Clinical features
Mixed vaginitis has the following clinical features in contrast to simple vaginitis.
1. Regarding clinical features, mixed vaginitis is atypical. For example, some patients produce green-yellow, thin, purulent vaginal discharge; we found that this discharge was also observed in patients with single TV infection or those with AV mixed vaginitis. Clinical findings are thus unable to distinguish between single and mixed infections. In addition, mixed vaginitis can be characterized by single vaginitis, also can simultaneous presence of two or more potential vaginitis features(4, 9). Patients with AV plus BV reported a genital fish-like odor (indicator of BV) more frequently than those with single AV. Patients with AV plus VVC more often reported genital itching (indicator of VVC) than those with single AV(9). Symptoms varied among the patients with mixed vaginitis. The most frequently reported symptoms included a change in the characteristics of discharge (color, consistency, odor), genital itching, and burning pain.
2. Mixed vaginitis is hard to eradicate, and recurrence is frequent. For example, in a multicenter, prospective, open-label study, fenticonazole was evaluated in 101 women. On day 8, the eradication rate of mixed vaginitis (45%) was lower than that of single-pathogen infection (VVC 70%, TV 70%, BV 67%); 28 days later, the relapse rate was 23% in the mixed infection group and 0% in both the C. albicans and T. vaginalis groups(27). In addition, mixed infections lead to a high-dose therapeutic challenge. Liang Q reported that the complete eradication rate was significantly higher in the nifuratel-500 group than in the nifuratel-250 group among those with mixed vaginitis(28). A similar conclusion in an in vitro study showed that increasing fenticonazole concentrations can overcome potential interference betweenC. albicans and S. aureus or other bacterial species in mixed infections(29). This is likely due to the diverse behavior of the pathogenic vaginal flora that seems to affect the immune response of the host, making cure difficult.