Bacterial vaginitis has not been cured and infected with mold!

Only for medical professionals to read and refer to.
Standardized medication is critical case details.
20-year-old Xiao Liu came to the hospital for examination because of genital itching and increased leucorrhea
.

The examination revealed that there are a large number of clue cells in the leucorrhea (a large number of clue cells appear in vaginal secretions, indicating bacterial vaginosis)
.

So the doctor prescribed metronidazole and azithromycin for 7 days each, as well as other vaginal drugs
.

After 5 days of medication, she found that the leucorrhea not only did not decrease, but also had a tofu-like change and a tingling sensation in the vagina, so she reexamined the leucorrhea, and the result suggested that she was infected with fungal vaginitis again! Xiao Liu emphasized that she did not have sex during the medication period, and is currently living alone.
She suspected that the current situation was caused by the doctor's improper medication
.

Drug analysis Bacterial vaginitis and fungal vaginitis are common gynecological diseases, although the treatment plan has been very mature, but there are always patients repeatedly, the treatment effect is not good
.

Bacterial vaginosis (BV): can be infected through sexual behavior, mainly manifested as increased leucorrhea, fishy or ammonia odor, often accompanied by vaginal burning, pain during intercourse and genital itching
.

Vaginal vaginosis (VVC): also known as vulvovaginal candidiasis, it is more common in patients with long-term use of antibiotics, extensive use of immunosuppressants and estrogen, diabetic patients and pregnant women.
The main symptoms include increased leucorrhea and curd-like leucorrhea.
and genital itching
.

When a patient is infected with bacterial vaginosis alone, nitroimidazoles (metronidazole and tinidazole) and clindamycin can be used for treatment according to the guidelines recommended.
The specific drug regimen is shown in the figure below
.

The guideline recommends that metronidazole be used alone, while patients take metronidazole and azithromycin for 7 days each.
It is not ruled out that the use of antibiotics leads to the reduction of probiotic lactobacilli in the vagina, which promotes the proliferation of molds and causes fungal vaginitis
.

Condition discussion Xiao Liu's experience is representative
.

China's "Guidelines for the Diagnosis and Treatment of Bacterial Vaginosis" (Revised 2021) pointed out that before the treatment of bacterial vaginosis, it should be fully evaluated whether there is other vaginal inflammation, and the appropriate corresponding antibacterial drugs should be selected according to the specific type of mixed infection, so as to reduce the risk of infection.
The occurrence of fungal vaginitis caused by the use of antibiotics
.

At present, Xiao Liu belongs to mixed vaginitis with BV+VVC.
Compared with vaginitis with single infection, the course of disease is longer and the recurrence rate is higher.
The recurrence rate of infection is more than 40%
.

Since there is no unified treatment and follow-up plan for mixed vaginitis at home and abroad, in principle, the treatment and follow-up of each simple vaginitis should be referred to, and the combined application of different antibiotics should be selected according to the combination of different pathogens.
The treatment drugs should be selected according to the change, and the patients with no obvious symptoms and signs should be treated in sequence according to the types of the main pathogens causing the symptoms
.

According to the "Expert Consensus on the Diagnosis and Treatment of Mixed Vaginitis (2021 Edition)", the BV+VVC or vaginal trichomoniasis+VVC medication regimen is: oral nitroimidazole + topical antifungal drug topical combined administration (nitroimidazole + Antifungal drugs such as clotrimazole, etc.
) orally combined administration (nitroimidazoles + antifungal drugs such as fluconazole, etc.
) In addition, vaginal microecological preparations can be combined with antibacterial treatment to supplement vaginal lactobacilli in time to restore vaginal microflora.
Ecological balance plays an important role in consolidating the therapeutic effect and preventing recurrence
.

Key points for the use of vaginal microecological preparations: Lactobacillus live bacterin can be used with antifungal drugs and metronidazole.
It cannot be used with aminoglycosides, macrolides, and beta-lactams.
It is not recommended for severe fungal vaginitis.
Intravaginal application of oral lactobacillus (Roy's, rhamnose) can also be used to restore vaginal probiotic flora.
The frequency of vaginitis is high, and the treatment is relatively simple, which results in the current situation of non-standard and empirical treatment of vaginitis.
Cause some patients vaginitis repeatedly, the treatment effect is not good
.

In the treatment of vaginitis, standard medication and treatment according to the guidelines can achieve better therapeutic effect
.

References: [1] Gao Yueqian, Bai Junyi, Wang Chen, et al.
Interpretation of the diagnosis and treatment of vaginal inflammation in the 2021 US Centers for Disease Control and Prevention "Guidelines for the Treatment of Sexually Transmitted Infections" [J].
Chinese Journal of Practical Gynecology and Obstetrics, 2021, 37(11):6.
[2] Infectious Diseases Collaborative Group of Obstetrics and Gynecology Branch of Chinese Medical Association.
Guidelines for Diagnosis and Treatment of Bacterial Vaginosis (2021 Revised Edition)[J].
Chinese Journal of Obstetrics and Gynecology,2021,56(1) : 4.
[3] Infectious Diseases Collaborative Group of Obstetrics and Gynecology Branch of Chinese Medical Association, Liu Zhaohui.
Expert consensus on diagnosis and treatment of mixed vaginitis (2021 edition) [J].
Chinese Journal of Obstetrics and Gynecology, 2021, 56(1): 4 .