nystatin-a1 and Leukorrhea

(1) To compare the effectiveness of two clinical protocols for the management of vaginal discharge in the situations where no laboratory facilities are available but speculum examination is possible and where basic laboratory facilities are available. (2) To determine clinical and simple laboratory indicators for diagnosis of patients with vaginal discharge in the local setting.. Alternate allocation of subjects to one of two management protocols.. Women presenting to university gynaecology outpatients department with a complaint of vaginal discharge.. Subjects were alternately allocated management according to one of two protocols: one without (group A) and one with (group B) immediate access to results of basic laboratory tests. Full clinical assessment including speculum examination and microbiological assessment for infection with gonorrhoea, chlamydia, candida, trichomonas, and bacterial vaginosis was performed on all women. Follow up assessment of clinical and microbiological response was performed 1-2 weeks later.. At initial assessment, both groups were similar in all respects except that more group B women had inflammation of the vulva. The prevalences of various conditions were: candidiasis 22%, bacterial vaginosis 38%, trichomoniasis 4%, chlamydia 4%, gonorrhoea 0.4%. There was no association between any demographic characteristic and diagnosis of cause of the discharge. Both protocols resulted in clinically and statistically significant improvements for women with candidiasis, bacterial vaginosis, and trichomoniasis. There were no clinically important differences in outcomes between the two protocols. The sensitivities and specificities of various indicators were: curd-like vaginal discharge for candidiasis, 72% and 100%; homogeneous vaginal discharge for bacterial vaginosis or trichomoniasis, 94% and 88%; absent or scanty lactobacilli for bacterial vaginosis, 99% and 68%; > 20% clue cells for bacterial vaginosis, 81% and 99%; visible endocervical mucopus for chlamydia or gonorrhoea, 36% and 86%; microscopic endocervical mucopus for chlamydia or gonorrhoea, 64% and 69%.. Both protocols were equally effective in managing women with abnormal vaginal discharge. Simple clinical indicators for candidiasis, bacterial vaginosis, or trichomonas as in protocol A are sufficiently sensitive and specific for use in situations with no laboratory support. A modification to protocol A could increase detection of bacterial vaginosis at basic health service level. Further work is needed to identify appropriate indicators for infection with chlamydia or gonorrhoea.

Topics: Adult; Anti-Infective Agents; Candidiasis, Vulvovaginal; Clinical Protocols; Doxycycline; Female; Gonorrhea; Humans; Leukorrhea; Metronidazole; Microbiological Techniques; Middle Aged; Nystatin; Ofloxacin; Physical Examination; Trichomonas Vaginitis; Uterine Cervicitis; Vaginosis, Bacterial

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Vulvovaginal; Clinical Trials as Topic; Drug Evaluation; Exanthema; Female; Humans; Leukorrhea; Nystatin; Pregnancy; Pruritus

Topics: Adult; Female; Humans; Leukorrhea; Metronidazole; Nystatin; Sexually Transmitted Diseases

Topics: Adult; Antitrichomonal Agents; Diabetes Complications; Drug Combinations; Female; Humans; Leukorrhea; Middle Aged; Nystatin; Pharmaceutical Vehicles; Vaginitis

A guest faculty discussed the management of patients with vaginal infections. It was agreed that correct diagnosis is necessary before therapy. Diagnosis can be accomplished by a microscopic examination in 90% of the cases. The cytologic smear is also very important. Specific culture media may be useful for troublesome cases, for instance, blood agar fo Haemophilus vaginalis, Trichocel medium for Trichiomonas vaginalis, Neckerson's medium for candidal species and Thayer-Martin for Neisseria gonorrhoeae. Patient history is important since some infections tend to occur in certain patients such as candidiasis in patients with diabetes mellitus, patients who are pregnant or are taking broad spectrum antibiotics, estrogen or contraceptive pills. The pH of vaginal secretions may also be helpful in making the diagnosis. It was suggested that the term "nonspecific" vaginitis is a misnomer and is used to conceal ignorance. Others felt that such agents as soap, vaginal deodorant spray, and clothing may be causatives. The term "psychogenic leukorrhea" was discussed with varying conclusions. Routine treatment for each form of vaginitis was outlines and treatment for recurrent, persistent trichomoniasis and moniliasis was given. It was agreed that douching will not cure vaginitis but may be useful in removing excessive secretion. It is not recommended for routine hygeine but is acceptable following menstruation or intercourse.

Topics: Adult; Candidiasis, Vulvovaginal; Child; Chronic Disease; Clioquinol; Estrogens, Conjugated (USP); Female; Haemophilus Infections; Humans; Leukorrhea; Metronidazole; Nitrofurazone; Nystatin; Pregnancy; Sulfates; Therapeutic Irrigation; Trichomonas Vaginitis; Vagina; Vaginal Smears; Vaginitis

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteria; Candidiasis, Vulvovaginal; Estrogens; Female; Humans; Leukorrhea; Metronidazole; Nystatin; Pregnancy; Trichomonas Vaginitis

Topics: Adolescent; Adult; Female; Humans; Imidazoles; Leukorrhea; Male; Nystatin; Oxytetracycline; Vaginitis

Topics: Candidiasis, Vulvovaginal; Female; Humans; Leukorrhea; Nystatin; Trichomonas Vaginitis

Topics: Adrenal Cortex Hormones; Androgens; Anti-Bacterial Agents; Estrogens; Female; Humans; Hydrocortisone; Leukorrhea; Metals; Methyltestosterone; Metronidazole; Nystatin; Paromomycin; Penicillin G; Stilbenes; Sulfanilamides; Sulfonamides

Topics: Candida; Candidiasis; Female; Humans; Leukorrhea; Nystatin