Есть ли ЛЕКАРСТВО?!

[DSK]

Слышал что появились новые препараты для лечения молочницы.. Так ли это? На сколько я понимаю мне нужно будет принимать их вместе с девушкой, не опасно ли это? И вообще, стоит ли? (Лето, молочница усилилась.. Неприятно!) Что Вы порекомендуете для лечения или для длительного снятия симптомов?

[Dr.Vad]

Кое что сможете почерпнуть отсюда, не последний писк, но все же:

BMJ. 1995 May 13;310(6989):1241-4.
Management of genital candidiasis. Working Group of the British Society for Medical Mycology.

Summary points

Vaginal candidiasis affects about 75% of women, 40-50% having recurrent episodes

Pruritus vulvae and vaginal discharge are the cardinal symptoms

Candida albicans accounts for about 90% of infections and C glabrata for 5%

C glabrata infections are often resistant to azoles

Recurrent episodes require clinical examination, culture of swabs, and consideration of underlying disease

Male partners who do not have symptoms need not be examined, have swabs taken for culture, or be treated

Reduction of intestinal colonisation is of no value in preventing recurrence

Management

Most women with vaginal candidiasis respond to topical treatment with nystatin or an imidazole, such as clotrimazole or miconazole. A few women have recurrent infection and require special management, which we will discuss later.
Five imidazole derivatives--clotrimazole, econazole, isoconazole, ketoconazole, and miconazole--are available in several topical formulations for the treatment of genital candidiasis. Clotrimazole, econazole, ketoconazole, and miconazole nitrate are marketed as creams for vulvitis, and clotrimazole, econazole nitrate, isoconazole nitrate, and miconazole nitrate are marketed as pessaries. These drugs, most of which are produced in different formulations, give higher cure rates than nystatin with shorter courses of treatment, and all of them have a similar, low relapse rate. Treatment times range from one to six nights. Shorter regimens achieve better patient compliance,18 but treatment courses of less than six nights should be reserved for first episodes. If further tests are performed to confirm cure, vaginal specimens should not be taken until at least three to four days after the end of treatment.
Itraconazole and fluconazole have been licensed for the short term oral treatment of vaginal candidiasis. Fluconazole is given as a single dose of 150 mg and itraconazole as two doses of 200 mg eight hours apart with food. These drugs are more expensive than topical preparations, but patient compliance is improved.19 Futhermore, if the vulva is very inflamed an oral preparation is much less painful to administer.
Nystatin was the first polyene antifungal to be applied to the treatment of vaginal candidiasis. It is still one of the cheapest agents for the treatment of this condition, but it requires a longer treatment period (two weeks) and has a lower cure rate than the topical or oral azoles.20 It is not available without a prescription, but it is often useful in women whose condition has failed to respond to azole treatment.
The many preparations and recommended treatment regimens attest to the need for further improvements in the treatment of vaginal candidiasis. Recommended regimens are not clearly related to differences between drugs, possibly owing more to commercial considerations than to careful comparisons.

