OTC and alternative vaginitis medicines "unlikely to be of benefit" -- Temple researchers.

OTC, ALTERNATIVE MEDICINE VAGINITIS REMEDIES HEALTH BENEFIT QUESTIONED by Paul Nyirjesy, MD, et al., Temple University, in a study published in the July issue of Obstetrics & Gynecology. "Women with chronic vaginal symptoms often use over-the-counter and alternative medicines that add to health care costs and are unlikely to be of benefit," Nyirjesy and colleagues state. For the purposes of Nyirjesy's study, vaginitis comprises a variety of gynecological inflammations or infections, including yeast infections and bacterial infections.

The Temple researchers interviewed 105 patients referred by their gynecologists to the Temple University Vaginitis Referral Center for chronic vaginal symptoms. The patients were questioned about their use of OTC and alternative treatments during the previous year, the amount spent on such treatment and whether they told their physicians about the treatments. The patients' mean age was 36, and their median symptom duration was two years.

Nearly three-fourths (77, or 73.3%) of the patients had self-treated with over-the-counter medicines such as miconazole (74% of OTC users), clotrimazole (37.7%), povidone-iodine (13%) and hydrocortisone (9.1%). The median spending for OTC products was $50; the range was $2 to $1,000.

Forty-four (41.9%) of the patients had tried alternative medicines, most often acidophilus pills taken orally (22 patients, or 50%) or vaginally (five, 11.4%); yogurt orally (nine, 20.5%) or vaginally (eight, 18.2%); vinegar douches (six, 13.6%); and boric acid (six, 13.6%). Four (9.1%) of the patients had used garlic pills and the same number tried herbal teas. Two (4.5%) had acupuncture sessions. The median expenditure for alternative treatment was $35 (range $0 to $1,200).

Sixty-eight (88.3%) of OTC users had told their physicians about their self-treatment, compared to 31 (70.5%) of those who used alternative treatments. "Patients who had used over-the-counter remedies were more likely to have also used alternative medicines," the authors note.

Most of the women referred to the center thought they had recurrent yeast infections and some had been given that diagnosis by their health care provider. The researchers diagnosed 29 (27.6%) of the patients as having vulvovaginal candidiasis; 18 (17.1%) with vulvar vestibulitis; 16 (15.2%) with irritant dermatitis; 11 (10.5%) with bacterial vaginosis; and seven (6.7%) with physiologic discharge. Ten patients' symptoms resolved completely before evaluation.

"Statistical analysis correlating over-the-counter or alternative medicine use with actual diagnosis revealed that women who actually had candidiasis were more likely to have used alternative medicines (19 of 44) in the preceding year than other patients (15 of 61)," Nyirjesy et al. state. "Other common diagnoses were not associated with either over-the-counter or alternative medicine use."

"Our results indicated that, in a patient population in which the initial diagnoses have not been clearly established, antimycotic agents are often overused," the authors assert. "Furthermore, with 15% of patients having an irritant dermatitis that can be worsened by inappropriate topical therapy, over-the-counter use may exacerbate symptoms and increase patient costs, especially if those symptoms become significant enough to require referral to a specialized center."

"We have shown that use of over-the-counter and alternative medicines figure prominently as treatment modalities in women with chronic vaginal symptoms," Nyirjesy et al. conclude. "The effects of these treatments remain unclear and, given the extent of their use, further investigation is warranted."