Advise your patients: Just say no’ to douching
New additions are available for diagnosis and treatment of vaginal infections, but don’t overlook an important strategy to help prevent infections: Tell your patients to stop douching.
A recent clinical study has linked douching with increased risk of bacterial vaginosis (BV), the most common vaginal infection.1 This finding changes the popular perception that douching is harmless, says the study’s lead author, Sharon Hillier, PhD, associate professor in the department of obstetrics, gynecology, and reproductive sciences at the University of Pittsburgh and director of reproductive infectious disease research at Magee Women’s Hospital in Pittsburgh. Of the 182 women who were BV-free at the start of the two-year study, those who practiced douching were twice as likely to develop the infection, the findings show.
"I think that many patients mistakenly believe that douching is a health-promoting behavior, that it helps cleanse the vagina or in some way helps prevent infection," Hillier notes. "I think clinicians need to let patients know that by washing the vagina, they remove the beneficial bacteria that live there that help prevent infections."
Women need to understand that the vagina is a unique ecosystem in the body, and that using harsh chemicals in that ecosystem can have significant effects, Hillier says.
"I think most women don’t understand, to be quite blunt, that the mouth and vagina are quite different and that washing the vagina is not like brushing your teeth," she explains. "In fact, when you wash the vagina, it actually sets women up for more infections."
Many vaginal infections are ecosystem imbalances, Hillier says. When patients use douches, they may be masking odors that signal vaginal infections such as BV, says David Soper, MD, professor and director of the division of gynecology at the Medical University of South Carolina in Charleston.
"We are concerned that particularly young women, women who don’t have good access to health care, or women who are at risk for STDs may choose douching or some over-the-counter compounds to treat a vaginal discharge or whatever that may be an indication of more serious infections," he notes.
A new diagnostic tool for quick detection of vaginal infections, as well as a new dosing regimen for treatment of BV, soon will be available to clinicians. The U.S. Food and Drug Administration has given approval for the FemExam TestCard to facilitate routine testing for vaginitis and has cleared marketing for a new once-a day dosing of MetroGel-Vaginal metronidazole vaginal gel.
The FemExam, developed and manufactured by Litmus Concepts of Santa Clara, CA, is a credit-card-size disposable device that allows clinicians to perform an initial test for vaginitis while the patient is in the office. By running a cotton swab containing undiluted vaginal fluid over two circular test areas, a clinician can detect within seconds, through color changes in the circles, for high or low pH levels, as well as for the presence of volatile amines.
At press time, results of the soon-to-be-published clinical trials of the device were scheduled to be presented at the August meeting of the Washington, DC-based Infectious Diseases Society for Obstetrics and Gynecology. The findings indicate that the FemExam offers high levels of sensitivity and specificity, says Hillier, who served as lead investigator for the trials.
"A total of 607 women were evaluated for bacterial vaginosis, and we were able to demonstrate in the clinical study that 163 or 90% of 180 women who had bacterial vaginosis were detected using this card, and only 13 or 3% of the 425 women negative for this were thought to be positive," Hillier explains. "It had a sensitivity of 90% and a specificity of 97%."
A sales, marketing, and distribution partner for the product should be announced this month, with product availability and costs to follow, says Marian Buccafurni, Litmus co-founder and chief financial officer. Litmus hopes to keep the cost low enough for the FemExam to become part of a routine standard of care, she states.
Clinicians heretofore have relied upon use of laboratory pH strips to test for imbalances in pH, the "whiff test" for presence of amines, and wet mount slides under the microscope to help determine the presence of vaginal infections. While the thought of a quick, easy-to-use test may sound attractive, the fundamentals of microscopy still apply when it comes to diagnosing vaginal infections, Soper says. However, use of devices such as the FemExam is an improvement for those clinicians who rely only on a visual exam, don’t use microscopy skills, and may miss diagnosis of vaginal infections as a result, he says.
Enhanced patient compliance is the goal for the new once-a-day dosing regimen for MetroGel-Vaginal, manufactured by 3M Pharmaceuticals of St. Paul, MN. In unpublished clinical trials including more than 500 women diagnosed with BV, the once-a-day dosing of the 0.75% vaginal gel was found to yield equivalent efficacy to the twice-daily dosage regimen previously recommended for the medication. The women were treated with the intravaginal medication either once or twice a day for five days. "There was equal efficacy between the two arms of the study," says Soper, who led one of the study centers. By minimizing the number of applications, researchers hope more patients will finish the course of treatment, he notes.
Reference
1. Hawes SE, Hillier SL, Beneditti J, et al. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996; 174:1,058-1,063.
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