 0.028-0.7). CONCLUSION: Probiotics have a beneficial effect in the treatment of women with vulvovaginal candidiasis. Our results provide evidence for an alternative treatment modality for vaginal candidiasis using probiotics. [ABSTRACT FROM AUTHOR]

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermeir@s is the property of Colegio Oficial de Enfermeria de Lugo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Infectious vaginitis due to bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and Trichomonas vaginalis accounts for a significant proportion of all gynecologic visits in the United States. A prospective multicenter clinical study was conducted to validate the performance of two new in vitro diagnostic transcription-mediated amplification nucleic acid amplification tests (NAATs) for diagnosis of BV, VVC, and trichomoniasis. Patient- and clinician-collected vaginal-swab samples obtained from women with symptoms of vaginitis were tested with the Aptima BV and Aptima Candida/Trichomonas vaginitis (CV/TV) assays. The results were compared to Nugent (plus Amsel for intermediate Nugent) scores for BV, Candida cultures and DNA sequencing for VVC, and a composite of NAAT and culture for T. vaginalis The prevalences of infection were similar for clinician- and patient-collected samples: 49% for BV, 29% for VVC due to the Candida species group, 4% for VVC due to Candida glabrata, and 10% for T. vaginalis Sensitivity and specificity estimates for the investigational tests in clinician-collected samples were 95.0% and 89.6%, respectively, for BV; 91.7% and 94.9% for the Candida species group; 84.7% and 99.1% for C. glabrata; and 96.5% and 95.1% for T. vaginalis Sensitivities and specificities were similar in patient-collected samples. In a secondary analysis, clinicians' diagnoses, in-clinic assessments, and investigational-assay results were compared to gold standard reference methods. Overall, the investigational assays had higher sensitivity and specificity than clinicians' diagnoses and in-clinic assessments, indicating that the investigational assays were more predictive of infection than traditional diagnostic methods. These results provide clinical-efficacy evidence for two in vitro diagnostic NAATs that can detect the main causes of vaginitis.

Compared with sun-exposed melanomas, less is known regarding the pathogenesis of sun-protected melanomas. Sun-protected melanomas share many epidemiologic factors, but their genetic heterogeneity is not well studied. We investigated the genomic profile of acral, mucosal, and vulvovaginal melanomas. We hypothesize that mucosal melanomas, recognized for their uniquely aggressive clinical behavior, have distinct genomic features. We performed whole transcriptome messenger RNA and DNA (1711 genes) sequencing, messenger RNA expression profiling, tumor mutational burden, ultraviolet signature, and copy number variants analysis on 29 volar/digital acral, 7 mucosal, and 6 vulvovaginal melanomas. There was significant genetic heterogeneity, particularly in acral melanomas, with 36% having BRAF alterations, whereas other melanomas had none (P =.0159). Nonzero ultraviolet signatures were more frequent in acral melanomas, suggesting greater ultraviolet involvement. Mucosal melanomas formed a distinct group with increased expression of cell cycle and proliferation genes. Various targetable aberrations were identified, such as AURKA and ERBB2 , in mucosal and acral melanomas, respectively. The sample size was a small. There is significant genetic heterogeneity among sun-protected melanomas. Mucosal melanomas have upregulation in cell cycle and proliferation genes, which may explain their aggressive behavior. Ultraviolet radiation plays some role in a subset of acral but not other melanomas. [ABSTRACT FROM AUTHOR]

ABSTRACT The polymorphic fungus Candida albicans remains a leading cause of both invasive and superficial mycoses, including vulvovaginal candidiasis (VVC). Metabolic plasticity, including carbohydrate catabolism, confers fitness advantages at anatomical site-specific host niches. C. albicans possesses the capacity to accumulate and store carbohydrates as glycogen and can consume intracellular glycogen stores when nutrients become limited. In the vaginal environment, estrogen promotes epithelial glycogen accumulation and C. albicans colonization. However, whether these factors are mechanistically linked is unexplored. Here, we characterized the glycogen metabolism pathways in C. albicans and investigated whether these impact the long-term survival of C. albicans, both in vitro and in vivo during murine VVC, or virulence during systemic infection. SC5314 and 6 clinical isolates demonstrated impaired growth when glycogen was used as the sole carbon source, suggesting that environmental glycogen acquisition is limited. The genetic deletion and complementation of key genes involved in glycogen metabolism in Saccharomyces cerevisiae confirmed that GSY1 and GLC3, as well as GPH1 and GDB1, are essential for glycogen synthesis and catabolism in C. albicans, respectively. Potential compensatory roles for a glucoamylase encoded by SGA1 were also explored. Competitive survival assays revealed that gsy1Δ/Δ, gph1Δ/Δ, and gph1Δ/Δ sga1Δ/Δ mutants exhibited long-term survival defects in vitro under starvation conditions and in vivo during vaginal colonization. A complete inability to catabolize glycogen (gph1Δ/Δ sga1Δ/Δ) also rendered C. albicans significantly less virulent during disseminated infections. This is the first study fully validating the glycogen metabolism pathways in C. albicans, and the results further suggest that intracellular glycogen catabolism positively impacts the long-term fitness of C. albicans in nutrient deficient environments and is important for full virulence. IMPORTANCE Glycogen is a highly branched polymer of glucose and is used across the tree of life as an efficient and compact form of energy storage. Whereas glycogen metabolism pathways have been studied in model yeasts, they have not been extensively explored in pathogenic fungi. Using a combination of microbiologic, molecular genetic, and biochemical approaches, we reveal orthologous functions of glycogen metabolism genes in the fungal pathogen Candida albicans. We also provide evidence that extracellular glycogen poorly supports growth across the Candida species and clinical isolates. Competitive fitness assays reveal that the loss of glycogen synthesis or catabolism significantly impacts survival during both in vitro starvation and the colonization of the mouse vagina. Moreover, a global glycogen catabolism mutant is rendered less virulent during murine invasive candidiasis. Therefore, this work demonstrates that glycogen metabolism in C. albicans contributes to survival and virulence in the mammalian host and may be a novel antifungal target.

