Genital infections

Patients have a variety of complaints caused by bacterial vaginosis, and due to the odour, it is also unpleasant for the woman herself as well as for those around her. It occurs when the number of lactic acid bacteria (lactobacilli), which ensure an acidic environment (pH 3.8 to 4.4) in the vagina, decreases. As a result, the pH rises and harmful bacteria can spread. Many patients notice the disorder by a grey-white discharge (fluorine), often smelling fishy. Vaginosis also increases the risk of gynaecological infections, including those of the mucous membrane of the Zervix and uterus as well as the fallopian tubes. Bacterial vaginosis is particularly problematic during pregnancy, as the women affected are more likely to experience premature labour pains, early rupture of the amniotic sac or premature birth. Treatment is usually local with antibiotics such as metronidazole (for example Arilin® vaginal suppositories or Vagi-Metro® cream) or clindamycin (for example Sobelin® vaginal cream). In more severe cases, oral use is advisable.

As a supportive measure, but also for prevention, PTA can recommend vaginal preparations with lactic acid or lactobacilli, such as KadeFungin® FloraProtect, KadeFungin® Lactic Acid Cure, Vagisan® Lactic Acid Vaginal Suppositories, Lactofem® Lactic Acid Vaginal Suppositories or Vagiflor® Vaginal Suppositories.

Dr. Christian Albring, President of the Professional Association of Gynaecologists and gynaecologist in private practice in Hanover, says in an interview with the PTA-Forum: »Probiotics could have a positive effect on the healthy bacteria in the vagina and strengthen the local immune system. The disadvantage is that germs can get into the vagina from the outside when they are inserted.«

Vaginal mycosis manifests itself in an increased discharge, which is yellowish-white in colour and appears curd-like to crumbly. The women affected often describe the external genital area as red and swollen, furthermore they complain of constant itching and severe burning. Typical pathogens are dermatophytes, yeasts of the Candida type such as Candida albicans or moulds. Reasons for excessive colonisation can be a weakened immune system, diabetes or pregnancy. A past antibiotic treatment is also a possible cause.

Over-the-counter medicines are available for treatment. The prerequisite for self-medication is that the patient is over 18 years of age, is not pregnant and does not have vaginal mycosis for the first time. In the case of an initial infection, medical treatment is always indicated, as well as in the case of symptoms such as abdominal pain, very strong itching, fishy-smelling, foamy, greenish-yellow discharge or general symptoms such as a temperature or aching limbs.

The drug of choice for self-medication is the imidazole clotrimazole, which is effective against various fungi as well as some types of bacteria. It is available in the form of vaginal tablets, suppositories and creams, and as a skin cream for application to the vulva, that is the external female genital organs.

Combination packs such as KadeFungin®3 Combination Pack, Canesten® GYN 3-day combination pack, Vagisan® Myko Kombi 3 Days or Canesten® GYN Once Combi Mycosis contain both a product for treating the vagina and one for the external genital area. They are recommended if the vagina as well as vulva are affected. The over-the-counter preparations are intended for a one- and three-day therapy. A total dose of 500 to 600 mg of active ingredient is used in both forms of therapy. However, there is a difference in dividing the amount of active ingredient: The vaginal tablet for the one-day therapy contains 500 mg of clotrimazole as opposed to 200 mg per tablet in the three-day combination pack. The advantage of the one-day therapy could be a better adherence, plus the fact that the symptoms recede more quickly.

For one day respectively three days, the patient inserts a vaginal tablet once a day in the evening before going to bed using the applicator provided. The easiest way to do this is to lie on your back with your legs slightly bent. At night, the active ingredient can spread easily and there is less leakage. After use, clean the applicator carefully with warm water. If the vaginal mucosa is very dry, the vaginal tablets will not dissolve sufficiently. A cream for intravaginal application by applicator is then more suitable.

Skin creams for external use should be applied thinly to the external genital organs up to the anus using the finger. External treatment should be carried out up to three times a day for one to two weeks.

Nystatin from the group of polyenes is a second-choice remedy and is only effective against yeast fungi. Corresponding preparations such as Biofanal® as an ointment, suspension gel, film-coated tablets, vaginal tablets or a combination pack (ointment plus vaginal tablets) should be recommended by PTA if clotrimazole is contraindicated.