Lriog-2021-1

LRIOG N.1 2021

In this issue:

Editorial

Greetings from the Editor-in-Chief

Tito Silvio Patrelli

PDF DOI:10.53146/lriog120211 Abstract

Original Article

Androgens and genitourinary syndrome of the menopause.
Why, when and for whom they could be indicated

Alessandra Graziottin

PDF DOI:10.53146/lriog120212 Abstract

Vulvar condilomatosis

Roberto Senatori

PDF DOI:10.53146/lriog120213 Abstract

Extramammary paget’s disease of the vulva (EMPDV), this unknown

Francesco Sopracordevole, Nicolò Clemente, Anna del Fabro

PDF DOI:10.53146/lriog120214 Abstract

Vulvar pain and diagnosis of comorbidities – Key factors from the Vu-Net study on 1183 cases – part 1

Alessandra Graziottin, Dania Gambini, Filippo Murina e i ricercatori del Gruppo Vu-Net

PDF DOI:10.53146/lriog120215 Abstract

Clitoris: target of many vulvar diseases

Pietro Lippa, Federica Frascani

PDF DOI:10.53146/lriog120216 Abstract

Bartholini’s gland cysts

Franco Anglana, Michela Angelucci

PDF DOI:10.53146/lriog120217 Abstract

Lichen sclerosus

Paolo Inghirami, Roberto Senatori

PDF DOI:10.53146/lriog120218 Abstract

COVID: related cutaneous and mucosal lesions, focus on vulvar and perineal area

Gabriella Fabbrocini, Luigi Gallo

PDF DOI:10.53146/lriog120219 Abstract

Genital filler: the 5 Ws –What, Who, Where, When, Why?

Elena Fasola

PDF DOI:10.53146/lriog1202110 Abstract

Vulvar herpes: clinics and therapy

Stefano Astorino

PDF DOI:10.53146/lriog1202111 Abstract

Syphils: why the disease is more insidious in women

Alessandra Graziottin, Elena Boero

PDF DOI:10.53146/lriog1202112 Abstract

Staphylococcus aureus vulvitis: an insidious infection that stresses the importance of appropriate intimate hygiene

Alessandra Graziottin, Elena Boero

PDF DOI:10.53146/lriog1202113 Abstract

Critical Review

Regenerative vulvo-vaginal laser: when, how and why

Filippo Murina

PDF DOI:10.53146/lriog1202114 Abstract

Report

Vulvar and perivulvar infection of bacterial pathogenesis

Paola Salzano

PDF DOI:10.53146/LRIOG1202115 Abstract

Quarterly magazine: Nr.1 – 2021
e – ISSN: 1824 – 0283

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Vulvar and perivulvar infection of bacterial pathogenesis

Vulvar and perivulvar infection of bacterial pathogenesis

Paola Salzano – Orcid

Scientific coordinator of the “Vulva Forum” Naples

 

paola.salzano@gmail.com


DOI: 10.53146/lriog1202115

Abstract

Why are women vulnerable to bacterial infectious disease of the vulvar and perivulvar area? What kind of medical history and physical examination must be performed to arrive at a correct diagnosis? How to make a differential diagnosis between the various vulvar infectious skin diseases? Infectious diseases of the vulvar and perivulvar area have different characteristics and symptoms depending on their nature and etiological triggering factors. Abscesses, pus-containing skin sacs, are caused by bacteria of the Staphylococcus Aureus species. Folliculitis, a type of small skin abscess that affects the hair follicle, is often triggered by improper depilatory practices. Impetigo, a superficial skin infection usually caused by S. Aureus and minus S. Pyogenes, can arise as a complication of pre-existing dermatitis. Hidradenitis, characterized by painful nodules, abscesses, sinus tracts and scars, can occur due to genetic, hormonal, infectious and even immunological factors. Abscesses, folliculitis, impetigo and hidradenitis are all diseases of bacterial origin that can affect subjects at different stages of development, including women of childbearing age, with a peak incidence around the age of 20-30. For this reason and for their tendency to also arise in the vulvar and perivulvar area, they constitute a frontier study subject between dermatology and gynecology, offering significant food for thought on the dermatological skills that the gynecologist will have to acquire for the purposes of treatment. The aim of this work is therefore to offer an overview of these diseases from a purely gynecological point of view, focusing on diagnostic methods, anamnesis and therapeutic perspectives, with the auxiliary purpose of guiding the gynecologist in identifying and removing those predisposing factors that can trigger the chronicity of infectious vulvar diseases.

