Definition
Vaginitis refers to inflammation of the vagina and the mucous membrane that covers it, often resulting (but not always) in bacterial or fungal infections.
Causes
Vaginal inflammation is mainly due to bacterial infections (eg Trichomonas vaginalis trichomoniasis) and fungal infections (eg Candida albicans candidiasis); however, it is possible that vaginitis is also a consequence of alterations in the vaginal mucosa (due to the reduction of estrogenic levels, typical of the post-menopausal period), dietary deficiencies and incorrect / poor intimate hygiene.
Risk factors for vaginitis: unprotected sexual intercourse with subjects at risk, bacterial vaginosis
Symptoms
Given the etiological variability, the symptomatology of vaginitis depends on the triggering cause; in general, the patient complains of dyspareunia, difficulty during urination, vaginal irritation, abnormal whitish or bloody vaginal discharge outside the cycle, itching and stranguria.
Information on Vaginitis - Vaginitis Drugs is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Vaginitis - Vaginitis Drugs.
drugs
The choice of a drug rather than another clearly depends on the etiological element involved in vaginitis. For example, for Candida vulvovaginitis the patient must be treated with drugs aimed at eradicating the fungus; the treatment will be different in case of Trichomonas vaginitis .
It is strongly advised to also subject the sexual partner to therapy, since inflammation, even if indirectly, is one of the sexually transmitted diseases.
In the case of Candida vaginitis (see the specific article dedicated to drugs against candida), the most widely used drugs in therapy are: topical antifungals / for systemic action:
- Nystatin (eg MYCOSTATIN, Nizoral) We recommend administering tablets / sugar-coated tablets with 500, 000 IU nystatin per ml (or 100, 000 IU / ml oral suspension) three times a day. The duration of therapy must be established by the doctor. The drug belongs to the class of polyenics and acts as a powerful antimicrobial: for this reason, it is indicated in the case of candida vaginitis.
- Itraconazole (eg Sporanox): is an azole drug that acts as an antifungal, interfering with the formation of the cell membrane of the fungus. Generally, it is given in the form of an oral suspension or tablets (200 mg): one tablet is taken per day for one or two weeks. The dose may increase from 100 to 400 mg a day, depending on what is prescribed by the doctor and the severity of the vaginosis.
- Clotrimazole (eg. Gyne-Lotrimin, Gyne-Lotrimin-3, Mycelex-7 and, subject to medical prescription, Gyno-canesten): insert a vaginal tablet (100 mg) deeply into the vagina - or apply the cream using a special applicator (1% ) - for 7 consecutive days, before going to bed. For recurrent candida vulvovaginitis, we recommend applying a 500 mg clotrimazole (vaginal) glow plug once a week for six months.
- ANIDULAFUNGINA (ex. ECALTA): it is an echinocandin with antifungal activity. The drug is presented in powder form for infusion solutions. Although more suitable for systemic candidiasis, it is sometimes prescribed even in the case of candida vulvovaginitis. It is given with an initial dose of 200 mg on the first day, followed by 100 mg / day for about two weeks. The duration of the treatment must be established by the doctor.
- CANCIDAS (eg CASPOFUNGIN): is another exponent of echinocandins. The drug is administered with a single loading dose of 70 mg, followed by a dose of 50 mg a day (or 70 mg if the subject weighs more than 80 kg). The duration of therapy for the treatment of vaginitis is indicated by the doctor.
In the case of Trichomonas vaginitis, systemic treatment with metronidazole or tinidazole is preferable (see the specific article dedicated to drugs against trichomoniasis):
- Metronidazole (eg Metronid, Deflamon, Flagyl): it is the drug of excellence used for trichomonas vaginitis treatment. It is recommended to take 200 mg of metronidazole every 8 hours for a week. Alternatively, take 400-500 mg of substance every hour for a period of 5-7 days, or 2 grams in a single dose.
- Tinidazole (eg. Trimonase, Fasigin-N): it is recommended to take 2 grams of the drug in a single dose. Generally, tinidazole is recommended in case of non-response to metronidazole treatment.
As Candida and Trichomoniasis are responsible for sexually transmitted infections, the sexual partner must also undergo pharmacological treatment.
The integration of vaginal flora with lactobacilli (YOVIS ®, LACTEOL FORTE ®), through local applications, represents a valid therapeutic option in the presence of bacterial vaginitis. Among the various lactobacilli strains, the most suitable for this purpose seem to be those producing hydrogen peroxide. Oral supplementation seems to be less effective for this purpose, although it has an important preventive role due to the effect on the intestinal level, where it reduces the proliferation of pathogens (such as Candida albicans ) that could alter the normal vaginal flora.
Atrophic vaginitis is a variant of vaginitis: it is an inflammation of the vagina and the mucosa that covers it, caused by a reduction in vaginal tissues or a lack of lubrication of the vaginal walls. This is due to an estrogenic deficiency, typical of the post-menopausal period. Among the drugs most used in therapy, we recall:
- Estradiol (eg. Climara, Estrofem, Ephelia, Systen, Vagifem, Progynova): take the drug (ESTROGENI) per os 1-2 mg per day; parenterally, administer the drug at a dose of 10-20 mg every 4 weeks. It is possible to insert a vaginal ring into the vagina (release: 0.05 mg / day or 0.1 m a day): the vaginal ring must remain in the same position for three months, and then be replaced, if necessary, by a new one . The topical application of a 0.025-1 mg patch is also possible: apply 1-2 times a week, according to the doctor's instructions.
- Estradiol + norethindrone (Combined sex hormones. Ex. Activelle, Femhrt): it is recommended to take a tablet (1 mg of estradiol + 0.5 mg of norethindrone; or 0.5 mg of estradiol + 0.1 mg of norethindrone) one once a day. Alternatively, apply a patch (0.05 mg of estradiol + 0.14 mg of norethindrone) twice a week. It is also possible to increase the dosage of the active ingredients, when necessary (0.05 mg of estradiol +0.25 mg of norethindrone). The drug should be prescribed by your doctor.
- Esterified estrogens (eg Menest, Estratab): take 0.3-1.25 mg of oral drug once a day. Generally, the duration of treatment varies from one to five years.
- Estropipato: it is an estrogen useful in case of atrophic vaginitis. The dose depends on the condition of the woman's uterus. Generally, when the uterus is intact (there are no problems), it is advisable to take a dose varying from 0.625 to 5 mg a day, orally. In the case of atrophic vaginitis, it is possible to take the estropipato in combination with a targeted estrogen-progestin therapy, established by the attending physician.
