Effects of Melatonin Alone or Associated with Acyclovir on the Suppressive Treatment of Recurrent Genital Herpes: A Prospective, Randomized, and Double-Blind Study.

Suppressive therapy of recurrent genital herpes is a challenge, and melatonin may be an alternative. OBJECTIVE: To evaluate the action of melatonin, acyclovir, or the association of melatonin with acyclovir as a suppressive treatment in women with recurrent genital herpes. DESIGN: The study was prospective, double-blind, and randomized, including 56 patients as follows: (a) The melatonin group received 180 placebo capsules in the 'day' container and 180 melatonin 3 mg capsules in the 'night' container (n = 19); (b) The acyclovir group received 360 capsules of 400 mg acyclovir twice a day (one capsule during the day and another during the night) (n = 15); (c) the melatonin group received 180 placebo capsules in the 'day' container and 180 melatonin 3 mg capsules in the 'night' container (n = 22). The length of treatment was six months. The follow-up after treatment was six months. Patients were evaluated before, during, and after treatment through clinical visits, laboratory tests, and the application of four questionnaires (QSF-36, Beck, Epworth, VAS, and LANNS). RESULTS: No statistically significant difference was observed for the depression and sleepiness questionnaires. However, in the Lanns scale for pain, all groups decreased the mean and median values in time (p = 0.001), without differentiation among the groups (p = 0.188). The recurrence rates of genital herpes within 60 days after treatment were 15.8%, 33.3%, and 36.4% in the melatonin, acyclovir, and association of melatonin with acyclovir groups, respectively. CONCLUSION: Our data suggest that melatonin may be an option for the suppressive treatment of recurrent genital herpes.

Microablative fractional radiofrequency as a therapeutic option for vulvar lichen sclerosus: a pilot study.

OBJECTIVES: To assess the clinical response to and the histomorphometric effects of microablative fractional radiofrequency (MFR) in women with symptomatic vulvar lichen sclerosus (VLS). METHODS: This was a pilot study on the use of MFR for the treatment of VLS. Upon recruitment and at each treatment session, all participants were examined and each of their symptoms were rated on a visual analog scale. After the procedure, the participants completed a satisfaction questionnaire. We compared the morphometric findings of vulvar biopsies performed at enrollment and after the last treatment session. The participants were divided into three groups according to previous treatment with corticosteroids: G1, no previous treatment; G2, treated for up to 5 years; and G3, treated for >5 years. RESULTS: This study included 26 women. After two to three sessions, most participants in all groups became either "asymptomatic" or "much better" than before treatment and were "very satisfied" or "satisfied" with the intervention. Pruritus and burning sensation were the most frequently reported symptoms. Nearly 40% of the participants in all groups reported complete remission of symptoms. The improvement was rated as moderate or higher by 80%, 76%, and 66% of the women in groups 1, 2, and 3, respectively. The improvement of symptoms persisted for 11 months (range, 7-16 months), on average, after the treatment. Type III collagen concentration significantly increased and was associated with important symptom improvement. Tissue trophism and vascularization also increased but did not reach statistical significance, probably because of the small number of cases. CONCLUSIONS: MFR may be an effective and safe treatment for symptomatic VLS.

Microablative fractional radiofrequency as a therapeutic option for vulvar lichen sclerosus: a pilot study

OBJECTIVES: To assess the clinical response to and the histomorphometric effects of microablative fractional radiofrequency (MFR) in women with symptomatic vulvar lichen sclerosus (VLS). METHODS: This was a pilot study on the use of MFR for the treatment of VLS. Upon recruitment and at each treatment session, all participants were examined and each of their symptoms were rated on a visual analog scale. After the procedure, the participants completed a satisfaction questionnaire. We compared the morphometric findings of vulvar biopsies performed at enrollment and after the last treatment session. The participants were divided into three groups according to previous treatment with corticosteroids: G1, no previous treatment; G2, treated for up to 5 years; and G3, treated for >5 years. RESULTS: This study included 26 women. After two to three sessions, most participants in all groups became either "asymptomatic" or "much better" than before treatment and were "very satisfied" or "satisfied" with the intervention. Pruritus and burning sensation were the most frequently reported symptoms. Nearly 40% of the participants in all groups reported complete remission of symptoms. The improvement was rated as moderate or higher by 80%, 76%, and 66% of the women in groups 1, 2, and 3, respectively. The improvement of symptoms persisted for 11 months (range, 7-16 months), on average, after the treatment. Type III collagen concentration significantly increased and was associated with important symptom improvement. Tissue trophism and vascularization also increased but did not reach statistical significance, probably because of the small number of cases. CONCLUSIONS: MFR may be an effective and safe treatment for symptomatic VLS.

Age-related acceptability of vaginal self-sampling in cervical cancer screening at two university hospitals: a pilot cross-sectional study.

