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Noncancer risk assessment: reproductive toxicology.

In summary, the concerns that environmental and other agents are causing adverse effects on reproductive function in humans are real, although the risk is not necessarily well characterized. The range of concerns for the types of effect that agents might have on reproduction span the full range of reproductive events. There is a fairly high background of reproductive disease in humans which decreases the sensitivity for identifying agents that have a subtle, but adverse, effect on reproductive performance of humans. Because our animal studies identify a large number of agents that cause some adverse reproductive effect at the dose levels tested, the concern is raised about the oversensitivity of animal models for predicting adverse effects in humans. Until we better understand the biology underlying the reproductive process of humans and animals, it will be difficult to make animal studies more specific in their predictiveness. Continued research to better understand the biology of reproduction in humans and animals should help to identify the types of data generated in animals that are most predictive of an adverse effect in humans.

Animals↗
PubMed2000

Treatment of recurrent vulvovaginal candidiasis.

Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. Although greater than 50 percent of women more than 25 years of age develop vulvovaginal candidiasis at some time, fewer than 5 percent of these women experience recurrences. Clinical evaluation of recurrent episodes is essential. Patients who self-diagnose may miss other causes or concurrent infections. Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. If microscopic examination of vaginal secretions in a potassium hydroxide preparation is negative but clinical suspicion is high, fungal cultures should be obtained. After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. Because many patients experience recurrences once prophylaxis is discontinued, long-term therapy may be warranted. Patients are more likely to comply when antifungal therapy is administered orally, but oral treatment carries a greater potential for systemic toxicity and drug interactions.

Antifungal Agents↗