Keywords: abscess; folliculitis; impetigo; hidradenitis; vulvitis; infection.

Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Regenerative vulvo-vaginal laser

Regenerative vulvo-vaginal laser: when, why, when

Filippo Murina – Orcid

Lower Genital Tract Pathology Service, V. Buzzi Hospital – University of Milan

filippomurina577@gmail.com


DOI: 10.53146/lriog1202114

Abstract

The use of lasers to treat gynaecological conditions including genitourinary syndrome of the menopause (GSM) has become increasingly popular over recent years. The evidence suggests laser therapy may be beneficial as a non-hormonal treatment in GSM. However, we do not know what the optimum treatment regime or interval is or what the role is for sexual hormones either before or in addition to laser treatment. It was demonstrated that a combination regimen of laser and ospemifene may improve clinical effectiveness. Application of the regenerative laser to the vestibule for vulvar pain and dyspareunia is a promising and safe treatment option in postmenopausal women with the use of appropriate parameters. Clinicians need to be aware of the limitations, risks and outcomes of laser therapy as well as the need for careful evaluation of women to ensure appropriate patient selection. Patients also need to be advised and counselled about realistic expectations of outcomes. Indiscriminate treatment of patients with little evaluation and assessment and counselling will lead to poor satisfaction outcomes and morbidity.

Keywords: laser; genitourinary syndrome of the menopause; dyspareunia; vulvar pain.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Staphylococcus aureus vulvitis

Staphylococcus aureus vulvitis: an insidious infection that stresses the importance of appropriate intimate hygiene

Alessandra Grazziottin1,2 – Orcid, Elena Boero1 – Orcid

1 – Alessandra Graziottin Foundation for the treatment of pain in women – Onlus

2 – Gynecology and Medical Sexology Center, H. San Raffaele Resnati, Milan

Corresponding author: Alessandra Graziottin

direzione@studiograziottin.it


DOI: 10.53146/lriog1202113

Abstract

Why do folliculitis and other bacterial vulvar infections represent disorders of interest in the gynecological practice? Which predisposing, precipitating, and maintaining factors should be considered by the gynecologist when recurrent bacterial infections of vulvar skin become a clinical challenge? When is it appropriate to think of Staphylococcus aureus as a principle etiological agent? Why do S. aureus vulvar infections represent an emerging threat for women’s health? New hygienic and cosmetic practices, including over-zealous cleansing and micro- and macro-traumatic hair removal techniques, lead to a significant increase of vulvar infections in the clinical practice. Factors predisposing to bacterial vulvar infections, such as personal and familial diabetes and obesity, indicate to the gynecologist an alteration of the vulvar ecosystem, which can predispose to more severe pathologies. S. aureus, the main infectious agent, causes increasing medical concerns because of its pathogenic and invasive capacity. Moreover, the rapid ability of S. aureus of developing antibiotic resistances is even more challenging in surgical specialties, especially in obstetrics and gynecology, for the reduced availability of effective antibiotics for treatment. The gynecologist has an important educational role on the appropriate hygiene principles, to reduce bacterial vulvar infections, more threatening for their increasing invasive potential, especially in more vulnerable subjects.

