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Biomedical subjects

Jack D. Sobel

Publications and source records attributed to Jack D. Sobel.

8 recordsLinked to original sources
PubMed2003

Antibiotic-associated Vulvovaginal Candidiasis.

Vulvovaginal candidiasis (VVC) is one of the most common causes of vaginitis, and its incidence has increased markedly during the past three decades. The widespread overuse of antibiotics has been suggested as one of the major factors contributing to the increasing incidence of VVC. However, evidence supporting this association has been limited because few studies with rigorous scientific methodology have been conducted. Moreover, existing data regarding the risk for developing VVC after antibiotic use are conflicting. This review examines the available information in the literature regarding antibiotic-associated VVC, its incidence, and its potential mechanisms. Implications for clinical practice and research are also discussed.

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PubMed2003

Erosive Vulvovaginitis.

The presence of erosive changes in the vulva, vagina, or both areas constitutes a major diagnostic and therapeutic challenge for clinicians. Often, biopsy is required to obtain an accurate diagnosis. Despite the wide differential diagnosis, therapeutic options often are limited, although new treatment modalities have been recently introduced.

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PubMed2002

Pathogenesis of Recurrent Vulvovaginal Candidiasis.

Recurrent vulvovaginal candidiasis (RVVC) is by no means uncommon and is a source of considerable physical suffering, in addition to serving as a major therapeutic challenge. The syndrome is multifactorial in etiology, hence management strategies must recognize the complex etiologic pathways. Considerable progress has been made in identifying secondary causes, including biologic and host factors. Specifically, Candida microbiologic studies have revealed that azole resistance in Candida albicans is rare and infection by less sensitive non-albicans Candida species is uncommon. At least half the women with RVVC have no identifiable host or microbial predisposing factors, and an immune-based hypothesis has been generated.

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PubMed2001

Antimicrobial Resistance in Vulvovaginitis.

Although antimicrobial resistance has had an enormous impact on selection and utilization of antibiotics in virtually all aspects of clinical medicine, both inpatient and community based, little attention has been directed at antimicrobial resistance occurring in vaginal infections. Little evidence exists that frequent relapses of bacterial vaginosis or vulvovaginal candidiasis are due to antimicrobial resistance. Similarly, metronidazole-resistant trichomoniasis remains rare. Nevertheless, abuse of over-the-counter antimycotics, as well as widespread prescription of systemic oral azoles, could result in spread of azole-resistant Candida albicans, and even more likely could lead to an increase in non-albicans Candida species with intrinsic azole resistance. Problematic species include Candida glabrata and rarely Candida krusei.

Journal Article↗
PubMed1999

Limitations of antifungal agents in the treatment of Candida vaginitis: future challenges.

The availability of several potent antifungal agents, systemic or topical, over the counter or prescription would suggest that therapeutic needs for Candida vaginitis are minimal or absent. Unfortunately, unmet needs still exist. Moreover, the pharmaceutical industry has abandoned Candida vaginitis and no new agents or studies are imminent. Perhaps the most important advance in the last decade has been the recognition that therapy must be individualized and that not all forms of Candida vaginitis are equal. A critical factor is duration of therapy and the need for maintenance therapy in recurrent candidiasis. In addition, serious deficiencies exist in the therapy of C. glabrata vaginitis, an emerging problem. Azole therapy for C. glabrata frequently fails, depleting the therapeutic armamentarium of successful options. Additional therapeutic challenges remain for women who can be easily controlled but not cured with intensive azole therapy in spite of absence of in vitro antifungal resistance. Any advance in non-drug related therapy will require a better understanding of the immunopathogenesis of VVC and effective naturally occurring host protective mechanisms. Copyright 1999 Harcourt Publishers Ltd.

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