1. Probiotics as adjunct therapy for vulvovaginal candidiasis
- Probiotics for the treatment of vulvovaginal candidiasis in non-pregnant women: A systematic review and meta-analysis of randomized controlled trials in American Journal of Obstetrics & Gynecology
Vulvovaginal candidiasis (VVC), commonly known as vaginal yeast infection, is a common cause of vaginal discomfort and itching, and can significantly affect quality of life. While azole antifungal medications are the first-line treatment, patients with recurrent VVC who use these medications long-term may eventually develop drug resistance. Accordingly, there is increased interest in alternative and/or adjunctive treatment options for management of VVC. In this systematic review and meta-analysis of 14 randomized controlled trials investigating the use of probiotics in relation to traditional antifungal agents, the authors concluded that combination therapy with both antifungals and probiotics provided significantly higher short-term cures, clinical cures, and 6 month recurrence rates for VVC, and decreased 3-month rates of recurrent VVC; no longer-term effects were noted. Antifungals outperformed probiotics alone for short-term cure, while probiotics alone showed some benefit for recurrent VVC at 6 months compared with placebo. The authors call for additional studies, but conclude that combination therapy with antifungals and probiotics has the potential to enhance VVC cure rates, as well as the duration of cure for recurrent VVC.
2. ACOG guidance on unexplained elevated hCG
- ACOG Clinical Consensus No. 11: Management of Positive Human Chorionic Gonadotropin Test Results in Nonpregnant Patients Without Gynecologic Malignancy in Obstetrics & Gynecology
Human chorionic gonadotropin (HCG) is a hormone produced after implantation, and is most commonly seen in pregnancy, gestational trophoblastic neoplasm, or certain germ cell tumors. However, there are rare scenarios in which a patient may have an elevated HCG even when when pregnancy and gynecologic malignancy have been excluded. In this new Clinical Consensus published by the American College of Obstetricians and Gynecologists, the authors outline an structured approach to elevated HCG in these individuals. The Clinical Consensus describes some of the most common reasons for these elevated HCG results, including antibody production, kidney failure, and a rare familial syndrome. It provides a framework that can guide healthcare professionals, with possible next steps of comparing urine and serum HCG results, repeating testing with a different assay, or tracking the patient’s follicle-stimulating hormone. Providers can also consider non-gynecologic malignancies, which can occasionally cause HCG to be elevated, but should followed only after an initial, less invasive evaluation. This Consensus is a useful clinical reference for a scenario that can otherwise prompt unnecessary intervention.
3. Paracervical blocks reduce pain during IUD placement
- A double-blind, triple-arm randomized controlled trial of 1% lidocaine paracervical block for intrauterine device (IUD) insertion in Contraception
IUDs are highly effective forms of long-acting contraception, and can be safely used by almost all patients. However, concern about pain during placement remains a meaningful barrier to IUD uptake. In this randomized controlled trial, researchers compared pain scores among patients receiving a lidocaine paracervical block, a normal saline block, or a capped-needle control. Patients who received paracervical blocks with lidocaine, including nulliparous patients, reported lower pain scores at key steps in IUD placement (tenaculum placement, sounding, and IUD placement). Pain during block placement itself was minimal, and patient satisfaction was significantly higher among those who received a lidocaine block. This data can be used to support routinely offering paracervical blocks for outpatient IUD placement.
4. Lidocaine spray does not significantly reduce IUD insertion pain
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