BACKGROUND: To determine whether age is a barrier against acceptability of cervicovaginal self-sampling in screening for cervical cancer at two gynecology outpatient clinics. METHODS: This is a cross-sectional study involving 116 women over 21 years of age with an abnormal Pap smear. Clinical and laboratorial data were recorded in electronic files. Women received detailed self-collection instructions. After the self-sampling procedure (Evalyn Brush®), women were instructed to answer a questionnaire about vaginal self-sampling acceptability that consisted of seven multiple-choice items. The participants were divided into three age brackets: 21 to 29 years, 30 to 49 years, and 50 years and over. Chi-square, Fischer exact, Kolmogorov-Smirnov and Kruskal-Wallis tests were used. RESULTS: The analysis of the participants' perception of the procedure stratified according to age groups showed a decline in the fear of hurting oneself during the procedure as age increased. Most participants reported that it was very easy to understand how to use the self-sampling brush and that it was easy to use it. Most of them were neither embarrassed nor afraid of getting hurt during the procedure. The majority preferred self-sampling to collection by a healthcare professional. The main reason was practicality: the possibility of choosing the place and time for sampling. CONCLUSIONS: The participating women found self-collection simple to understand and easy to accept regardless of age. The younger women indicated more fear and discomfort in self-sampling, which points to the need for attraction strategies that are more appealing to the younger generations.

Líquen escleroso vulvar: descrição de cinco casos de sucesso com laser Erbium-YAG 2940 / Vulvar lichen sclerosus: description of 5 cases successfully treated with the 2940nm Erbium-YAG laser

Líquen escleroso é dermatose crônica com predileção pela região genital. Acomete, principalmente, a raça branca, sendo mais frequente em mulheres. O tratamento-padrão é feito com corticosteroides tópicos de alta potência. Tratamentos com propionato de testosterona, imunomoduladores tópicos, terapia fotodinâmica, crioterapia, antibioticoterapia e laserterapia são citados na literatura. Neste artigo são relatados cinco casos de pacientes com liquen escleroso vulvar, sem sucesso com o clobetasol tópico, submetidas ao tratamento com Laser Erbium YAG 2940 fracionado. Os resultados foram bastante satisfatórios, sugerindo a laserterapia como opção no tratamento do líquen escleroso, incluídos casos de insucesso com o uso corticoides tópicos.

Lichen sclerosus is a chronic dermatosis, usually anogenital and mainly affecting pos-menopausal women. The use of topical corticosteroids is the mainstay of medical treatment. Other treatments are topical testosterone, calcineurin inhibitors, photodynamic therapy, cryotherapy, antibiotic therapy and laser therapy. In this article, five patients with vulvar lichen sclerosus which had no response to treatment with topical clobetasol, had good results when treated with fractional Erbium:YAG laser 2940.

The acceptability of vaginal smear self-collection for screening for cervical cancer: a systematic review.

Cervical cancer is a major cause of death in adult women. However, many women do not undergo cervical cancer screening for the following reasons: fear, shame, physical limitations, cultural or religious considerations and lack of access to health care services. Self-collected vaginal smears maybe an alternative means of including more women in cervical cancer screening programs. The objective of this systematic review was to evaluate the acceptability of vaginal smear self-collection for cervical cancer screening. We selected articles from PubMed, the Cochrane Library and Embase that were published between January 1995 and April 2016. Studies written in English, French, Italian, Portuguese or Spanish that involved women between 18 and 69 years of age who had engaged in sexual intercourse were included in this review. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Nineteen studies were ultimately evaluated in this review. Most of the included studies (n=17) demonstrated that the self-collection method exhibited outstanding acceptability among women with respect to cervical cancer screening, and only two studies indicated that self-collection exhibited low acceptability among women in this context. The acceptability of self-collection was determined subjectively (without standardized questionnaires) in 10 studies (53%) and via structured and validated questionnaires in the remaining studies. The results of our review suggest that the self-collection method is well-accepted and may therefore encourage greater participation in cervical cancer screening programs. However, additional studies are required to verify these results.

The acceptability of vaginal smear self-collection for screening for cervical cancer: a systematic review

Cervical cancer is a major cause of death in adult women. However, many women do not undergo cervical cancer screening for the following reasons: fear, shame, physical limitations, cultural or religious considerations and lack of access to health care services. Self-collected vaginal smears maybe an alternative means of including more women in cervical cancer screening programs. The objective of this systematic review was to evaluate the acceptability of vaginal smear self-collection for cervical cancer screening. We selected articles from PubMed, the Cochrane Library and Embase that were published between January 1995 and April 2016. Studies written in English, French, Italian, Portuguese or Spanish that involved women between 18 and 69 years of age who had engaged in sexual intercourse were included in this review. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Nineteen studies were ultimately evaluated in this review. Most of the included studies (n=17) demonstrated that the self-collection method exhibited outstanding acceptability among women with respect to cervical cancer screening, and only two studies indicated that self-collection exhibited low acceptability among women in this context. The acceptability of self-collection was determined subjectively (without standardized questionnaires) in 10 studies (53%) and via structured and validated questionnaires in the remaining studies. The results of our review suggest that the self-collection method is well-accepted and may therefore encourage greater participation in cervical cancer screening programs. However, additional studies are required to verify these results.

