Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole.

OBJECTIVE: An attempt was made to validate recent recommendations that women with complicated Candida vaginitis (severe or recurrent, non-albicans Candida spp or abnormal host) require longer-duration antifungal therapy to achieve clinical cure and mycologic eradication. STUDY DESIGN: A prospective, multicenter, randomized, double-blind study was performed comparing a single dose of 150 mg of fluconazole with 2 sequential 150-mg doses of fluconazole given 3 days apart. RESULTS: Five hundred fifty-six women with severe or recurrent Candida vaginitis were enrolled, and 398 had at least one postbaseline evaluation (intent to treat) and of these 309 were fully evaluable (efficacy-valid). At baseline, 92% of vaginal isolates were Candida albicans. The 2-dose fluconazole regimen achieved significantly higher clinical cure rates in women with severe vaginitis when evaluated on day 14 (P =.015) and higher clinical and mycologic responses persisted at day 35. Women with recurrent but not severe vaginitis did not benefit clinically short term by the additional fluconazole dose. Multivariate logistic regression analysis showed that being infected with non-albicans Candida predicted significantly reduced clinical and mycologic response regardless of duration of therapy. Fluconazole therapy was well tolerated and free of serious adverse effects. CONCLUSION: Treatment of Candida vaginitis requires individualization, and women with severe Candida vaginitis achieve superior clinical and mycologic eradication with a 2-dose fluconazole regimen.

Evaluation of a deoxyribonucleic acid probe for the detection of Trichomonas vaginalis in vaginal secretions.

OBJECTIVE: Our purpose was to compare Affirm VP, a new deoxyribonucleic acid probe test, with standard "wet preparation" microscopic examinations and culture for the identification of Trichomonas vaginalis organisms in vaginal secretions. STUDY DESIGN: We examined vaginal samples from 615 women with symptoms or signs of vaginitis for T. vaginalis using the deoxyribonucleic acid probe test, microscopic examination of wet preparations of vaginal secretions, and culture in modified Diamond's medium. RESULTS: T. vaginalis was identified in specimens from 95 (15.4%) of the 615 patients. Cultures in Diamond's medium identified 93 (98%) of the 95 infected patients. Vaginal wet preparation identified 76 (80%) of the infected women. The deoxyribonucleic acid probe test detected 86 (90.5%) of the 95 infected patients. There was one false-positive deoxyribonucleic acid probe test (specificity 519/520: 99.8%). CONCLUSION: The Affirm VP deoxyribonucleic acid probe test had a sensitivity of 90% and a specificity of 99.8% for the identification of T. vaginalis organisms in women with symptoms with a high prevalence of trichomoniasis. Such a nonculture test may be of considerable benefit in diagnosing T. vaginalis infections, especially in settings where microscopy, culture, or both are unavailable, inconvenient, or unreliably performed.

Syphilis in pregnancy.

The course and outcome of 356 pregnant patients who had a positive serologic test for syphilis and who had delivery at the LSU Medical Center between Jan 1, 1982 and Dec 31, 1984 were compared to those of our general obstetric population. Records of these women and their infants were reviewed for details of prenatal care, diagnosis of syphilis, past treatment, discharge diagnoses, and follow-up. Syphilis occurred during the index pregnancy in 159 cases. Women with syphilis were older, likely to be black and unmarried, and likely to have been pregnant before. Their prenatal care was the same as that of our general obstetric population. Prematurity in syphilitic pregnancies was twice that of our general population; stillborns were four times as common. Eighty-six patients were treated before delivery and 73 were not; the latter included women without prenatal care, those who contracted syphilis after negative early pregnancy screening, and those not treated because of physician error. Forty-nine infants had probable congenital syphilis; seven were stillborn and 42 liveborn.

Ovarian myxoma.

A case of primary ovarian myxoma is reported. The tumor is rare as there are only two previously reported cases in the literature.