how to improve diagnosis and treatment

2023-04-21 09:38:59

Vulvovaginal infections or vulvovaginitis involve inflammation of the vaginal mucosa and vulvar skin, although it does not always affect both areas simultaneously.

These infections can present various symptoms and signs depending on the type of infection, the most frequent being: pruritus (itching), burning, pain (vulvodynia), erythema (redness of the skin), inflammatory edema of the skin and mucous membranes, and increased vaginal discharge with different characteristics depending on the causative agent.

The most frequent pathologies are vulvovaginitis candidiásica and the vaginosis bacteriana.

According to SEGO, alterations in the vaginal microbiota are currently considered to be the fundamental axis of the pathophysiology of vaginal infections.

“In clinical practice, it is not always possible to determine the etiological causes or the triggering factors of this type of infection, while the treatment may not be adequate since sometimes it is the woman herself who diagnoses and treats herself, resulting in the appearance of relapses or repetition of the infection”, which is a problem for the patient, but also for the specialist who treats her, points out this medical society.

This is the reason why SEGO has launched this practical guide, a pioneering document in Spain, in order to improve and promote the clinical care of women who suffer from these infections, between 40 and 50% suffer at least twice in his life.

The guide includes all the conceptual and descriptive information on the most common vulvovaginal infections, their possible causes and symptoms, the main guidelines and measures based on scientific evidence for diagnosis and treatment by professionals, the most recent therapeutic novelties, as well as as well as the actions to be carried out in the event of possible relapses or recurrences by the patients.

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The document dedicates a section to the vulvovaginitis candidiásicaan inflammatory disease of the vagina caused by different species of fungi, mainly the Candida species, which accounts for approximately 25% of infectious vulvovaginitis.

This infection is a very common process in adult women, with a higher incidence among those 20-
40 years. It is estimated that by the age of 25, 50% of women will have had at least one
candidal vulvovaginitis and that among premenopausal women 75% will have suffered at the time of
least one episode of this infection, and 45% two episodes or more.

In turn, it is estimated that 5% of women with candidal vulvovaginitis will end up presenting a recurrent infection and that between 5 and 8% of all adult women will have this pathology with recurrence.

Triggers:

• Poor control of diabetes.
• Use of antibiotics (which causes an imbalance of the vaginal microbiota).
• Elevated estrogen levels (due to contraceptive use, pregnancy, and having estrogen therapy).
• Suffering from immunosuppressive diseases (HIV, lupus or others).

The SEGO explains that for its detection, a thorough exploration and complementary tests must be carried out to confirm the symptoms, “since one of the frequent causes of therapeutic failure is an erroneous diagnosis.”

In the case of candidal vulvovaginitis relapsing (recurring or that reappear after a healing period), the guidelines recommend reinforcing the treatment, since in a considerable percentage of cases the pharmacological treatment with azoles does not eliminate the presence of the fungus in the vagina and it develops again when they occur. favorable environmental conditions.

It also recommends prolonging oral therapy to 14 days, and the option of maintenance treatment for 6-12 months. Likewise, it considers the prescription of Lactobacillus vaginally as a safe and cost-effective therapeutic alternative in patients with a high risk of recurrence.

Vaginosis bacteriana

The vaginosis bacterianaan infection caused by an imbalance of the vaginal microbiota and the increase of various bacteria that, in most cases, is asymptomatic, although in others the main symptom is increased vaginal secretion.

This infection is estimated to affect 8-30% of sexually active women in developed countries and among its risk factors are tobacco, the use of vaginal douches or intravaginal hygiene products, or being a black woman.

“Although it is not considered a sexually transmitted infection (STI), it is a pathology that increases with the number of sexual partners. In this sense, and given the increased risk of STIs, bacterial or viral, in women who suffer from bacterial vaginosis, the guide recommends carrying out an HIV screening in those patients who have it recurrently (relapsing).

Regarding treatments, in addition to the classic antibiotics, lactic acid or probiotics are increasingly being valued, which allow us to reduce resistance to antibiotics.

The relapse rate for bacterial vaginosis is quite high, with up to 30% of women diagnosed with a second infection within the first 3 months, and up to 50% with a second infection within the first year.

For these cases, the guidelines establish repeat treatment, and in women with documented recurrences, repeat intermittent long-term therapies are considered in order to suppress the abnormal growth of the bacteria.

A gynecologist checks up a patient. /EFE/Morell

Other vulvovaginal infections

This SEGO practical assistance guide also includes sections on two other vulvovaginal infections: vulvovaginitis caused by trichomonas vaginalis (called trichomoniasis)and the noninfectious vulvovaginitis.

In the first case, the trichomoniasisit is a rare infection and in decline in Western countries, whose infected patients remain asymptomatic for the most part (more than two thirds).

The most appropriate treatments and recommendations to follow are also for the sexual partners of the patients. Sexual abstinence is proposed until the infection disappears.

Despite its low prevalence, its clinical importance stands out among girls and women who have suffered sexual abuse, since in this population group these infections are more frequent and represent 6% of all vulvovaginal infections.

Regarding non-infectious vulvovaginitisthe main symptoms (soreness, perineal pain, contact dysuria and, rarely, increased vaginal secretion) and the guidelines and actions to be carried out for its correct diagnosis (which may include, in addition to the physical examination, an examination and biopsy of the the skin when diagnostic doubts arise).

Likewise, it includes the usual ways for its treatment, which consists of avoiding irritants in the vaginal area, together with the adoption of therapeutic measures to alleviate the symptoms, and the use of topical corticosteroids to reduce the effect of said symptoms.