Association between mannose-binding lectin and interleukin-1 receptor antagonist gene polymorphisms and recurrent vulvovaginal candidiasis.

OBJECTIVE: The influence of functional polymorphisms in the genes coding for mannose-binding lectin (MBL) and interleukin-1 receptor antagonist (IL-1ra) on recurrent vulvovaginal candidiasis (RVVC) were examined in an urban Brazilian population. METHODS: DNA was isolated from buccal swabs of 100 women with RVVC and 100 control women and tested by gene amplification for a single nucleotide polymorphism in codon 54 of the MBL2 gene and for a length polymorphism in intron 2 of the IL1RN gene. Genotype and allele frequencies were compared between groups. RESULTS: The frequency of the variant MBL2 B allele, associated with reduced circulating and vaginal MBL concentrations, was 27.0% in RVVC and 8.5% in control women (p < .0001). The MBL2 B,B genotype was present in 12% of RVVC patients and 1% of controls (p = .0025). The IL1RN 2 allele frequency, associated with the highest level of unopposed IL-1ß activity, was 24.0% in RVVC and 23.4% in controls. The IL1RN genotype distribution was also similar in both groups. CONCLUSION: Carriage of the MBL2 codon 54 polymorphism, but not the IL1RN length polymorphism, predisposes to RVVC in Brazilian women.

Prevalência da papilomatose vestibular e infecção pel HPV na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / The prevalence of vestibular papillomatosis and HPV infection analyzed in the division of gynecology of Hospital das Clínicas, São Paulo, University Medical School, São Paulo

Objetivos: determinar a prevalência da papilomatose labial em pacientes assintomáaticas na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Método: foram avaliadas 100 mulheres, todas fizeram citologia oncológica da face interna dos pequenos lábios, cervical e vulvoscopia quando o teste do acético ou lugol eram positivos...

Neoplasia intraepitelial vulvar: aspectos atuais do tratamento / Vulvar intraepithelial neoplasia: current aspects of the treatment

O tratamento padrao da neoplasia intraepitelial vulvar (NIV) e a excisao cirurgica, que pode ser combinado...

Climaterio e hormonioterapia de reposicao (vantagens e desvantagens) / Climatery and hormonal therapy (indications and contra-indications)

As mulheres no periodo do climaterio estao predispostas a varias doencas como a osteoporose e as doencas cardiovasculares (CVD). Observou-se que estas doencas apresentam uma nitida relacao com a queda da taxa hormonal de estrogenios nesta fase. Para reverter este quadro, utilizamos a hormonioterapia de reposicao. Esta apresenta pontos discutiveis como o aumento da probalidade de cancer de mama e a hiperplasia endometrial, com posterior malignizacao em alguns casos. Isto levou os diversos autores estudarem os verdadeiros efeitos positivos da hormonioterpia de reposicao, principalmente no que diz respeito ao uso exclusivo de estrogenios.

Avaliaçåo clínica do tratamento do líquen escleroso vulvar com clostebol (acetato de 4-clorotestosterona) / Clinic evaluation of the vulvar lichen sclerosus treatment by clostebol (4-clorotestosterone acetate)

Realizou-se estudo aberto e comparativo entre cloetebol/neomicina e clostebol no tratamento tópico exclusivo do líquen escleroso vulvar. Foram estudadas 33 pacientes, cuja idade variou de 27 a 72 (53,23) anos, divididas de forma homogênea em grupos A (clostebol/neomicina) e B (clostebol). Aspectos clínicos (prurido, eritema, edema e extensåo da lesåo branca) e a avaliaçåo clínica global (efeito terapêutico) foram analisados na visita inicial e aos 30, 60 e 90 dias de tratamento. Os resultados nos grupos A e B revelaram-se: excelente em 5 (29,5 por cento) e 2 (12,5 por cento), bom em 7 (41,2 por cento) e 6 (37,5 por cemto), regular em 1 (5,8 por cento) e 2 (12,5 por cento) e nulo em 4 (23,5 por cento) e 6 (37,5 por cento) casos, respectivamente. Concluiu-se que o clostebol/neomicina é interessante alternativa terapêutica no líquen escleroso vulvar, mas nåo de forma absoluta ou exclusiva

Vaginites inespecíficas: tratamento comparativo entre secnidazol e metronidazol / Nonspecific vaginitis: comparative treatment between secnidazole and metronidazole

