PubMed · 17151050
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D J White, A Vanthuyne. 2006. Vulvovaginal candidiasis.. https://doi.org/10.1136/sti.2006.023168
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The vulva is a neglected area of the skin, hidden away by ignorance, embarrassment, and taboo with the result that women with vulvar diseases, desperate for help, suffer needlessly and waste millions of dollars on inadequate or inappropriate treatment. As the skin experts, dermatologists are vital for vulvar care. This article covers a range of subjects from normal anatomy to atypical presentations of common infections, such as candidiasis and herpes simplex virus. Tips are presented on the management of common vulvar dermatoses and there is a brief overview of pearls in diagnosis and therapy. Dermatologists are uniquely qualified to care for this area.
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BACKGROUND: The most frequent cause of preventable early premature births (< 32 + 0 gestational weeks) is urogenital tract infection (UTI). Screening for UTI and Chlamydia are now standard examinations. Detection of ascending genital infections, especially bacterial vaginosis, plays an ever-increasing role. Lactobacilli, which produce, e. g., lactic acid, H2O2, biosurfactants and coaggregation molecules, are particularly important for the vaginal biosystem. Some evaluations suggest that early diagnosis and therapy within this "lactobacilli-protection system" apparently leads to better results in the prevention of prematurity. Our screening recommendations for the pregnant patient comprise vaginal pH measurements both at the regular prenatal care visits and particularly the self measurement within the framework of our Self-Care Program. MATERIALS: 140 participating women were questioned for a second time. The data were compiled by the patients themselves. RESULTS: Due to elevated pH values, 21% of the women consulted their physician earlier than foreseen. Diagnoses: In 46% there was a disturbance of the vaginal milieu, in 4% bacterial vaginosis, in 33% Candida infection and in 21% "everything was OK". In spite of self-measured normal pH values in 25% of the patients the physician diagnosed the following: 25% disturbance of the vaginal milieu, 7% bacterial vaginosis, 32% infection with other bacteria (mainly Streptococci) and 50% Candida infection. CONCLUSION: Elevated pH values (measured by the patient) seem to indicate much more often a disturbance of vaginal milieu rather than an already existing bacterial vaginosis. Further investigations are necessary. The chances to treat vaginal disturbances--before a concrete infection is diagnosed--seem to be better for participants in the Self-Care Program.