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CLINICAL REVIEW: Jeanne Marrazzo Extracts from "Concise Clinical Evidence": Vulvovaginal candidiasis BMJ 2002; 325: 586 [Full text]

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Systemic versus local medication of vulvo-vaginal infections

Sarman Singh, New Delhi (India)   (13 September 2002)

Nutritional Ignorance Will Sabotage Treatment

Joseph M Mercola   (13 September 2002)

Systemic versus local medication of vulvo-vaginal infections 13 September 2002
Sarman Singh, Professor of Clinical Microbiology All India Institute of Medical Sciences, New Delhi (India) Send response to journal: Re: Systemic versus local medication of vulvo-vaginal infections	I read with keen interest the Clinical review on Vulvo-vagnal candidiasis by Jeanne Marrazo, published in the BMJ (September 14, Vol 325, 2002 p586-7). The clinical evidences reviewed are interesting and in-depth. However, I would like to mainly comment on the local versus systemic treatment of vaginal infections. My specific disagreement is on the overall benefits of oral antifungals for this infections. We know that systemic adminstration of antifungals has several side-effects as mentioned in the NNH11 study. More over the systemic treatment can not be administered for a very long period due to these side effects while local treatment can be continued for a long period with no significant side effects. As highlighted in the study NNT3 and NNT4 the effectiveness of one anti-microbial may differ from another irrespective of the route of administration, the ideal way to compare the choice of route to administer the drug is by tolerance and minimal side effects. We reported a case of vulvo-vaginal enterobiasis long back in 1989 who did not respond to any of the systemic anthelminthic treatment. Not only that we also tried larger doses and longer duration which caused more intolerability and no beneficial effects. More over the systemic treatment is also significantly costly. Only the local treatment was found effective.(1) I think that similar to our anthelminthic case report, fungal infections should preferably be treated by local anti-fungals rather than systemic administration of higher doses for prolonged periods. I also do not agree with the RCTs recommendations that treatment of sexual partner does not have any beneficial effect. It is convention as well as well reported that conjugal candidiasis is very common and it may not be important for treating the current infection but it is strongly recommended for preventing recurrent vaginal candidiasis.(2-4) Sarman Singh, MD All India Institute of Medical Sciences, New Delhi 1. Singh S, Samantaray JC. Tropical anthelminthic treatment of recurrent genitourinary enterobiasis. Genitourinary Medicine 1989; 65: 284-5. 2. Mathai R, Prasad PV, Jacob M, Babu PG, John TJ. HIV seropositivity among patients with sexually transmitted diseases in Vellore. Indian J Med Res 1990;91:239-41 3. Spinillo A, Carratta L, Pizzoli G, Lombardi G, Cavanna C, Michelone G, Guaschino S. Recurrent vaginal candidiasis. Results of a cohort study of sexual transmission and intestinal reservoir. J Reprod Med 1992;37(4):343-7 4. Ogunbanjo BO. Isolation of yeasts from male contacts of women with vaginal candidosis. Genitourin Med 1988;64(2):135-6
Nutritional Ignorance Will Sabotage Treatment 13 September 2002
Joseph M Mercola, Medical Director Optimal Wellness Center Schaumburg, IL 60194 Send response to journal: Re: Nutritional Ignorance Will Sabotage Treatment	Any pharmacological treatment for Candida that does not address the fiber depleted carbohydrate ingestion of the affected patient is a prescription for recurrence of the underlying infection. Without restriction of these simple sugars the yeast cells will have fuel to spur their growth that invariably allows them to survive the barrage of biochemicals that are directed at them. The drugs actually worsen the situation as they promote the development of resistant strains. Restriction of all grains and most underground vegetables is typically required to effectively provide symptomatic relief of recurrent Candida infections. Additionally, the regular ingestion of freshly crushed garlic cloves will provide significant quantities of allicin that has been shown in multiple trials to provide a less toxic, less expensive and far more effective alternative.