BACKGROUND: Recurrent vulvovaginal candidiasis (RVVC) is a problematic form of mucosal Candida infection, characterized by repeated episodes per year. Candida albicans is the most common cause of RVVC. Currently, there are no immunotherapeutic treatments for RVVC. METHODS: This exploratory randomized, double-blind, placebo-controlled trial evaluated an immunotherapeutic vaccine (NDV-3A) containing a recombinant C. albicans adhesin/invasin protein for prevention of RVVC. RESULTS: The study in 188 women with RVVC (n = 178 evaluable) showed that 1 intramuscular dose of NDV-3A was safe and generated rapid and robust B- and T-cell immune responses. Post hoc exploratory analyses revealed a statistically significant increase in the percentage of symptom-free patients at 12 months after vaccination (42% vaccinated vs 22% placebo; P = .03) and a doubling in median time to first symptomatic episode (210 days vaccinated vs 105 days placebo) for the subset of patients aged

Gynecologic tract melanoma (GTM) is a rare malignancy with historically poor outcomes. The current study examines patterns of care and oncologic outcomes in a large single-institution cohort from the contemporary therapeutic era. Patterns of care and predictors of outcomes were evaluated for all GTM patients without metastatic disease at diagnosis who were treated at our institution between 2009 and 2020 with >6 months of follow-up. Of the 124 patients included, anatomic subsites were vulvar (n = 82, 66%), vaginal (n = 34, 27%), or cervical (n = 8, 6%). Primary tumor was resected for 85% (n = 106) with surgical nodal evaluation for 60% (n = 75). Systemic therapy, most commonly immune checkpoint inhibitors (ICI, 58% systemic therapy), was used to treat all except one unresectable patient (17/18) and 33% (35/106) of resectable patients. Seven patients received neoadjuvant ICI. Fourteen patients received adjuvant radiation therapy to the pelvis (RT, 13% of those undergoing resection). With a median follow-up of 45 months, 100 patients (81%) recurred. Four-year actuarial outcomes were: 46% local control, 53% nodal control, 36% distant metastasis-free survival, 17% disease-free survival, 49% melanoma-specific survival and 48% overall survival. Mitotic rate > 10/mm2, nodal involvement and non-vulvar anatomic subsite were associated with poor outcomes. Patients treated after 2016 did not have significantly better outcomes than those treated earlier. Patients with GTM continue to have poor outcomes in the contemporary therapeutic era with particularly notable poor local disease control relative to other mucosal melanoma subtypes. More effective oncologic therapy is needed. • Gynecologic tract melanoma patients continue to have poor outcomes in the contemporary therapeutic era. • About half of patients will have primary disease progression with almost two-thirds developing distant metastasis. • High mitotic rate and vaginal or cervical disease predict for worse outcomes. • Radiation therapy may play a role in improving local disease control. [ABSTRACT FROM AUTHOR]

Background: Vulvovaginal candidiasis is the second most common cause of vulvovaginal infections. Due to the increasing resistance to synthetic antifungal drugs, the use of drugs with a natural origin is a priority. The aim of the present study was to compare the effectiveness of Arnebia euchroma with vaginal cream clotrimazole 1% United States Pharmacopeia (USP) for the treatment of vulvovaginal candidiasis. Materials and Methods: This triple-blind trial study was performed on 112 women with diagnosed Candida vaginitis clinically and by a laboratory test, patients were randomly divided into two groups receiving Arnebia euchroma and vaginal clotrimazole (56 people per group) in clinics and medical centers Ahvaz (Iran) from April 2018 to April 2019. Clinical and laboratory symptoms were recorded at the beginning of the study and 1 week after the end of treatment by a researcher-made questionnaire. Data analysis were performed using SPSS software v-23. p < 0.05 was considered significant. Results: After the intervention, vaginal culture was negative in terms of Candida in 17 (36.17%) patients of the Amoeba euchroma group and 37 (69.81%) patients of the clotrimazole group. The Chi-square showed that there was a significant difference between the culture results in both groups (χ2 = 10.10, df = 1, p = 0.001). No differences were observed between the two groups in terms of vaginal symptoms based on adjustment for age and using a logistic regression model. Conclusions: A vaginal cream containing Arnebia euchroma could reduce the complaints of vulvovaginal candidiasis. But, future studies with larger sample sizes and different dosages are recommended.

Background/Objectives: To compare the quality of life in patients with vulval lichen sclerosus (VLS), vulval lichen planus (VLP) and chronic vulvovaginal candidiasis (CVVC), as measured by the Vulval Quality of Life Index (VQLI). Methods: A retrospective, single‐centre cohort study was conducted at a combined dermatology and gynaecology practice from March 2018 to November 2021. VQLI scores and patient data were systematically collected and recorded in an online patient database. Treatment regimens were individualised and titrated to clinical response. Results: Over 3 years, a total of 200 women were recruited: 59 with CVVC, 79 with VLP and 62 with VLS. The median duration of follow‐up for all patients was 45.43 (16.25–80.89) weeks. At baseline, the median (interquartile range [IQR]) VQLI score was 24.00 (19.00–31.00), 21.00 (12.00–26.00) and 14.00 (7.00–26.00) for CVVC, VLP and VLS, respectively. At follow‐up, the median (IQR) VQLI score for CVVC, VLP and VLS was 9.00 (3.00–15.00), 9.00 (3.00–16.00) and 5.00 (2.00–10.00), respectively. All three groups showed a significant improvement in VQLI score (p < 0.0001). At baseline, the highest scoring domains were 'Sexual Function' for CVVC and 'Future Health Concerns' for VLP and VLS. At follow‐up, the highest scoring domains were 'Sexual Function' for CVVC and VLP, and 'Future Health Concerns' for VLS. Conclusions and Relevance: Vulval disease has an immense impact on QOL, especially in patients with CVVC. The VQLI is useful to clinicians in identifying the unique impact of each vulval condition on a patient's QOL in order to provide better patient‐focussed care. [ABSTRACT FROM AUTHOR]

Background: Injuries of lower genital tract are commonly seen in obstetrics patients during labor and delivery. Nonobstetric genital injuries are seen less commonly. Research on injuries to the lower genital tract from nonobstetric trauma is therefore scant. The purpose of this study was to document causes, treatment, and outcomes among patients of lower genital tract injuries visiting to B. R. D. Medical College and Nehru hospital, Gorakhpur, U.P. Methods: Admission and operation theater registers of the department of obstetrics and gynecology during 1 year were scrutinized for cases admitted with the diagnosis of genital trauma. Bed-head tickets of patients were scrutinized with the help of a data abstraction form, and information regarding age, cause of injury, site, size and pattern of injuries, treatment, and short-term outcome were recorded. Results: Of a total of 43 cases of traumatic genital tract injuries, 39 women received treatment. Maximum cases were seen in girls aged 6–10 years. Three women were pregnant at the time of injury. Noncoital injuries predominated over coital injuries, i.e., 59% versus 38.4%. Among the noncoital injuries, fall was the most common cause accounting for 75% of the cases. Coital injuries following consensual sex occurred more commonly in women who were sexually active, lactating, or postmenopause. The chief presenting complaint was vaginal bleeding. Vaginal wall laceration/tear was the most common injury reported. Multiple injuries were seen in 40% (17/39) of the cases. Twenty-one cases of laceration/tear (53.8%) were repaired surgically of which seven required examination and repair under anesthesia. Vulvar hematomas were managed by incision and drainage. There was no major morbidity or mortality. Conclusions: The results of this study from eastern Uttar Pradesh, India, support those from other developing nations. Noncoital injuries were found to be the most predominant cause of non-obstetric genital trauma, though, contrary to others, children were seen to be at the greatest risk. It is important to teach children about playing safely and following safety measures while on the road. We must also make them aware so that they do not become victims of rape. [ABSTRACT FROM AUTHOR]

