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| History of
the PAV trial | References » |
Vaginal candidiasis or thrush is a common and irritating problem for many women. It may cause symptoms of vaginal itch and irritation and/or discharge.
The PAV (post-antibiotic vulvovaginitis) trial is important as symptomatic vulvovaginal candidiasis following antibiotics is a common problem in Australian general practice. Studies have found that up to 70% of women have experienced thrush at some time in their lives(1).
Several studies have confirmed what most women already know: that vaginal candidiasis has a significant negative effect on women's wellbeing. A recent study, which examined the psychological factors associated with recurrent vaginal candidiasis, reported that the symptoms seriously interfered with their subjects' sexual and emotional relationships(2). Another study found that 46% of their sample of 490 women with vaginal symptoms, admitted to having the condition on their minds all or most of the time(3). A study of 30 women who had purchased an antifungal agent found that two-thirds reported at interview that their vaginal symptoms had made them feel "… miserable, uncomfortable, embarrassed and even frightened" and that they felt a sense of shame and spoiled identity(4).
Concern about PAV affects whether women take antibiotics as prescribed and some women use unproven expensive complementary therapies, in particular lactobacillus acidophilus, in an attempt to prevent its occurrence.
Currently we do not know whether lactobacillus works to prevent thrush after antibiotics.
This trial, which builds on our recent work regarding post-antibiotic vulvovaginal candidiasis (PAV) in women, aims to answer the question of whether the commonly used complementary therapy, lactobacillus, is effective in the prevention of post-antibiotic vulvovaginal candidiasis.
Complementary therapies are a big issue in Australia. In 1993 Australians spent an estimated $621 million on complementary therapies, with premenopausal women being the commonest consumers(5). Recent work has found that Victorian general practitioners are also interested in complementary therapies and are recommending them to their patients(6). However, this increased usage and recommendation of complementary therapies by both patients and doctors has not yet been paralleled by an increase in the evidence base about effectiveness.
General practitioners as well as their patients need reliable, rigorous evidence about complementary therapies, in order to make informed decisions about their use.
| References |  |
1. Fidel PL, Sobel JD. Immunopathogenesis
of recurrent vulvovaginal candidiasis. Clinical Microbiology Reviews 1996;9(3):335-48.
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2. Irving G, Miller D, Robinson
A, Reynolds S, Copas A. Psychological factors associated with recurrent
vaginal candidiasis: A preliminary study. Sexually Transmitted Infections
1998;74(5):334-9.
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3. O'Dowd T, Parker S, Kelly
A. Women's experiences of general practitioner management of their vaginal
symptoms. British Journal of General Practice 1996;46:415-8.
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4. Chapple A, Hassell K, Nicolson
M, Cantrill J. 'You don't really feel you can function normally': women's
perceptions and personal management of vaginal thrush. J of Reproductive
and Infant Psychology 2000;18(4):309-19.
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5. MacLennan A, Wilson D, Taylor
A. The Escalating Cost and Prevalence of Alternative Medicine. Preventive
Medicine 2002;35:166-173.
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6. Pirotta M, Cohen M, Kotsirilos
V, Farish S. Complementary therapies: have they become accepted in general
practice? MJA 2000;172(3):105-109.
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| History of the PAV trial | |
The trial builds on work previously done by our group in Melbourne which found that about 40% of women in general practice waiting room sample used lactobacillus or yoghurt products to prevent or treat post-antibiotic vulvovagintis (PAV).
PAV was launched in November 2001 in 4 sites in the inner north-western region of Melbourne. Additional general practice clinics have become involved during 2002. In September the Royal Women's Hospital also became a recruitment site. Recent approval for another 6 sites brings us to a total of 26 registered sites spread widely across Melbourne. In October, several community pharmacies agreed to be involved in PAV. Currently there are over 40 sites acting as recruitment centers for PAV.