Foram estudadas, na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, 91 pacientes portadoras de vaginite inespecífica. O diagnóstico foi baseado nos seguintes parâmetros: positividade do teste das aminas; presença de células indicadoras (clue cells); pH vaginal maior ou igual a 5,0 e ausência de processos específicos detectáveis através do exame clínico e/ou bacterioscópico a fresco. Em estudo aberto, randomizado, comparativo, as pacientes foram divididas em dois grupos - grupo secnidazol com 43 pacientes e grupo metronidazol com 48 - que receberam, respectivamente, quatro comprimidos de 500 mg em dose única (2 g) e 400 mg duas vezes ao dia por sete dias, ambos exclusivamente por via oral. A avaliaçäo clínica e laboratorial foi realizada na visita inicial, três e 30 dias após o término da medicaçäo. Os resultados revelaram, nos grupos secnidazol e metronidazol, cura clínica ou melhora acentuada da vaginite em 93.1% e 95,8% das pacientes, respectivamente. Efeitos adversos leves foram registrados em 14 casos do grupo secnidazol e em 4 do grupo metronidazol. Os autores concluem que o secnidazol oral em dose única constitui alternativa terapêutica nas vaginites inespecíficas, pois apresenta eficácia e boa tolerabilidade

Estudo comparativo entre tioconazol e miconazol no tratamento das infecçöes vaginais causadas por Candida albicans / Comparative study between tioconazole and miconazole in the treatment of vaginal infections due to Candida albicans

Em estudo aberto comparativo, foram avaliadas a eficácia, tolerabilidade e aceitabilidade do tratamento, em 60 pacientes portadoras de vulvovaginite causada por Candida albicans, sendo 33 pacientes tratadas com tioconazol, pomada vaginal a 6,5%, aplicada em dose única, e 27 com miconazol, creme vaginal a 2%, aplicado durante 14 dias. Observou-se uma remissäo nos sinais e sintomas mais rápida e significativa (p <0,01) no grupo tratado com tioconazol em relaçäo ao grupo miconazol, por ocasiäo do 16§ e 60§ dia. A avaliaçäo clínica global mostrou resultados excelentes ou bons em 97% das pacientes do grupo tioconazol, comparativamente a 78% do miconazol. Quanto à avaliaçäo microbiológica, ocorreu cura em 76% nas pacientes tratadas com tioconazol e em 67% das tratadas com miconazol. O tratamento com tioconazol teve melhor aceitaçäo por parte das pacientes, pois 100% das mesmas referiram ser a terapêutica com este agente cômoda, sendo que 41% das pacientes tratadas com miconazol referiram dificuldade na manutençäo do tratamento. Conclue-se que o tioconazol, pomada a 6,5%, aplicada em dose única no tratamento da candidíase vaginal evidenciou maior rapidez de açäo, bem como eficácia clínica e microbiológica superior ao miconazol

Tratamento da distrofia vulvar crônica: análise prospectiva de 50 casos / Treatment of chronic vulvar dystrophy: prospective study of 50 cases

Durante 1976 a 1984, 50 portadoras de distrofia vulvar crônica foram diagnosticadas e prospectivamente tratadas no Setor de Patologia Vulvar Benigna da Faculdade de Medicina da Universidade de Säo Paulo (Serviço Prof Carlos Alberto Salvatore). Todos os casos foram confirmados histologicamente a fim de submeterem-se a tratamento específico. Uma biópsia de controle foi sistematicamente indicada ao final do tratamento. Em 21(42,0%) casos de líquen escleroso, empregaram-se duas aplicaçöes tópicas diárias de propionato de testosterona a 2,0%, obtendo-se melhoria em 15(71,0%). Em 18(36,0%) casos de lesäo hiperplásica, 15(83,0%) relataram alívio sintomático com duas aplicaçöes tópicas de pomada de hidrocortisona a 1,5%. Onze (22,0%) casos de distrofia mista sujeitaram-se aos dois tratamentos supracitados, em dias alternados, com 100,0% de melhora clínica. Além de medidas higiênicas comuns, todas as pacientes fizeram uso de vitaminas A e E e de anti-histamínicos. O período de tratamento variou de 6 a 12 meses, sem qualquer efeito colateral. O estudo comparativo das biópsias antes e após o tratamento permitiu verificar que näo houve modificaçöes anatomopatológicas das lesöes, apesar do resultado clínico. Dois (4,0%) casos de distrofia vulvar crônica acompanhados de atipia celular foram tratados por ressecçäo cirúrgica da lesäo. Em nossa experiência, pacientes com distrofia vulvar crônica necessitam, obrigatoriamente, submeter-se a rigoroso seguimento, realizando-se exame clínico e ginecológico a cada seis meses e por longo período de tempo. Biópsias devem ser rotina vigente teste de Collins positivo