Normal vaginal discharge is white or clear and has a slight, but non-offensive odour. Discharge comprises desquamated vaginal epithelial cells, bacteria, and glandular secretions, and protects women against vaginal infection.2 Unfortunately, the vaginal microbiome is extremely sensitive to disruptions. Disruptions may be caused by for example pregnancy, menses, contraceptives, diet, and the use of some female hygiene products.2 These disruptions interfere with the protective effects of Lactobacillus spp, a gram-positive bacteria, and can result in an imbalance in the vaginal microbiome (dysbiosis), which predispose women to infection.2 Lactobacillus contributes to acidic vaginal pH, which plays a valuable role in vaginal health. The normal vaginal pH for women of reproductive age ranges from 3.8 to 5. A reduction in Lactobacillus increases vaginal pH, thus enabling pathogenic organisms to colonise the vagina.2,3
THE ROLE OF ANTISEPTICS IN VAGINAL DISCHARGE SYNDROMES
According to Mendling et al frequent recurrences of vaginal infections and increasing resistance to metronidazole and clindamycin are common in women with vaginal discharge syndromes. Furthermore, microbial pathogens form biofilms on mucosa and abiotic structures preventing effective treatment of infections.4,5
Improvement of symptoms, elimination of harmful pathogens and restoration of a healthy lactobacilli-dominated vaginal flora are the main goals of treatment.5 Current treatments are effective in the short-term with reported cure rates of between 70%–80%. To achieve better long-term results, stress Mendling et al, every effort should be made to eliminate factors that predispose women to recurrent infection.5 Furthermore, due to the risks associated with some vaginal infections during pregnancy, safe therapies for pregnant women are also extremely important.5
Alternative treatments are a key medical need in the management of vaginal infections, note Mendling et al. According to the authors, using agents with a broad-spectrum antimicrobial mode of action is an effective alternative therapy to treat vaginal infection.5 The use of broad-spectrum antiseptics is one such alternative therapy. Dequalinium chloride (DQC) is an antiseptic with broad microbicidal activity against aerobic and anaerobic bacteria, as well as yeasts.6
DQC works by increasing cell permeability, and decreasing bacterial enzyme activity, which result in cell deaths. DQC exhibits a rapid bactericidal and fungicidal action (within 30- to 60-minutes). Although the vaginal application of DQC results in high local concentration, systemic exposure is negligible due to low concentrations.5
Numerous studies have demonstrated that DQC is effective and safe to use in the treatment of BV and other vaginal infections. Mendling et al conclude that DQC could offer an attractive treatment for vaginal infections, both for bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) as well as in case of mixed infections.5
REFERENCES
- Sherrard J, Wilson J, Donders G, Mendling W, Jensen JS. 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. Int J STD AIDS, 2018.
- Holdcroft AM, Ireland DJ, Payne MS. The Vaginal Microbiome in Health and Disease—What Role Do Common Intimate Hygiene Practices Play? Microorganisms, 2023.
- Lin Y-P, Chen W-C, Cheng C-M, Shen C-J. Vaginal pH Value for Clinical Diagnosis and Treatment of Common Vaginitis. Diagnostics, 2021.
- Gaspar C, Rolo J, Cerca N, Palmeira-de-Oliveira R, et al. Dequalinium Chloride Effectively Disrupts Bacterial Vaginosis (BV) Gardnerella spp. Biofilms. Pathogens,2021.
- Mendling W, Weissenbacher ER, Gerber S, et al. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet, 2016.
- Lopes dos Santos Santiago G, Grob P, Verstraelen H, Waser F, Vaneechoutte M.Susceptibility testing of Atopobium vaginae for dequalinium chloride. BMC Res Notes, 2012.