Most of the feminine hygiene products sold in the market contain heavy chemicals that damage the mucosa. The well-designed intim formulation cleans without damage, supports the flora, protects against dryness, and maintenances of balanced microflora. For this purpose, we designed formulations made with natural raw materials such as manuka oil and Salix alba bark extract and investigated their irritation potential and effectiveness. A healthy vagina is dominated by Lactobacillus that produces lactic acid, resulting in a characteristic acidic environment (pH 3-4), as it correlates with vaginal health by inhibiting the growth of bacteria and may also play a part in local immune defense. This new manuka oil- salix bark extract containing wash formulation was specifically formulated to achieve a formulation pH of 4.6-4.8 to be compatible with the normal skin pH range and to help maintain vulvovaginal skin homeostasis and provide protection against harmful bacteria. The formulation we designed was used by volunteers for 4 weeks and was found suitable in terms of gentle clean, refreshing feeling, shooting the skin, smell and irritation properties. None of the volunteers have experienced any side effects during product application. Our study findings further support other studies that have found that women who use intim wash attitudes and perceptions about hygiene. [ABSTRACT FROM AUTHOR]

Genital rejuvenation encompasses not only the nonsurgical interventions but also the surgical procedures that are utilized to improve the functional aspects and/or enhance the aesthetic presentation of the genitalia of women (vaginal rejuvenation) and men (scrotal rejuvenation). Vaginal rejuvenation was introduced into the medical literature in 2007; yet, within the last decade, physician and patient interest in this field has markedly increased. In contrast, the term scrotal rejuvenation was only coined in 2018. Rejuvenation of the genitalia may be considered for hair-associated (alopecia and hypertrichosis), morphology-associated (vulvovaginal atrophy, excess clitoral or labial tissue, scrotal wrinkling, and vaginal or scrotal laxity), and vascular-associated (angiokeratomas) changes of the vagina and scrotum. As women and men gain insight into the conditions that are amendable to genital rejuvenation, the demand for vaginal rejuvenation and scrotal rejuvenation will likely increase. Genital rejuvenation may become the next frontier in medical and cosmetic dermatology and dermatologists have the opportunity to provide rejuvenation of the vagina and scrotum for their patients.

Previous studies have revealed that Candida albicans isolates involved in chronic vulvovaginal candidosis (cVVC) phenotypically express less virulent traits than clinical isolates involved in sporadic infections. In this study, we aimed to further explore this finding by studying the behaviour of those same clinical isolates in in-vitro models of infection. Eighteen clinical Candida albicans isolates were collected from women suffering sporadic (eight isolates) or chronic infections (ten isolates). Adhesion to HeLa cells (human cervical cancer epithelial cell line) and resistance to phagocytosis by RAW 264.7 cells (murine macrophages cell line) were tested in-vitro. In addition, phenotypic expression of virulence factors related with either adhesion or resistance to phagocytosis was tested in-vitro. Results indicated that yeast isolates involved in sporadic infection adhered in a higher proportion of HeLa cells than those of chronic infections, which was related with their ability to produce biofilm (p < 0.05). The ability to evade phagocytosis was related to an elevated production of proteases (p < 0.05) by chronic isolates, while sporadic isolates' resistance to phagocytosis was related to a higher hydrophobicity of cell walls (p < 0.05). We conclude that the evasion of macrophage-mediated phagocytosis related to the production of proteases might be an important factor involved in the recurrence of vulvovaginal candidosis infection. [ABSTRACT FROM AUTHOR]

Objectives: Cytolytic vaginosis is a very rare entity that may be clinically misdiagnosed as vulvovaginal candidiasis. The aim of this study was to determine the incidence of cytolytic vaginosis in patients displaying symptoms similar to vulvovaginal candidiasis and to develop a clinicopathological diagnostic and therapeutic approach. Materials and Methods: In total, 3000 cervical smear samples were evaluated at our center between 2015 and 2018. Patients whose PAP smears demonstrated significant epithelial cytolysis, naked nuclei, excessive increase in lactobacilli population, absent or minimal neutrophils and no microorganisms were subjected to a symptom assessment questionnaire and had their vaginal pHs measured. They were classified into two groups according to their complaints, symptoms and vaginal pHs: Cytolytic vaginosis and Asymptomatic intravaginal lactobacillus overgrowth. A standardized NaHCO3 Sitz bath therapy was applied to the cytolytic vaginosis group. Results: Fifty-three of the patients (1.7%) were diagnosed as cytolytic vaginosis. After Sitz bath therapy, there was a statistically significant decrease in the cytolysis and lactobacillus scores of the patients. Vaginal discharge of 43 (81%) patients ceased completely while that of the remaining 10 (19%) patients decreased after the therapy. The improvement was statistically significant (P < 0.001). There was a complete resolution in 28 (96%) patients with severe; and in 21 (94%) patients with intermediate vaginal discomfort, after the therapy. Dyspareunia was resolved in 35 (97%) patients (P < 0.001). Conclusion: Cytolytic vaginosis is a rare entity that can be diagnosed with the help of cytopathology and has a therapy based on the modulation microbiota by decreasing the vaginal pH.

Background: The prevalence of vaginal candidiasis is high in women and proper treatment is essential in this regard. Materials and Methods: This single-blind randomized controlled clinical trial was conducted on 120 women who were referred to Hamadan health centers in 2019. The patients were randomly divided into Clotrimazole cream and Nika vaginal cream groups each including 60 cases. The intervention group received Nika vaginal cream once a day for a week and those in the control group were given Clotrimazole vaginal cream in the same way. The clinical symptoms were studied by clinical examinations and the culture of vaginal discharge before and 7 days after the treatment to confirm the diagnosis of Candida albicans. The results were analyzed by SPSS 21.0 using an independent t test, Mann–Whitney U test, and Chi-square, Fisher's exact, and McNemar's tests, the significance level was set at 0.05. Results: Most patients in both groups reported no clinical symptoms after the intervention, and no significant difference was observed between the two groups in this regard (χ2 = 2.23, p = 0.566). Conversely, a significant difference was found in Nika and Clotrimazole groups before and after the intervention regarding improving Vulvovaginal Candidiasis (VVC) symptoms χ2 = 86.01, χ2 = 99.41, respectively (p < 0.001). Finally, 84.48% and 75.86% of women in the Nika χ2 = 45.02 (p < 0.001) and Clotrimazole cream χ2 = 40.02 (p < 0.001) groups had negative culture results after the intervention. Conclusions: In general, the Nika and Clotrimazole vaginal creams have the same effects concerning improving the symptoms of vaginal candidiasis and thus can be used to treat VVC.

