This thesis deals with several aspects of (abnormal) vaginal discharge, focusing especially on clue cell-positive discharge (bacterial vaginosis, nonspecific vaginitis). It reports data on epidemiology and clinical features, pathogenesis, and treatment of this vaginal disease entity, as well as on women's experience of troublesome vaginal discharge. Chapter III discusses the question whether or not symptoms and signs have a discriminatory ability in the diagnosis of specific vaginal infections. If so, this could help the physician to reach a diagnosis with minimum effort. However, data from the literature indicate that this ability is limitedl. While bacterial vaginosis and trichomoniasis undoubtedly have much in common, e.g. the overgrowth of anaerobic bacteria, the question is whether the difference between the two entities ends with the pathognomonic presence of clue cells and trichomonads, or whether other discriminating features can be detected. Chapter IV reports on an extensive clinical and laboratory study of women with these vaginal infections. The available information on the extent of the problem of vaginal discharge is incomplete. Hard figures, which probably represent only the tip of the iceberg, are being collected by several sentinel stations. Data on views of women on vaginal discharge and their behaviour in this context are virtually lacking. In order to find answers to some questions, a survey was held among 5,900 women. It is reported in chapter V. Wet mount microscopy of vaginal discharge from women with clue cellpositive discharge (CCPD) invariably shows that a minority of vaginal epithelial cells (VECs) are covered with bacteria, a finding also reported by other authors. Chapter VI studies this 'selective' bacterial adherence and focuses on vitality and glycogen content of VECs, as well as on the morphology of bacterium-VEC interaction. Chapter VII evaluates the efficacy of single-dose tinidazole in the treatment of non-specific vaginitis. Metronidazole, another nitroimidazole combination, has been shown to be very effective in a regimen of 2x500 mg for one week. From the point of view of patient compliance and cost effectiveness single-dose treatment seems preferable. Although there is no convincing evidence that metronidazole has teratogenic properties in human beings, the drug should be used only reluctantly during pregnancy. Since CCPD is perhaps the most prevalent vaginal infection, the development of an effective treatment which can be safely used during pregnancy seems important. In chapter VIII the efficacy of amoxycillin and amoxycillin plus clavulanic acid in the treatment of CCPD is compared with that of metronidazole. Povidone-iodine has been used for local treatment of vaginitis since the early Sixties. Its vaginal use nowadays mainly concerns the treatment of chronic, non-specific vaginal infections. Most studies report moderate efficacy (up to 70%) of povidone-iodine, administered either as pessary, solution or gel. Only one study seriously questions the efficacy of povidone-iodine as a vaginal therapeutic • Chapter IX concerns a double-blind, placebo-controlled study of the efficacy of povidone-iodine in the treatment of CCPD.

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Erasmus University Rotterdam
A.C. Drogendijk , E. Stolz (Ernst)
hdl.handle.net/1765/51224
Erasmus MC: University Medical Center Rotterdam

van der Meijden, W. (1987, September 4). Bacterial vaginosis (clue cell-positive discharge) : diagnostic, ultra-structural and therapeutic aspects. Retrieved from http://hdl.handle.net/1765/51224