Management of recurrent candidiasis

Recurrent vaginal candidiasis is a difficult problem to manage. Patients often suffer from depression. They may already have or will develop psychosexual problems as a result of their illness. Correct diagnosis is vital, and patients should be encouraged to avoid potential precipitating factors, though these may not be obvious. Other diagnoses include herpes simplex infection, allergic reactions, and bacterial vaginosis. Physical examination, investigations to exclude diabetes mellitus (and possibly HIV infection), and mycological investigation are essential and, if possible, should be performed when the patient has symptoms but has had no treatment.
There is no need to investigate oral or intestinal colonisation with C albicans in women with recurrent vaginal candidiasis. In the past, clinicians often attributed recurrent infection to repeated reinoculation of the genital tract from a persistent intestinal reservoir. This belief was based on the finding that patients often harbour the same strain of C albicans in the genital and intestinal tracts.22 23 24 Two controlled trials showed, however, that oral nystatin treatment, given to reduce intestinal colonisation with C albicans, failed to prevent recurrence of symptoms of vaginal infection.
Asymptomatic colonisation of the male genital tract by C albicans is about four times more common in partners of infected women.27 Moreover, strain typing methods have indicated that infected partners often harbour identical strains.22 24 28 The role of sexual transmission in vaginal infection is unknown, and topical or oral treatment of the male partner does not seem to prevent recurrence in the woman. In most cases, recurrence of symptoms probably results from vaginal relapse after inadequate treatment of a previous episode.9 The endometrium is not a common reservoir for yeasts, and therefore infection there is an unlikely cause of recurrent vaginal candidiasis.29 Whatever the source of vaginal reinfection or relapse, women with recurrent candidiasis differ from women with infrequent episodes in being unable to tolerate small numbers of organisms reintroduced or persisting in the genital tract. Strain typing methods have shown that women with recurrent and infrequent infection usually harbour the same strains of C albicans.
Most patients with recurrent candidiasis can be managed with intermittent prophylactic treatment with a single dose or multiple doses of topical or oral antifungals given to prevent symptomatic episodes. Local treatment with clotrimazole or miconazole at every two to four weeks suppresses symptoms even if mycological cure is not achieved.30 31 Intermittent single doses of oral fluconazole 150 mg are also effective.9 After symptoms have been suppressed for three to six months, regular treatment can be discontinued and the patient reassessed. Many women do not revert to the previous pattern of frequent recurrence.
Although antifungal drug resistance does sometimes have a role in treatment failure, other factors such as allergic reactions or poor compliance are much more common reasons for a poor clinical or mycological response. Nevertheless, drug resistance should be considered if yeasts other than C albicans are recovered from swabs taken from women with recurrent vaginal candidiasis. By comparison with C albicans, isolates of C glabrata are much less sensitive to fluconazole and other azoles.21 Women with recurrent C glabrata infection can sometimes be managed with nystatin or boric acid treatment. Such patients are best referred to a specialist.
Patients with recurrent candidiasis often resort to home remedies, such as vaginal yoghurt douches or special diets, and there is no doubt that some women derive some benefit from them. Other general measures recommended for the prevention of candidiasis include wearing loose fitting cotton underwear and avoiding the wearing of tights altogether. Little data are available on the efficacy of these measures. Likewise, discontinuation of the oral contraceptive pill has little scientific support.

Penile candidosis

In men genital candidiasis usually presents as a balanitis or balanoposthitis. Patients often complain of soreness or irritation of the glans penis; less commonly they have subpreputial discharge. Maculopapular lesions with diffuse erythema of the glans penis are often present; occasionally, there is oedema and fissuring of the prepuce. Itching, scaling, cutaneous lesions are sometimes found on the penis or in the groin. Men with insulin dependent diabetes may present with an acute fulminating oedematous form of balanoposthitis with ulceration of the penis and fissuring of the prepuce. White plaques can be found on retraction of the prepuce. About a fifth of male contacts of women with recurrent vaginal candidiasis complain of soreness and itching of the glans penis soon after intercourse and lasting for 24-48 hours. Men who have a penile catheter inserted long term or those using Paul's tubing are prone to chronic or recurrent penile candidiasis.
Diagnosis should not be on clinical grounds alone as balanitis and balanoposthitis have other causes. Specimens for mycological investigation should be taken from the coronal sulcus and subpreputial sac. Patients should be investigated for diabetes mellitus.
Genital candidiasis in men should be treated with saline washes or local applications of an antifungal cream. Nystatin should be applied morning and evening for at least two weeks. Clotrimazole, miconazole, or econazole creams should be applied for at least one week. Female partners should also be investigated. Men who fail to respond to treatment should be referred to a specialist for investigation for other infectious or non-infectious causes of their condition. Long term antifungal treatment may be appropriate for those with recurrent penile candidiasis associated with catheters or drainage devices.

[DSK]

Отлично, первый ответ и такой полный! Спасибо! Действительно немного устарело, но зато достаточно полно. А вот если перевести на советсткую действительность? Кроме нестатина какие есть у нас средства (вроде описанного в тексте крема для мужчин) Кроме того сейчас появились новые свечи для женщин и даже какой-то комплекс, который должны принимать оба партнёра. Что на счёт них думают врачи?

