What are the reasons for our lack of success in treating vaginitis despite our various empirical treatment approaches? Where are we going wrong?

Objectives: Vaginitis poses a significant challenge for women of all ages, impacting their quality of life. Clinicians struggle with diagnosis and management, facing treatment resistance and patient hygiene habits. We aimed to compare the effectiveness of vaginal and combined empirical treatments for vaginitis and identify factors contributing to treatment failure. Materials and Methods: A retrospective cross-sectional study, incorporating both quantitative and qualitative approaches, was conducted on 369 patients who sought care at the gynecology outpatient clinic between 2021 and 2023 with complaints of vaginal infection. Empirical treatment was initiated after obtaining vaginal culture samples, and the diagnosis of vaginal candidiasis was confirmed through culture results. The specimens were collected at the gynecology outpatient clinic of Kafkas University Hospital. Comprehensive demographic information was gathered from all patients presenting with complaints of vaginal infection. The “daily hygienic behaviors questionnaire” was also administered, evaluated, and documented for each patient. The treatment responses of patients who presented to the clinic and were treated with two different empirical treatments, determined randomly by the attending clinician’s preference, were evaluated. In our clinic, empirical treatment involved either vaginal treatment with 750 mg metronidazole + 200 mg miconazole nitrate or a combination of vaginal 750 mg metronidazole + 200 mg miconazole nitrate and oral 150 mg fluconazole, administered based on the clinician's choice. Results: There was no statistically significant difference in the results of the two empirical treatments administered to the patients. There was no significant difference in demographic characteristics in the two treatment groups. Previous antibiotic use was significantly higher in the vaginal treatment group (p<0.05). When the questionnaires questioning the personal hygiene habits of the patients with treatment failure were evaluated, erroneous habits that could explain this failure in treatment were revealed. Conclusion: Candida infections, especially fluconazole-resistant strains, pose challenges. Access to microbiological testing and detailed medical histories is crucial. Patient education on culture-based treatment is essential. Addressing these challenges requires a sustainable solution.