Abstract
Background: Vaginal discomfort (VD) due to infections remains a challenge in clinical practice. Since many microbial agents grow in anaerobic conditions, a novel approach using oxygen supply has been proposed.
Objective: The aim of this pilot study was to verify the clinical effects of vaginal oxygen insufflation in women presenting with vaginal infections.
Methods: Fertile age women with a diagnosis of vaginal infections of different etiology were enrolled in a randomized, controlled, open label, monocentric trial. Women with vulvo-vaginal atrophy, amenorrhea since at least 3 months and exposure to antibiotics in the previous 30 days were excluded. Gynecological examination and vaginal swabs were performed. Women were randomized to 3 treatment groups. Group A received vaginal normobaric, high concentration oxygen supply (O2 concentration >95%, 3 lt/min for 20 minutes), twice/week for 2 weeks; group B received vaginal oxygen as Group A added to a targeted antibiotic or antimycotic treatment for 5-7 days; Group C received only the targeted antibiotic or antimycotic treatment for 5-7 days. Subjects rated vaginal discharges, vulvovaginal itching/burning and dyspareunia before and 10-14 days after end of treatment on a Likert scale. VD score was obtained with the sum of single symptoms.
Results: Out of 36 randomized women 32 were analyzed. Bacterial vaginosis (n=14), candidiasis (n=7) and aspecific vaginal infections (n=11) were equally distributed among groups. Baseline VD, as well as single symptom scores were not different among groups. At the end of the treatments, the VD score was significantly reduced by 89.2 ± 7.1% in Group A, by 85.1 ± 10.1% in group C and to a lesser extent by 52.8 ± 9.2% in group B, with significant reduction occurred in single symptoms.
Conclusions These findings demonstrate that the vaginal supply of high concentration oxygen has proven efficacy in patients presenting with vaginal infections.
References
Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991;165 (4 pt 2):1168-1176.
Eleutério J Jr, Campaner AB, Carvalho NS. Diagnosis and treatment of infectious vaginitis: Proposal for a new algorithm. Front Med (Lausanne). 2023;10:1040072.
Oduyebo OO, Anorlu RI, Ogunsola FT. The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev. 2009;(3):CD006055.
Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Front Reprod Health. 2023;5:1100029.
Goldman, Schafer AI (Eds). Goldman’s Cecil Medicine. (Twenty-Fourth Edition) 2012, Elsevier Press.
André AC, Debande L, Marteyn BS. The selective advantage of facultative anaerobes relies on their unique ability to cope with changing oxygen levels during infection. Cell Microbiol. 2021;23(8):e13338.
Palmieri B, Condemi L, Bertozzi E, Garoia F, Vadalà M. Relapsing Vulvovaginal Candidiasis: Treatment with Oxygen Therapy and Hyaluronic Acid. Macedonian J Med Sci. 2022;10(B):2258-2266.
Barbero M, Villasco A, Villa M, Badellino E, Marello E, Botta G. Conjugate treatment with high concentration normobaric oxygen and hyaluronic acid for vaginal atrophy: a prospective study. Eur Rev Med Pharmacol Sci. 2023;27(5):2011-2017.
Massarotti C, Asinaro G, Schiaffino MG, et al. Vaginal oxygen plus hyaluronic acid on genito-urinary symptoms of breast cancer survivors. Climacteric. 2023;26(2):129-134.
van Schalkwyk J, Yudin MH; Infectious disease committee. Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis. J Obstet Gynaecol Can. 2015;37(3):266-274.
Bradshaw CS, Morton AN, Hocking J, et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis. 2006;193(11):1478-1486.
Aslam B, Wang W, Arshad MI, et al. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist. 2018;11:1645-1658
Armstrong-Buisseret L, Brittain C, Kai J, et al. Lactic acid gel versus metronidazole for recurrent bacterial vaginosis in women aged 16 years and over: the VITA RCT. Health Technol Assess. 2022;26(2):1–170.
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Reports. 2021;70(4):1–187.
Noormohammadi M, Eslamian G, Kazemi SN, Rashidkhani B, Malek S. Association of dietary glycemic Index, glycemic load, insulin Index, and insulin load with bacterial vaginosis in Iranian women: a case-control study. Infect Dis Obstet Gynecol. 2022:1225544.
Petricevic L, Witt A. The role of Lactobacillus casei rhamnosus Lcr35 in restoring the normal vaginal flora after antibiotic treatment of bacterial vaginosis. BJOG. 2008;115(11):1369-1374.
Ling Z, Liu X, Chen W, et al. The restoration of the vaginal microbiota after treatment for bacterial vaginosis with metronidazole or probiotics. Microb Ecol. 2013;65(3):773–780.
Cohen CR, Wierzbicki MR, French AL, et al. Randomized trial of lactin-V to prevent recurrence of bacterial vaginosis. N Engl J Med. 2020;382(20):1906–1915.
Memar MY, Yekani M, Alizadeh N, Baghi HB. Hyperbaric oxygen therapy: Antimicrobial mechanisms and clinical application for infections. Biomed Pharmacother. 2019;109:440-447.
Cimşit M, Uzun G, Yildiz S. Hyperbaric oxygen therapy as an anti-infective agent. Expert Rev Anti Infect Ther. 2009;7(8):1015-1026
Sheikh AY, Gibson JJ, Rollins MD, Hopf HW, Hussain Z, Hunt TK. Effect of hyperoxia on vascular endothelial growth factor levels in a wound model. Arch Surg. 2000;135(11):1293-1297.
Müller-Heupt LK, Wiesmann-Imilowski N, Schröder S, et al. Oxygen-Releasing Hyaluronic Acid-Based Dispersion with Controlled Oxygen Delivery for Enhanced Periodontal Tissue Engineering. Int J Mol Sci. 2023;24(6):5936.
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