Safety and efficacy of a new imidazole fungicide, Sertaconazole, in the treatment of fungal vulvo-vaginitis: a comparative study using Fluconazole and Clotrimazole.

Background: Sertaconazole is a new imidazole fungicide introduced for vulvo-vaginal candidiasis. It has an azole group with benzothiophene that inhibits biosynthesis of ergosterol and brings about a massive leak of cytoplasm with consequent fungal cell death. Objective: Assess the safety and efficacy of Sertaconazole in the treatment of fungal vulvo-vaginitis for comparison with Fluconazole and Clotrimazole. Subjects and methods: One-hundred eighty-eight outpatients with fungal vulvo-vaginitis were recruited at Siriraj Hospital, Thailand between August 31, 2004 and January 30, 2006. The patients were given Sertaconazole, Fluconazole, or Clotrimazole, and received vaginal swab and culture for fungus at seventh and 28th days after treatment. Results: Out of 188 cases, 177 cases were followed-up completely. Sertaconazole group included 66 cases where 35 cure, 20 fail, and 7 recurrent cases. Fluconazole group included 60 cases and had 37 cure, six fail, and 20 recurrence cases. Clotrimazole group included 55 cases and had 32 cure, nine fail and 11 recurrent cases. There were risk factors of fungal vulvo-vaginitis, including frequent micturition and small toilet shower flushing. Conclusion: Sertaconazole had similar effectiveness and less side-effect as compared with Fluconazole and Clotrimazole. It appeared to work well with lowest recurrence.

Operational Research for STD Service: Improvement of Treatment and Care at Siriraj Hospital.

Objective: Operational research for sexually transmitted disease (STD) service was conducted to: 1) create the potential for systematic care: to assess and monitor for HIV and STI; 2) create the linkage among OB-GYN, Medicine and Pediatric Departments of Siriraj Hospital; 3) cervical cancer screening in HIV-infected females by Pap smear once a year; 4) create a system file for collection of STI data of the unit; 5) promote HIV counseling, disclosure and keep records; 6) promote condom usage and reduce risk behaviors of HIV-infected females continuously. Methods: HIV positive females attending STD Clinic, Department of Obstetrics & Gynecology, Siriraj Hospital were enrolled in to the study during March 1, 2005 to September 1, 2006. The procedures include: 1) provide STI testing/treatment, risk-reduction and HIV disclosure counseling, provision of free condoms, and cervical cancer screening at least once a year; 2) develop standardized procedures and data collection tools and strengthen data management; 3) refer women from different departments to the STI clinic for screening; 4) provide training in risk reduction counseling and HIV disclosure counseling. Results: Most of the primary visits were check-up. Chlamydial infection was 2.1% (year 2005). GC infection was 0.5% (year 2005). Abnormal Pap was significantly related to low CD4 count. L-SIL = 9.3%; H-SIL = 26.8%. Among the participants, 10.4% had CD4 count <200. Conclusion: Early detection and treatment of STI is 30%. Early detection of cervical cancer and treatment were increased. Access to ARV for HIV-1 PMTCT was also increased. Cross sectional analysis will show more realistic data since the follow up visit may be a group who came to receive condoms which could be missed as high condom use rate. KPI of success in good clinical tracer include increased condom use and CD4 count, decrease STI, opportunistic infection, and viral load.