Objective: Genital infections that occur mostly in women are called vulvovaginal candidiasis. The study was conducted to determine the effect of genital hygiene behaviors on vulvovaginal candida in women with type 2 diabetes. Methods: Descriptive relational and the multi-centered study was conducted with 120 patients with type 2 diabetes who applied to the obstetrics and gynecology outpatient clinic of a public hospital in seven cities. The data were collected by using a questionnaire and the Genital Hygiene Behaviors Inventory. Frequency, arithmetic mean, standard deviation, minimum and maximum values, and Mann-Whitney U and Kruskal-Wallis tests were employed in the analysis of the data. Results: In the study, 94.2% of women with Type 2 diabetes had various vaginal symptoms, 63.7% of them applied to an obstetrician due to vaginal symptoms and, 54.9% of them were diagnosed and treated for vaginal candidiasis. 36.2% of them did not apply to the obstetrician despite having some symptoms. Women had some wrong behaviors and insufficient information on sexual health and genital hygiene although no difference was found between Genital Hygiene Behaviors Inventory and vulvovaginal candida. However, a significant difference between Genital Hygiene Behaviors and the history of urinary tract (p=0.004) and obstetric surgery or disease history (p=0.013). Conclusions: This study showed that diabetic women need to inform on genital hygiene behaviors as dimensions of diabetes education in order to prevent diabetes complications although no was found difference between genital hygiene behaviors and vulvovaginal candida. [ABSTRACT FROM AUTHOR]

Background Vulvovaginal candidiasis (VVC) is a common cause of vulvovaginal itching and discharge. This article discusses the latest CDC STI Treatment Guidelines for VVC. Methods A literature search of relevant topics was performed, and a team of experts was convened to discuss (1) diagnosis/testing modalities; treatment of (2) uncomplicated VVC , (3) complicated VVC, and (4) VVC caused by non- albicans yeast; (5) alternative treatment regimens; (6) susceptibility testing of yeast; Special Populations: (7) pregnancy and (8) HIV and VVC. Results Yeast culture remains the gold standard for diagnoses. Newer molecular assays have been developed for the diagnosis of VVC and perform well. Azole antifungals remain the treatment of choice for uncomplicated VVC. Two new drugs, TOL-463 and recently FDA-approved ibrexafungerp, appeared promising in clinical trials. For recurrent VVC, oteseconazole, not yet commercially available, may represent a new option. For non- albicans yeast infections in symptomatic patients, boric acid appears useful. No evidence supports the use of alternative treatments, including probiotics. Fluconazole during pregnancy may be associated with spontaneous abortion and craniofacial and heart defects. In women with HIV infection, lower CD4+ T-cell counts are associated with increased rates of VVC, and VVC is associated with increased viral shedding. Treatment measures in women with HIV infection are identical to those women without HIV infection. Conclusions There has been significant new knowledge generated about VVC since the 2015 CDC Guidelines which have led to changing recommendations. [ABSTRACT FROM AUTHOR]

Background: Vulvovaginal candidiasis is the second most common cause of vulvovaginal infections. Due to the increasing resistance to synthetic antifungal drugs, the use of drugs with a natural origin is a priority. The aim of the present study was to compare the effectiveness of Arnebia euchroma with vaginal cream clotrimazole 1% United States Pharmacopeia (USP) for the treatment of vulvovaginal candidiasis. Materials and Methods: This triple-blind trial study was performed on 112 women with diagnosed Candida vaginitis clinically and by a laboratory test, patients were randomly divided into two groups receiving Arnebia euchroma and vaginal clotrimazole (56 people per group) in clinics and medical centers Ahvaz (Iran) from April 2018 to April 2019. Clinical and laboratory symptoms were recorded at the beginning of the study and 1 week after the end of treatment by a researcher-made questionnaire. Data analysis were performed using SPSS software v-23. p < 0.05 was considered significant. Results: After the intervention, vaginal culture was negative in terms of Candida in 17 (36.17%) patients of the Amoeba euchroma group and 37 (69.81%) patients of the clotrimazole group. The Chi-square showed that there was a significant difference between the culture results in both groups (χ² = 10.10, df = 1, p = 0.001). No differences were observed between the two groups in terms of vaginal symptoms based on adjustment for age and using a logistic regression model. Conclusions: A vaginal cream containing Arnebia euchroma could reduce the complaints of vulvovaginal candidiasis. But, future studies with larger sample sizes and different dosages are recommended. [ABSTRACT FROM AUTHOR]

Abstract Background Accurate identification Candida is important for successful therapy and epidemiology study. The aim of research is to study API 20C yeast identification system identification rate by using molecular identification as gold standard and tested the antifungal susceptibility of Candida from patients with vulvovaginal candidiasis (VVC). Methods In total, 3574 yeast isolates were obtained from patients with VVC. API 20C yeast identification, molecular identification and in vitro antifungal susceptibility were performed. Results C. albicans was the predominant Candida species [2748 isolates, 76.9%] in VVC. The isolates from vaginal samples represented 22 species based on molecular identification. The API 20C system identifies only 11 of the species encountered during the study period. Based on the API 20C system, 3273 (91.78%) isolates were correctly identified to the species level. The correct identification rate of the API 20C system for rare yeast was 15.29% (26/170 isolates). Antifungal susceptibility was tested in a total of 1844 isolates of Candida from patients with VVC. C. albicans was susceptible to most of the tested antifungals. The MICs of azoles for C. glabrata were higher than those for C. albicans. The MICs of echinocandins for C. parapsilosis were higher than those for C. albicans. Conclusions The API 20C yeast identification system can be used to reliably identify the most common Candida species while molecular methods are necessary for the identification of closely related, emerging, and rare yeast species. The results from this study suggest that much of the previous studies on the epidemiology of VVC should be re-thought. C. albicans was susceptible to most of the tested antifungals.

