Antiseptics and disinfectants for the treatment of vaginal discharge in non-pregnant women (Protocol)
AuthorsAmaya Guio, Jairo
Grillo Ardila, Carlos F.
Toro Cubides, Angelica Maria
Parra Linares, Angelica Maria
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Pediatría. Grupo de Investigación de la Mujer y de la Infancia (GIMI)
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Pediatría
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Ginecología y Obstetricia
1361-6137 / 1469-493X (Electrónico)
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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the safety and effectiveness of antiseptics and disinfectants for the treatment of vaginal discharge in non‐pregnant women. Description of the condition A normal and healthy vaginal ecosystem is defined by an acidic environment (pH less than 4.5), which is inhospitable for most bacteria and viruses. This acidic environment is associated with the presence of lactobacilli and hydrogen peroxide (H2O2); a decrease of these buffer agents is linked with vaginal infections (Verstraelen 2009). Vaginal discharge syndrome represents a group of vaginal infections that are characterized by abnormal vaginal secretion, irritation, vulvar itching and sometimes vaginal odour (CDC 2017). In most cases, it is diagnosed by clinical signs (Gaitán‐Duarte 2013). The most common vaginal infections with vaginal discharge as the main clinical symptom are: bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and trichomoniasis (TV), which is a sexually transmitted infection (Gaitán‐Duarte 2013; Sherrard 2011). Prevalence varies from 40% for BV, to 12% for VC and less than 1% for trichomoniasis (Angel 2012). Bacterial vaginosis is an infection characterized by a change in the vaginal flora due to the decrease of lactobacilli, an increase in vaginal pH and anaerobic bacteria such as Gardnerella vaginalis, genital mycoplasma, anaerobic Gram‐negative rods, Gram‐positive cocci (Beigi 2004; Petersen 2002; Verstraelen 2012). Symptomatic patients are evidenced by foul‐smelling, profuse vaginal discharge (which is thin, white and homogenous, and coats the walls of the vagina and vestibule) and no signs of vulvar or vaginal inflammation (Verstraelen 2009). BV is not a sexual infection, though it is associated with sexual intercourse (Amaya‐Guio 2016). It can remit spontaneously or it can be persistent or recurrent, especially when the woman engages in vaginal douching or frequent sexual activity (which can cause changes in vaginal pH and lead to the decrease or lack of lactobacilli), or when lactobacilli are attacked by specific viruses and are subsequently unable to recolonize the vagina due to the overgrowth of anaerobic bacteria (Sherrard 2011). Bacterial vaginosis is a significant genital tract infection; published studies have found it to be associated with pelvic inflammatory disease, intrauterine infections, post‐procedural gynaecological infections, and predisposition to an increased risk of sexually transmitted diseases, such as trichomoniasis, gonorrhea, chlamydia and the human immunodeficiency virus (HIV) (Verstraelen 2009). Vulvovaginal candidiasis is caused by an overgrowth of Candida albicans (90%), C. glabrata,C. tropicalis, and other species (Sherrard 2011). This infection has inflammatory symptoms such as edema, erythema, vulvar excoriation, fissure formation, pruritus, superficial dyspareunia, dysuria, irritation, curdy vaginal discharge and soreness (Molteni 2004). Trichomoniasis is the most common non‐viral sexually transmitted infection, caused by an anaerobic protozoan called Trichomonas vaginalis (humans are the only known hosts). The symptoms include dysuria, itching, vulvar irritation, "strawberry" cervix visible to naked eye (2%), and occasionally, abdominal pain and greenish‐yellow, foamy, foul‐smelling vaginal discharge (KIissinger 2015; Jeffery 2017). The diagnosis of VB as the other two infections (VC and TV) in the vaginal discharge syndrome is by manly clinical symptoms. Treatment for vaginal discharge syndrome mainly includes antimicrobials, such as imidazoles (metronidazole or tinidazole) for VB and TV, or used as antifungal agents (clotrimazole or fluconazole) and lincosamines (clindamycin) for VB.
Link to the resourcehttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013467/full
SourceCochrane Database of Systematic Reviews; Volumen 11 , Páginas 1 - 11 (2019)
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