VAGINAL INFECTIONS IN DIABETIC WOMEN - IS EMPIRIC ANTIFUNGAL THERAPY APPROPRIATE

Background. Diabetes mellitus is reported to predispose women to vagin al candidiasis and hence patients attending busy diabetic clinics are often treated empirically with antifungal agents for genital symptoms. Goal of this study: To investigate the etiology of vaginal infections in diabetic women and to determine appropriateness of empiric antifun gal therapy for symptomatic women. Design: Prospective study performed on consecutive patients attending two diabetic clinics. Setting. Diab etic clinics serving developing communities belonging to two ethnic gr oups. Study Population: Two hundred and one women (101 African and 100 Indian) comprising 90 women with symptoms of pruritus vulvae and/or v aginal discharge and 111 asymptomatic women. Results: Candidiasis (50% vs. 24%; P = 0.012) and bacterial vaginosis (28% vs. 8%; P = 0.017) o ccurred significantly more frequently in symptomatic African women com pared to asymptomatic African women. Among Indian women bacterial vagi nosis (28% vs. 5%; P = 0.026) occurred more frequently in symptomatic women. The prevalence of trichomoniasis was similar in symptomatic and asymptomatic women of both ethnic groups. Mixed vaginal infections we re detected significantly more often in African compared to Indian wom en (24% vs. 5%; P = 0.03). Conclusion: In diabetic women with genital symptoms, an attempt at diagnosis should be made prior to commencement of therapy. However, in busy clinics with overstressed facilities whe re investigations cannot be performed, the use of empiric antifungal t herapy alone is not appropriate and consideration should be given to t he use of an antifungal plus a nitroimidazole agent which would be eff ective for both trichomoniasis and bacterial vaginosis.