Introduction: Vulvar occlusion and moisture buildup resulting from the use of sanitary pads, synthetic underwear and/or tight pants are considered risk factors for the development of vulvovaginitis (VV). However, this association is still poorly elucidated. Objective: To associate the use of sanitary pads and clothing with the presence of bacterial vaginitis (BV) and vaginal candidiasis (VC). Methods: Cross-sectional study aimed at analyzing the use of sanitary pads and clothing in 307 volunteers from 18 to 45 years old, with and without BV and/or VC. A questionnaire comprehending six domains was applied individually to the volunteers, in an outpatient gynecology clinic at a university hospital (University of Campinas, Brazil). This study analyzed three of six domains. Vaginal material was collected for microbiologic diagnosis of BV (Nugent criteria) and VC (Gram stain and culture of the fungus in Saboureaud). Exclusion criteria were: use of antibiotics within 15 days, history of cancer, positive HIV and/or syphilis and immunosuppressive disease. Statistical analysis were made with Fischer and chi-square tests, using the software EPI INFO 0.5. Significance level was set at p

The female genital tract angiomyofibroblastoma (AMFB) is a rare benign mesenchymal tumour that mostly affects premenopausal women. Although it is most commonly seen in the vulvovaginal region, it has also been documented in the inguinosacral region, pelvis, and retroperitoneum (1,2). Patients usually present with indolent, painless swelling in the vulvovaginal region, or a pedunculated lesion on rare occasions. Those that appeared in the vulva were frequently misdiagnosed as Bartholin cysts. Leiomyoma is a differential in the vaginal area. AMFB must be recognised from aggressive angiomyxoma (AA) due to the latter's potential for recurrence with typical infiltrative boundaries. We discuss a case of a 46-year-old woman who had a slow-growing paravaginal swelling incidentally discovered during a total hysterectomy for leiomyoma five years prior. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Vulvovaginal candidiasis (VVC) is a major concern for women of reproductive age group affecting more than 70% of total population of the mentioned population. Apart from Candida albicans as a predominant etiological fungal agent, other non albican species as C. glabrata, C. tropicalis, C. krusei, C. parapsilosis, Trichosporon spp. zygomycetes spp and Saccharomyces cerevisiae have also proven to be other important agents causing the disease. The situation becomes difficult when the usual conventional therapeutic modalities like oral and local azoles, as well as boric acid and flucytosine fail to cure the disease and raise the burden of resistant strains. RESULTS: Iberxafungerp, as a novel oral triterpenoid oral antifungal, has been evolved to treat VVC by interacting differently with the target cell unlike other echinocandins. Additionally, it has a broader antifungal spectrum, fungicidal activity against Candida spp., high tissue penetration into target tissues, activity at low pH, and no preclinical fetal toxicity, which addresses many of the unmet needs of existing antifungal drugs for VVC. CONCLUSIONS: Available data obtained from recently completed clinical trials on safety and efficacy of this drug in treatment of VVC, as well as recent approval from FDA raise a great hope to treat the drug-resistant pathogens.

This work aims to describe the actions to promote women's health within the scope of Primary Health Care (PHC) in a Basic Health Unit (UBS) in the Federal District, Brazil. This is a cross-sectional observational study developed through interviews with UBS doctors and nurses. The health professionals participating in the research had an average experience of five years and six months in PHC. Most of them mentioned addressing actions aimed at women's health in their crews and frequently diagnosing vulvovaginal candidiasis, mainly due to spontaneous demand. As main causes mentioned for the disease were intimate hygiene, the type of clothing of the patients and stress. Health education was exemplified as a conduct in the face of diagnosis and as an action to reduce cases. The study was able to reinforce the importance of activities carried out with strategic groups in the family health strategy, based on reflections on health education and the autonomy of women ahead of their quality of life and well-being. [ABSTRACT FROM AUTHOR]

Objective: To analyze the distribution characteristics of vaginal microecology and cervical human papilloma virus (HPV) in patients with vulvovaginal pruritus, dryness, pain and/or abnormal secretion, and to explore the relationship between vaginal microecology disorders and HPV infection. Methods: From February 1, 2019 to December 31, 2019, 483 patients with vulvovaginal pruritus, dryness, pain and/or abnormal secretion in the gynecological clinic of the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine were selected as the study subjects. Simultaneously, vaginal microecology and cervical HPV were detected and the results were analyzed. Results: Among the 483 patients, only 4 cases had normal vaginal microecology (0.8%) and 479 cases had microecology disorders (99.2%). of which 350 cases (73.1%) had microecological disorders (i.e. vaginal infections) with clear pathogens and 129 cases (26.9%) without clear pathogens. Among 350 cases of vaginal infection, 287 cases (82.0%) were single infection and 63 cases (18.0%) were mixed infection. The single infection of VVC (38.7%, 111/287) and mixed infection (79.4%, 50/63) with VVC had the highest incidence. The proportion of patients with decreased Lactobacillus and decreased H2O2 in vaginal infection was higher than that in vaginal microecological disorder without clear pathogens, and the difference was statistically significant (P＜0.05). Of the 483 patients, 162 were infected with HPV, at a rate of 33.5%. The HPV infection rate in vaginal infection (37.1%, 130/350) was significantly higher than that in vaginal microecological disorders without clear pathogens (24.0 %, 31/129). Among them, the HPV infection rate of patients with trichomonal vaginitis (TV), bacterial vaginosis (BV), aerobic vaginitis (AV), VVC, and BV intermediate were 73.3% (11/15), 52.9% (72/136), 34.5% (10/29), 29.2% (47/161) and 27.4% (20/73), respectively. Multivariate regression analysis showed that TV and BV were positively correlated with HPV infection (OR were 5.325 and 3.298, respectively, P＜0.05 ). Conclusions: Vaginal microecological disorders are common in patients with vulvovaginal pruritus, dryness, pain, and/or abnormal secretion, and they are susceptible to HPV infection. When vaginal infection occurs (especially TVand BV), the risk of HPV infection is greatly increased. [ABSTRACT FROM AUTHOR]

Candida albicans is part of the normal commensal microbiota of mucosal surfaces in a large percentage of the human population. However, perturbations of the host's immune response or bacterial microbiota have been shown to predispose individuals to the development of opportunistic Candida infections. It was recently discovered that a defect in the chemokine receptor CX3CR1 increases susceptibility of mice and humans to systemic candidiasis. However, whether CX3CR1 confers protection against mucosal C. albicans infection has not been investigated. Using two different mouse models, we found that Cx3cr1 is dispensable for the induction of interleukin 17A (IL-17A), IL-22, and IL-23 in the tongue after infection, as well as for the clearance of mucosal candidiasis from the tongue or lower gastrointestinal (GI) tract colonization. Furthermore, the dysfunctional human CX3CR1 allele CX3CR1-M280 was not associated with development of recurrent vulvovaginal candidiasis (RVVC) in women. Taken together, these data indicate that CX3CR1 is not essential for protection of the host against mucosal candidiasis, underscoring the dependence on different mammalian immune factors for control of mucosal versus systemic Candida infections.

