title: [Management of vaginal infection following failure of a probabilistic treatment: is the vaginal swab really useful?].
abstract: OBJECTIVE
  The aim of this observational national multi-centre study was to describe medical care of vaginal infections resisting a primary probabilistic treatment.
  
  
  METHODS
  Two hundred and seventy female patients were included during a 9-month period (from 2013, March 20th to 2013, December 7th) by 155 gynaecologists located throughout France.
  
  
  RESULTS
  All patients were presenting a vulvo-vaginitis episode which started about three weeks ago and which was characterized by leucorrhea (93 % cases), itching (88 % cases) and/or vulvar and/or vaginal irritation (88 % cases). In most cases, this episode was previously treated by a short course of an azole antifungal medication. This treatment was initiated by the patient herself without any doctor's prescription in six out of 10 cases and had no influence on the evolution of the original clinical symptoms. Second line treatments included azole antifungal medications (56 % cases), local fixed combinations (antifungal agent and bactericidal antibiotic) (29 %), metronidazole (9 %), oral antibiotics (7.4 %). At the end of the treatment, 85 % patients recovered from vaginitis symptoms. The recovery rate was 82.6 % for patients who got a bacteriological examination and 87.6 % for patients who were treated without any bacteriological examination. The difference is not statistically significant.
  
  
  CONCLUSIONS
  These results seem to show that a probabilistic medical care is as effective as (but probably more economical than) a therapeutic strategy guided by the results of further examinations in case of failure of a primary treatment. This conclusion should be confirmed by a medico-economic comparison after randomization.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France. Electronic address: Florence.BRETELLE@ap-hm.fr.
authors.forename: F
authors.initials: F
authors.lastname: Bretelle
authors.affiliation: Vivactis-M2 Research, 114, avenue Charles-de-Gaulle, 92200 Neuilly-sur-Seine, France.
authors.forename: P
authors.initials: P
authors.lastname: Chiarelli
authors.affiliation: Second Stage Pharma, 4, rue Saint-Augustin, 75002 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Palmer
authors.affiliation: Clinigrid, 92, boulevard Victor-Hugo, 92115 Clichy, France.
authors.forename: N
authors.initials: N
authors.lastname: Glatt
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D011446:Prospective Studies; D013048:Specimen Handling; D014627:Vaginitis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
keywords: Deuxième intention; Infection vaginale; Prélèvement vaginal; Second line therapy; Vaginal infection; Vaginal swab