Keywords: intimate hygiene; cutaneous infections; staphylococcus aureus; vulva.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Syphilis: why the disease is more insidious in women

Syphilis: why the disease is more insidious in women

Alessandra Grazziottin1,2 – Orcid, Elena Boero1 – Orcid

1 – Alessandra Graziottin Foundation for the treatment of pain in women – Onlus

2 – Gynecology and Medical Sexology Center, H. San Raffaele Resnati, Milan

Corresponding author: Alessandra Graziottin

direzione@studiograziottin.it


DOI: 10.53146/lriog1202112

Abstract

Why should syphilis be reconsidered in gynecological clinical practice? Why are women more vulnerable to late diagnosis? What are the key points for timely and effective diagnosis and treatment? What are the avoidable consequences of diagnostic and therapeutic delays? Syphilis is caused by the sexually and vertically transmitted bacterium Treponema pallidum. Syphilis, wrongly considered outdated, is making an aggressive comeback worldwide. From a medical point of view, diagnostic timeliness is hampered by: a lack of familiarity with this re-emerging disease and a consequent lack of consideration in the anamnestic picture and differential diagnosis; complex course, which alternates insidious and variable symptomatic phases, with periods of clinical latency, while the disease continues its pro-inflammatory and destructive action at the subclinical level. The late or missed diagnosis of syphilis leads to a prolonged infection, with permanent and at times fatal outcomes. The danger of a delay in diagnosis also results in persistent infectivity of the patients, who continue to infect their sexual partners, and the fetus, if pregnant. The aim of the work is: to identify the key points for timely and effective diagnosis and therapy of syphilis in gynecology, with a focus on vulvar and vaginal vulnerability; to analyze the reasons for its insidious hidden diffusibility; to discuss the diagnostic difficulties, the limited availability of the most effective drug, penicillin, the current lack of a vaccine and finally why it is difficult to follow the course of the disease and its therapy through laboratory diagnostics. The final goal is to enhance the diagnostic effectiveness of the gynecologist.

Keywords: syphilis; primary chancre; secondary syphilis; treponema pallidum; penicillin; vulva.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Vulvar herpes: clinics and therapy

Vulvar herpes: clinics and therapy

Stefano Astorino – Orcid

Operational unit of dermatology and stds – “Celio” Military Polyclinic, Rome

stefano.astorino.sa@gmail.com


DOI: 10.53146/lriog1202111

Abstract

Most young people with erosive-ulcerative-genital lesions (“Genital Ulcer Disease”) have genital herpes (prevalence 5-40%), sometimes associated with syphilis or other sexually transmitted diseases, with a significant risk of co-infection with HIV.
Also transmissible in asymptomatic (virus shedding) or “undiagnosed” due to mild, atypical symptoms (fissures, erythema, neuralgia), or hidden localizations, the primary infection of vulvar herpes (HSV2-1) has classic acute manifestations: pain, burning (sometimes sciatica, cruralgia, antalgic urinary retention), cluster vesicle- pustules on erythematous-edematous areas that evolve into confluent-polycyclic erosions, often ulcerative-aphthous-like; satellite lymphadenitis, fever sometimes high. In 1-3 weeks they heal (completely the erosions; ulcers with scars); after weeks or months of latency the secondary herpes relapses on average 5-6 times a year, with variable duration (on average 1 week). Relapsing symptoms and signs, similar to primary-Herpes, are more localized and attenuated, except in immunosuppressed, who manifest chronic, severe-ulcerative, disabling, hypertrophic-pseudo-tumor, generalized-varicelliform forms. Possible cause of fetal malformations, neonatal morbidity and lethality, herpes in pregnancy is effectively treated with systemic acyclovir. Sometimes it justifies caesarean-section. According to European-guidelines (2017), the diagnosis is clinical (when possible supported by PCR); topical antiviral-therapy offers few advantages (except foscarnet 1% in case of resistance and imiquimod 5% effective in HIV-associated pseudotumoral-forms) compared to local soothing-antiseptic and anti-inflammatory (including cortisone) therapy. Acyclovir (ACV), since its discovery (Elion_G.B.1978) the best systemic antiherpetic, is effective both with “episodic-therapy” (average adult dose: ACV tbl 200-800mg 3t./die for 7-10 days in primary-Herpes, for 2-5 days at each relapse) both with “continuous-suppressive-therapy” (if>6 relapses a year a.a.d.:ACV400mg 2t./die or similar: Famciclovir FCV 250mg 2t./die, Valaciclovir VLC 500mg 1t./die; replaceable in case of resistance with Foscarnet 40mg / kgI.V./8-12h.).

Keywords: vulvar herpes; HSV2-1; genital herpes; systemic antiviral therapy; topical therapy; guidelines.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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