Background: The prevalence of vaginal candidiasis is high in women and proper treatment is essential in this regard. Materials and Methods: This single-blind randomized controlled clinical trial was conducted on 120 women who were referred to Hamadan health centers in 2019. The patients were randomly divided into Clotrimazole cream and Nika vaginal cream groups each including 60 cases. The intervention group received Nika vaginal cream once a day for a week and those in the control group were given Clotrimazole vaginal cream in the same way. The clinical symptoms were studied by clinical examinations and the culture of vaginal discharge before and 7 days after the treatment to confirm the diagnosis of Candida albicans. The results were analyzed by SPSS 21.0 using an independent t test, Mann-Whitney U test, and Chi-square, Fisher's exact, and McNemar's tests, the significance level was set at 0.05. Results: Most patients in both groups reported no clinical symptoms after the intervention, and no significant difference was observed between the two groups in this regard (χ² = 2.23, p = 0.566). Conversely, a significant difference was found in Nika and Clotrimazole groups before and after the intervention regarding improving Vulvovaginal Candidiasis (VVC) symptoms χ² = 86.01, χ² = 99.41, respectively (p < 0.001). Finally, 84.48% and 75.86% of women in the Nika χ² = 45.02 (p < 0.001) and Clotrimazole cream χ² = 40.02 (p < 0.001) groups had negative culture results after the intervention. Conclusions: In general, the Nika and Clotrimazole vaginal creams have the same effects concerning improving the symptoms of vaginal candidiasis and thus can be used to treat VVC. [ABSTRACT FROM AUTHOR]

Seyededeh Sedigheh Hosseini,1,2 Hamidreza Joshaghani,3 Tahereh Shokohi,4 Alireza Ahmadi,1 Zahra Mehrbakhsh5 1Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran; 2Department of Laboratory Sciences, Faculty of Paramedicine, Gorgan University of Medical Sciences, Gorgan, Iran; 3Department of Clinical Biochemistry, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran; 4Department of Medical Mycology and Parasitology, Mazandaran University of Medical Sciences, Sari, Iran; 5Department of Biostatistics and Epidemiology, School of Health, Golestan University of Medical Sciences, Gorgan, IranCorrespondence: Seyededeh Sedigheh HosseiniLaboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan 4934174515, IranTel +9891137571228Fax +9832423630Email Hosseini.s@goums.ac.irPurpose: Antifungal resistance and virulence properties of Candida albicans (C. albicans) are growing health problems worldwide. The present study aims to investigate the effect of Zinc Oxide (ZnO) nanoparticles and Nystatin on SAP1-3 genes expression in C. albicans isolates of females with Vulvovaginal Candidiasis (VVC) isolated from Sayad Shirazi Obstetrics and Gynecology Hospital in Northeastern Iran during 2017– 2018.Patients and Methods: In this descriptive-analytic study, vaginal samples were collected from 280 VVC women. 196 (70%) of C. albicans isolates were identified by phenotypic and ITS genotypic methods. Susceptibility to Fluconazole C. albicans isolates was determined by the disk diffusion method. Detection of ERG11 gene was done by RT-PCR technique.Results: It was revealed that PCR amplified the ERG11 gene in all of the Fluconazole-resistant isolates. Real-time PCR was used to survey the effects of 3± 1.7μg/mL concentrations of ZnO nanoparticles and Nystatin on expression of SAP1-3 genes before and after treatment. 186 (95%) susceptible C. albicans and 10 (5%) Fluconazole-resistant C. albicans isolates from VVC were exposed to sub-minimum inhibitory concentrations (Sub-MIC) of ZnO-np (range=0.02– 12 μg/mL). Sub-MIC concentration was used for each strain, which reduced the expression of SAP1-3 genes to 1.8 MIC in the vaginal swabs. The observed reduction in gene expression was significant for both ZnO nanoparticles and Nystatin (P=0.01 and P=0.07, respectively).Conclusion: ZnO as antifungal agent can well reduce the growth and gene expression of SAP1-3 in the pathogenesis of VVC.Keywords: ZnO, gene expression, pathogenesis, vulvovaginal candidiasis

Vulvovaginal candidiasis (VVC) is a common disease that affects women′s quality of life. About 75% of women will be infected at least once in their lifetime, and VVC causes an economic burden of $1.8 billion each year. At present, treatment of VVC commonly used in clinic mainly includes azoles and polyenes. However, with the long-term use of clinical antifungal drugs, candida phenotype changes, virulence factor mutates, and non-candida infections increase, which pose challenges to the therapeutic effects of traditional antifungal drugs. We urgently need to develop new effective ones. For the treatment of VVC, the vaccines currently in clinical trials include PEV7 and NDV3, the drugs in the laboratory development stage are probiotics, antimicrobial peptides, herbs, nanoparticles, and some drugs include VT-1161, CD101, soluble β-glucan etc. have also shown antifungal effects in the research stage and are expected to be candidate drugs for the treatment of VVC. In general, the incidence and recurrence rate of VVC is high, there is an urgent need for new antibacterial drugs to improve the quality of life of patients and reduce the medical economic burden. [ABSTRACT FROM AUTHOR]

The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients. [ABSTRACT FROM AUTHOR]

Candida yeasts are the most frequent in the vaginal content. This yeast may be a normal microbiota but also causes candidiasis. In symptomatic cases, primary candidiasis (VVC) or recurrence (RVVC) can be considered. This study aims to compare the frequency and in vitro sensitivity profile of Candida species isolated in the vaginal content with the different stages of the presence of yeasts. A total of 258 non-pregnant patients with/without VVC were prospectively screened at a teaching Health Centre of the Faculty of Medicine, in the University of Sao Paulo. The vaginal isolates were identified by traditional and molecular methods. Yeasts were isolated in 160 women. 34% were asymptomatic, 34% with vulvovaginal candidiasis (VVC), and 32% recurrent vulvovaginal candidiasis (RVVC). C. albicans was the most frequent species with 50.1% (82/160), followed by C. parapsilosis 13.7%(22/160), C. glabrata 12.5% (20/160), and C. tropicalis (6.2%). Analysis by the group showed that, in the asymptomatic group, eight yeast species were isolated, C. albicans 44.5% (24/54), C. glabrata 20% (11/54), C. parapsilosis and Rhodotorula rubra being the most frequent. In the VVC group, 11 yeast species were identified. Most isolates were C. albicans 68.5% (37/54), C. tropicalis 7.5% (4/54), and C. parapsilosis 5.5% (3/54). In the RVVC group, ten species were identified, the most frequent being C. albicans 38.5% (20/52), C. parapsilosis 17% (9/52), C. glabrata 4% (8/52), and C. tropicalis 6% (3/52). Less frequent species, such as C. haemulonii and Trichosporon spp, were isolated in the VVC and RVVC groups, C. kefyr was isolated in the three groups studied, and Rhodotorula spp was isolated in the control and RVVC groups. Candida metapsilosis was present in two isolates from the RVVC group. Most isolates were considered sensitive to the tested antifungals. Less sensitivity was seen for caspofungin. In this study, we were able to verify that the most common species of yeasts found in vaginal secretion were isolated in the three groups studied; however, there was the diversity of species in VVC and RVVC. Cryptic species C. haemulonii and were isolated in symptomatic patients. High levels of MICs, some of the antifungals tested, in the control group, draw attention in the group of asymptomatic women. We would like to emphasize that this research aims to assist clinicians and gynecologists, as well as assist in the epidemiological studies of candidiasis, in our country, how to draw attention to the profile of sensitivity/resistance to antifungals. [ABSTRACT FROM AUTHOR]

