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JD Sobel

Publications and source records attributed to JD Sobel.

6 recordsLinked to original sources
PubMed2000

Nontrichomonal Purulent Vaginitis: Clinical Approach.

Although trichomonal vaginitis and cervicitis are responsible for most presentations of a frankly purulent vaginal discharge, nontrichomonal vaginitis and purulent exudate are being seen in an increasing number of cases. Purulent vaginitis remains poorly defined and largely ignored, with little increase in the amount of knowledge we have of this not infrequent entity. Accordingly, a variety of empirical therapies, often including multiple simultaneous measures, are prescribed. Considerable numbers of causes are now identified, and this review describes a step-by-step approach to diagnosis and management.

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PubMed2000

Management of Infections Caused by Candida glabrata.

Candida glabrata infections undoubtedly have become more frequent, and are now common. They appear to be the consequence of widespread and often indiscriminate use of azoles, especially fluconazole. This species constitutes the Achilles heel of all available azoles, including newer ones in the pipeline. Even when amphotericin B is used, higher dosages are now required. Little is known about the epidemiology of and risk factors for this troublesome species; even less about its virulence factors. However, studying the resistance mechanisms of this haploid organism may provide answers in developing new fungicidal agents.

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PubMed2000

The Evolution of Candida Species and Fluconazole Susceptibility among Oral and Vaginal Isolates Recovered from Human Immunodeficiency Virus (HIV)-Seropositive and At-Risk HIV-Seronegative Women.

Antifungal agents can effectively treat mucosal candidiasis; however, their use can lead to colonization with less susceptible species and to resistance among normally susceptible strains. Oral and vaginal Candida isolates obtained at 3 points over 2 years from human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women were identified by species and were evaluated for in vitro fluconazole susceptibility. Prevalence of non-C. albicans strains increased over time, and these strains were more likely among women reporting current antifungal use. Among C. albicans isolates, resistance was rare, with no evidence for progressive reduction in susceptibility over time. Among non-C. albicans isolates, reduced susceptibility occurred frequently and increased with time. HIV-seropositive women were more likely to have non-C. albicans isolates with reduced susceptibility as were women reporting current antifungal use. This evolution and selection of mucosa-colonizing Candida species with reduced susceptibility could play a critical early role in the development of antifungal resistance among C. albicans isolates responsible for refractory candidiasis.

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PubMed1999

Is There a Protective Role for Vaginal Flora?

The notion of a protective vaginal flora is relatively new. Resident flora manifest colonization resistance to prevent or reduce the likelihood of exogenous microorganisms, viruses, bacteria, yeast, or parasites becoming established in the lower genital tract of women following sexual (HIV, Neisseria gonorrhoeae, Escherichia coli, Candida albicans, Trichomonas vaginalis) or nonsexual (uropathogenic E. coli) transmission. The concept of preserving or reestablishing protective flora has been hastened by several factors, including the potential widespread use of vaginal microbicides, the increased heterosexual spread of HIV, and the imminent availability of exogenous Lactobacillus species probiotic therapy.

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