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.