Abstract The topic of vaginal discharge is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Health Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The chapter has been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects associated with vaginal discharge conditions, as well as guidance to health service managers and health professionals. Screening, diagnosing, and treating these conditions, the main complaints among women seeking health services, caused by infectious or non-infectious factors, also are presented. Besides, information is presented on surveillance, prevention, and control actions to promote knowledge of the problem and provide quality care and effective treatment.

We have previously reported that vaccination with rAls3p-N protein of Candida albicans, formulated with alum adjuvant (also designated as NDV-3) protects immunocompetent mice from, lethal disseminated candidiasis and mucosal oropharyngeal candidiasis. NDV-3 vaccine was recently, tested in a Phase 1 clinical trial and found to be safe, well-tolerated, and induced robust humoral and, cellular immune responses with increased interferon (IFN)-gamma and interleukin (IL)-17 secretion. In preparation for a Phase 2 clinical trial against vulvovaginal candidiasis (VVC), we evaluated NDV-3, efficacy in a murine VVC model. Here, NDV-3 induced a strong immune response characterized by high, anti-rAls3p-N serum IgG and vaginal IgA titers. Furthermore, moderate doses of the vaccine (a range of 1-30μg given subcutaneously [SQ] or 0.3-10μg given intramuscularly [IM]) elicited a 10-1000 fold, decrease in vaginal fungal burden vs. control (mice injected with alum adjuvant alone) in both inbred, and outbred mice infected with different clinical C. albicans isolates. Additionally, NDV-3 required both, T and B lymphocytes for efficacy in reducing C. albicans tissue burden, which is followed by a reduction, in neutrophil influx to the affected site. Finally, anti-rAls3p-N antibodies enhanced the ex vivo killing, of C. albicans by neutrophils primed with IFN-gamma. These data indicate that NDV-3 protects mice, from VVC by a mechanism that involves the concerted priming of both humoral and adaptive immune, responses.

We have previously reported that vaccination with rAls3p-N protein of Candida albicans, formulated with alum adjuvant (also designated as NDV-3) protects immunocompetent mice from, lethal disseminated candidiasis and mucosal oropharyngeal candidiasis. NDV-3 vaccine was recently, tested in a Phase 1 clinical trial and found to be safe, well-tolerated, and induced robust humoral and, cellular immune responses with increased interferon (IFN)-gamma and interleukin (IL)-17 secretion. In preparation for a Phase 2 clinical trial against vulvovaginal candidiasis (VVC), we evaluated NDV-3, efficacy in a murine VVC model. Here, NDV-3 induced a strong immune response characterized by high, anti-rAls3p-N serum IgG and vaginal IgA titers. Furthermore, moderate doses of the vaccine (a range of 1-30μg given subcutaneously [SQ] or 0.3-10μg given intramuscularly [IM]) elicited a 10-1000 fold, decrease in vaginal fungal burden vs. control (mice injected with alum adjuvant alone) in both inbred, and outbred mice infected with different clinical C. albicans isolates. Additionally, NDV-3 required both, T and B lymphocytes for efficacy in reducing C. albicans tissue burden, which is followed by a reduction, in neutrophil influx to the affected site. Finally, anti-rAls3p-N antibodies enhanced the ex vivo killing, of C. albicans by neutrophils primed with IFN-gamma. These data indicate that NDV-3 protects mice, from VVC by a mechanism that involves the concerted priming of both humoral and adaptive immune, responses.

Objectives: Cytolytic vaginosis is a very rare entity that may be clinically misdiagnosed as vulvovaginal candidiasis. The aim of this study was to determine the incidence of cytolytic vaginosis in patients displaying symptoms similar to vulvovaginal candidiasis and to develop a clinicopathological diagnostic and therapeutic approach. Materials and Methods: In total, 3000 cervical smear samples were evaluated at our center between 2015 and 2018. Patients whose PAP smears demonstrated significant epithelial cytolysis, naked nuclei, excessive increase in lactobacilli population, absent or minimal neutrophils and no microorganisms were subjected to a symptom assessment questionnaire and had their vaginal pHs measured. They were classified into two groups according to their complaints, symptoms and vaginal pHs: Cytolytic vaginosis and Asymptomatic intravaginal lactobacillus overgrowth. A standardized NaHCO3 Sitz bath therapy was applied to the cytolytic vaginosis group. Results: Fifty-three of the patients (1.7%) were diagnosed as cytolytic vaginosis. After Sitz bath therapy, there was a statistically significant decrease in the cytolysis and lactobacillus scores of the patients. Vaginal discharge of 43 (81%) patients ceased completely while that of the remaining 10 (19%) patients decreased after the therapy. The improvement was statistically significant (P < 0.001). There was a complete resolution in 28 (96%) patients with severe; and in 21 (94%) patients with intermediate vaginal discomfort, after the therapy. Dyspareunia was resolved in 35 (97%) patients (P < 0.001). Conclusion: Cytolytic vaginosis is a rare entity that can be diagnosed with the help of cytopathology and has a therapy based on the modulation microbiota by decreasing the vaginal pH. [ABSTRACT FROM AUTHOR]