[Dr.Vad]

С удовольствием ознакомлю Вас с мнением специалистов, если укажете названия тех самых наиновейших препаратов.

Rev Iberoam Micol. 2002 Dec;19(3):144-8.
New strategies for treatment of Candida vaginal infections.

Magliani W, Conti S, Salati A, Arseni S, Frazzi R, Ravanetti L, Polonelli L.

Dipartimento di Patologia e Medicina di Laboratorio, Sezione di Microbiologia, Universita degli Studi di Parma, Viale Gramsci 14, 43100 Parma, Italy. [Ссылки доступны только зарегистрированным пользователям ]

New strategies for treatment of vaginal candidiasis have been recently exploited, due to widespread occurrence of this disease, in particular as recurrent infections, limitations of safe and efficacious antifungals as well as the lack of reliable preventative approaches. In this review new chemotherapeutic and immunotherapeutic strategies, based on the improved understanding of the immunopathogenesis of this prevalent human infection, will be discussed. The role of killer antibodies (or their molecular derivatives), i.e. antibodies that show antibiotic activity bearing the internal image of a yeast killer toxin (KT), characterized by a wide spectrum of microbicidal activity, and of the specific cell wall KT receptor as putative new therapeutic agents and preventative or therapeutic vaccines, respectively, will be particularly outlined.



Arzneimittelforschung. 2002;52(9):699-705.

Antimicrobial activity of dequalinium chloride against leading germs of vaginal infections.

Della Casa V, Noll H, Gonser S, Grob P, Graf F, Pohlig G.

Medinova Ltd., Zurich, Switzerland.

Dequalinium chloride (CAS 522-51-0) and povidone iodine (CAS 25655-41-8) are known as antiseptic agents and used in the local treatment of vaginal infections. Clotrimazole (CAS 23593-75-1) is an anti-fungal drug and applied primarily in the therapy of vulvo-vaginal candidiasis and to a lesser extent in bacterial vaginosis and trichomoniasis. However, antimicrobial activities of those three agents in comparison to each other have not been reported so far. To address this issue the antimicrobial activities of these agents against 18 germs relevant to vaginal infections were determined. The tested species are representatives of the genera Staphylococcus, Streptococcus, Enterococcus, Listeria, Escherichia, Proteus, Gardnerella, Bacteroides, Prevotella, Porphyromonas, Candida, and Trichomonas. All micro-organisms were susceptible to dequalinium chloride with the exception of Proteus mirabilis. At a given dose, the activity of dequalinium chloride was higher as compared to the other substances. In view of its wide antimicrobial spectrum dequalinium chloride is an efficient alternative in the local therapy of vaginal infections such as fluor vaginalis, bacterial vaginosis, aerobic vaginitis, vulvo-vaginal candidiasis and trichomoniasis.

[DSK]

Супер оперативно! %) Я поражён.. Не знаю названий, знал бы - был бы рад. А что продаётся в России, содержащее препараты указанные вами? Интересуют естественно препараты, предназначенные для лечения пар.

[Dr.Vad]

С этой инфо потяжелее: наиболее просто найти онлайновский Видаль и поискать по имени понравившегося Вам препарата (особое внимание на фразу: Male partners who do not have symptoms need not be examined, have swabs taken for culture, or be treated)

[yananshs]

Diflucan (fluconazole) 150mg однократно. Для женщины. Партнеру при отсутствии симптоматики, действительно принимать ничего не рекомендуют.

[DSK]

А что кроме трещинок и неприятного запаха может быть доказательством наличия у мужчины молочницы??

[Dr.Vad]

Specimens for mycological investigation should be taken from the coronal sulcus and subpreputial sac.

[DSK]

А всетаки... Если можно, опишите внешние проявления молочницы у мужчины. И еще, разве такое возможно что девушка болеет, а ее постоянный сексуальный партнер нет?