A 23 years old girl has been having recurrent vaginitis for the last one year.She has been in relationship for the last few years. Barrier contraception is being used with the present partner. She used to have unprotected intercourse with the previous partner. The clinical picture is that of fungal vaginitis. Local antifungal agent, Clotrimazole (at times along with Clindamycin) have been administered few times. She was put on once a week Flucanozole tablet for 6 weeks. The couple had taken combination of Azithromycin, Flucanozole and Secnidazole few months back. GTT done recently is WNL. HIV and VDRL were done in February and repeated few days back. They are non reactive. High vaginal swab has been taken for culture. Vaginal secretions have been collected for cytology. Report is awaited. How to manage this case?
The screening process has been methodical with extensive screening for STI's , Diabetes and immune compromise undertaken. Repeat antifungals x 6 administered. Barriers are in use: Penis-vaginal transmission ruled out.
Is there another source for the vaginitis? gut and oral sources come to mind. Any information on whether cunnilingus and /or fellatio is practiced. Source/pool Identification
Suggest a medication break, diet change -try yogurt alternate day as a meal item or snack , avoid antibiotic use. How about some pro-biotics?
Gynaecology osteopathy treatments may be a good option in these cases
http://www.ncbi.nlm.nih.gov/pubmed/18614297
http://www.ncbi.nlm.nih.gov/pubmed/27261985
I would like to know from Maragda Estany how osteopathy is going to help in recurrent vaginitis? There is no painful condition involved.
As stated in [1], “Osteopaths consider that irritations in tissues and nerves and barriers to effective fluid circulations are all related (in part) to movement and biomechanical restrictions in the body tissues. Consequently, osteopaths consider that a normal part of medical management of pathology and disease should be restoring or improving movement in all body tissues where possible, as they believe that this will aid physiological recovery.
If movement is restored, communication between parts is more efficient, fluid circulation, and drainage improve, irritating signals are reduced and the body’s homeostatic and immune mechanisms can operate more effectively, thus restoring health and better function.
(...)
Visceral osteopathy is field concerned with:
- the three-dimensional dynamics of body biomechanics (including musculoskeletal, myofascial, connective tissue and organ structures).
- reflex activity in the central and peripheral nervous systems.
- neuroemotional-immune links.
- effective circulation and drainage of all the body fluid systems and tissues.
(...)
Manual techniques and good knowledge of anatomy and pathology will allow the osteopath to categorize and identify the tissue dysfunctions, enabling the manual treatment to be individualized to the patient.”
Therefore, in this case the mechanics of the symphysis pubis, obturator, piriformis, coccygeus muscles, general pelvic connective tissues and pelvic organs are particularly important. Evaluate sacrum at S2-S4 foramina and the mechanics of the cauda equina, sacroiliac and hip biomechanical links.
Please also consider that latex can be an issue.
[1] Stone, Caroline A. 2007: Visceral and Obstetric Osteopathy. Churchill Livingstone Elsevier. pp. 3, 162, 185.
Dear Peter,
There is neither vulvodynia nor dyspareunia. Her sexual history is normal. Though I didn't specifically concentrate on examination of pelvic floor, it seemed normal. There was no hyperactivity. Vaginal swab culture revealed growth of Candida.
What did you see in your wet mount microscopy? Can you share photos of the microscopy with us?
Dear Peter,
I will have to enquire the laboratory for that. In case I get photos, I shall share.
l think that acidifying the vaginal ph would help to restore the normal bacterial flora. NO vaginal use of any antimicrobial.
Veena,
What progress with your case?
Any new ideas out of all this suggestions?
Dear Neil,
The patient has been put again on prolonged antifungal treatment. She has been advised to reduce stress and take probiotics.
- Badges
- Science method