Perigenital hematoma a rare cause of postpartum hemorrhage. It corresponds to the detachment of the paravaginal, paracervical or parametrial connective tissue by vascular lesions generally due to direct trauma during childbirth. We report a case of a 19-year-old female patient who presented painful swelling of the vulva after vaginal delivery. The examination found a patient with a pale face and stable vital constants. Inspection of the vulva reveals a purplish-pink swelling of the right hemivulva of 20/14 cm (A), reaching the inguinal fold, the large gluteal fold in the mount of venus by compressing the left lip inside and the vaginal orifice. The deep vaginal examination showed an extension of the hematoma to the right lateral wall of the vagina and two tears (at the lateral cul de sac and 2 cm from the vestibular bulb). The management was surgical and medical by hemostatic sutures after evacuation of a 700ml hematoma and we repaired the episiotomy. The patient was given antibiotics and local antiseptic. No recurrence was noticed in the post-partum. Each perigenital hematoma is unique and the management is guided by clinical common sense. No need to intervene on vulvar hematoma of 3 cm whose size is stable and without maternal repercussions. Some offer simple monitoring for hematomas less than 5 cm or 8 cm. Active treatment is essential for vulvar hematomas greater than 10 cm. Evacuation of a stable hematoma increases the risk of recurrent bleeding. Its treatment is nowadays based on surgery and / or arterial embolization

Sanyuktha Tulasidas,1 Pooja Rao,2 Sevitha Bhat,2 Radhakrishna Manipura1 1Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, India; 2Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal McGill Center for Infectious Diseases, Mangalore, Manipal, India Introduction: Candida species, one among the opportunistic fungi, has become a common pathogen causing vaginal thrush and nosocomial bloodstream infections (BSIs). This study aims to evaluate the prevalence and antifungal susceptibility of various Candida species and slime production by Candida species in BSIs and vulvovaginal candidiasis (VVC). Materials and methods: A total of 176 samples were collected for a period of 1 year. Antifungal susceptibility testing and biofilm production testing were performed by the Kirby-Bauer method and crystal violet assay, respectively. Results: Out of 176 samples, 74 (42%) were from BSIs and 102 (58%) were from VVC. The biofilm production was comparatively high in blood isolates, 55 (74%), than cervical isolates, 45 (44%). Increase in the trends of non-albicans Candida (NAC) species was seen in our setup. Good susceptibility rates were seen among Candida species, 82.38% to voriconazole and an increasing resistance pattern of 26.13% to fluconazole. Conclusion: Speciation of Candida becomes important as the prevalence of NAC is increasing. Antifungal susceptibility testing by the disk diffusion method is cost effective and should be adopted in routine testing as there is an increasing azole resistance, especially in invasive NAC infections. In this study, there was no correlation of antifungal drugs with the biofilm production. Keywords: biofilm, Candida, azoles, vulvovaginal, bloodstream infections

To explore the relationship between gestational diabetes mellitus with premature rupture of membranes and vaginal microbial infection and pregnancy outcome. Methods: From June 2019 to June 2020, pregnant women with gestational diabetes mellitus and PPROM in our hospital were selected as the study group (n=64) and normal pregnant women in our hospital at the same time as the control group (n=50). Vaginal secretions were collected for the detection of group B streptococcus (GBS), bacterial vaginosis (BV) and Candida (CM). Cervical secretions were used for the detection of Ureaplasma urealyticum (UU) and Chlamydia (CT). The vaginal microbial infection and pregnancy outcomes were recorded. Results: There was significant difference in GBS, UU and CT infection between the two groups (P＜0.05), but there was no significant difference in BV and CM infection (P＞0.05). GDM combined with PPROM was positively correlated with GBS, UU and CT infection (r=0.293, 0.202, 0.189, respectively), and GBS infection was most significantly related. The incidence of chorioamnionitis was significantly higher in GBS and CT infection groups (r=0.375, 0.277), neonatal pneumonia was significantly higher in GBS, CT and BV infection groups (r=0.248, 0.239, 0.245), and the incidence of pathological jaundice in UU and CT infection groups was significantly higher (r=0.489, 0.292). Conclusions: It is of great significance to carry out vaginal microbiological detection in women with gestational diabetes mellitus, and the infection of GBS may lead to the occurrence of PPROM, and further lead to adverse pregnancy outcomes, such as chorioamnionitis and neonatal pneumonia. [ABSTRACT FROM AUTHOR]

Ano-uro-genital (AUG) mucosal melanomas are rare cancers associated with poor outcomes and limited evidence-based management. The United Kingdom AUG mucosal melanoma guideline development group used an evidence-based systematic approach to make recommendations regarding the diagnosis, treatment and surveillance of patients diagnosed with AUG mucosal melanomas. The guidelines were sent for international peer review, and are accredited by The National Institute for Health and Clinical Excellence (NICE). A summary of the key recommendations is presented. The full documents are available on the Melanoma Focus website. • Mucosal melanomas of ano-uro-genital structures are rare malignancies with poor prognoses. • Owing to their rarity, there is limited evidence in the literature to guide clinical decision making. • We provide a summary of the evidence and recommendations for the management of AUG melanoma. [ABSTRACT FROM AUTHOR]

Majority of defects after excision of vulvovaginal skin cancers is shallow in depth. A thin flap is thus suitable for pudendal defects. To create a thin pudendal artery flap, the relationship between fat thickness and age or body mass index (BMI) was examined. A total of 12 flaps in 7 cases were enrolled. In the initial 3 cases, five flaps were elevated in the subfascial plane of the gluteus maximus muscle based on the conventional method. In the 4th case with thick adipose tissue, the flap was elevated in the plane just below Camper's fascia (CF). We then adopted this modified flap elevation method in 7 flaps of the 4th to 7th cases. By using computed tomography, we evaluated the perineal fat thickness (PFT) and gluteal fat thickness (GFT) to determine the thickness of the flap. All flaps survived completely. In all flaps prepared with the modified method, debulking was not required. The mean PFT (34.4 ± 2.8 mm) of the patients less than 70 years of age was significantly higher than that of patients of 70 years or more (21.0 ± 3.5 mm). The mean GFT (18.4 ± 1.1 mm) of the patients with BMI ≥ 25 was significantly higher than that of patients with BMI < 25 (11.8 ± 1.2 mm). To create a thin pudendal artery flap, the method of elevating the flap in the plane just deep to CF should be adopted, especially in patients less than 70 years of age or with BMI ≥ 25. [ABSTRACT FROM AUTHOR]

Candida albicans, along with other closely related Candida species, are the primary causative agents of vulvovaginal candidiasis (VVC)-a multifactorial infectious disease of the lower female reproductive tract resulting in pathologic inflammation. Unlike other forms of candidiasis, VVC is a disease of immunocompetent and otherwise healthy women, most predominant during their child-bearing years. While VVC is non-lethal, its high global incidence and profound negative impact on quality-of-life necessitates further understanding of the host and fungal factors that drive disease pathogenesis. In this review, we cover the current state of our understanding of the epidemiology, host response, fungal pathogenicity mechanisms, impact of the microbiome, and novel approaches to treatment of this most prevalent human candidal infection. We also offer insight into the latest advancements in the VVC field and identify important questions that still remain. [ABSTRACT FROM AUTHOR]