Needless treatments: anti-fungal creams or tablets don't always work for vaginal itch
How To Treat Recurrent Bacterial Vaginosis, According To Ob-Gyns
Get evaluated by a health care provider to get the most accurate diagnosis, says Dr. Phillips—and find a new one if you're not getting good answers or helpful treatment as things stand.
Give health care providers all the info they need to make a complete diagnosis.
Bacterial STIs can also be strikingly similar to BV, symptom-wise. The condition can look a lot like trichomoniasis, which usually comes with funky-smelling discharge and itchiness, or Mgen, which causes unusual or smelly discharge, burning when you pee, and vulvar pain or discomfort. To avoid a misdiagnosis, Dr. Bovone recommends that providers test for all STIs, especially those with bacteria and parasites as vectors, or which come with symptoms of vaginal itching and discharge with an off odor (like gonorrhea and chlamydia). "We see it all, and can reassure you what is normal. And if anything is off, we can help," says Dr. Bovone.
Ask a doctor to test you for BV specifically, too. Dr. Phillips starts appointments with a verbal screening to clarify her patients' symptoms, then takes a vaginal swab sample to send out to a lab for analysis. Once she knows what's actually going on, she's able to devise a treatment plan.
When a doctor prescribes you treatment, follow their instructions and stick with it for the whole time you're supposed to—even if your symptoms get better.
Depending on the infection and the clinic, you might be given the option of oral or vaginal antibiotics (often, clindamycin or metronidazole) to treat BV. To target recurrent BV, Dr. Bovone explains that doctors might prescribe a longer course of treatment than they would for a one-off case, such as using an antibiotic for seven to 10 days, plus a weekly dose of a vaginal antibiotic gel for four to six months afterward to prolong the treatment. There are also newer treatments, including a clindamycin vaginal gel called Xaciato that can be applied like a tampon to deliver a strong single dose of medication.
BV can come creeping back if you veer off course with a prescribed treatment, such as not taking all of the antibiotics every day or stopping before the intended date, even if it seems like your symptoms are clearing up. "Inadequate treatment is a setup for a recurrence: BV is a disruption of the normal vaginal flora, and that flora needs to be re-established," says Dr. Bovone. It can become unclear whether the recurrence is a reinfection, or if the infection never really cleared in the first place. So, even if you're feeling better, don't stop taking medication before the set end date, or else you might risk a BV infection creeping back.
Keep things moisturized.
One way to keep your vaginal pH as close to acidic (and infection-free) as possible is to make sure there's enough lubrication on a day-to-day basis. Vaginal dryness, which can happen due to lower estrogen levels during menopause or during a period of breastfeeding, among other things, can lead to a less acidic pH, according to Dr. Minkin. She recommends a vaginal moisturizing gel like Replens to help with dryness.
Get a doctor's opinion before you use OTC suppositories, like those containing boric acid.
You may have heard of boric acid suppositories and other over-the-counter treatments that purportedly balance the vaginal microbiome. No matter what, you should speak with your health care provider to confirm you have BV before trying these out, Dr. Phillips says. From there, you should know that boric acid supplements are not FDA-approved, and that the jury's still out about whether boric acid on its own can help with BV. (SELF has a full rundown of how boric acid affects your vagina, including if you have a bacterial or yeast infection.)
Organon's XACIATO™ (clindamycin Phosphate) Vaginal Gel 2% Available Nationwide To Treat Bacterial Vaginosis (BV) In Females Aged 12 And Older
Despite being the most common vaginal condition,1 BV symptoms are often mistaken for a yeast infection2
Organon (NYSE: OGN), a global healthcare company with a focus on women's health, announced that XACIATO™ (clindamycin phosphate) vaginal gel 2% is available by prescription to treat bacterial vaginosis (BV). BV results from an overgrowth of certain bacteria, which upsets the balance of the natural vaginal microbiome (environment) and can lead to symptoms of odor and discharge.3 BV has also been shown to disproportionately affect non-Hispanic Black and Mexican American women.4,5
In addition to the physical symptoms,3 BV can also impact a woman's emotional wellbeing.2 In fact, a 2017 survey among 304 women diagnosed with BV2 found that 79% avoided intimacy with their partner2 and 68% felt self-conscious because of their condition.2 Most women with symptoms of BV require treatment.6 Women with recurrent BV have reported frustration with recurrence after initial treatment,7 with 58% of them experiencing recurrent infection within 12 months.7
XACIATO, pronounced zah-she-AH-toe, is a colorless single-dose vaginal gel that can be applied at any time of day and is formulated with the goal of limiting leakage and increasing vaginal retention time (time spent in place).4 As demonstrated by an in vitro study using clindamycin HCl, the gel increases viscosity (thickness and stickiness) at body temperature and gradually releases clindamycin, over time.4,8
"As a company focused on women's health, we make it a priority to listen to women and their providers, so that we understand their needs and put forward innovative solutions," said Juan Camilo Arjona Ferreira, M.D., Head of Research & Development and Chief Medical Officer at Organon. "What drew us to XACIATO is that it was formulated with specific needs in mind and studied in a patient population that was representative of women with BV."1
XACIATO is contraindicated in individuals with a history of hypersensitivity to clindamycin or lincomycin. Clostridioides difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including clindamycin, and may range in severity from mild diarrhea to fatal colitis. Careful medical history is necessary since CDAD has been reported to occur over 2 months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibacterial use not directed against C. Difficile may need to be discontinued.
"BV is the most common form of vaginitis,1,9 disrupting the lives of approximately 21 million women.1,5 For these women, it's important to consider her individual treatment needs, such as route of administration, cost, adverse events, dosing and duration of treatment,"7,10 said Erica Montes, M.D., Board-Certified Obstetrician and Gynecologist and a Fellow of the American College of OB/GYN. "The availability of XACIATO is important as it's one dose for women experiencing BV and it can be taken at any time of day."
In 2022, Organon and Daré Biosciences completed an agreement whereby Organon will license global rights to XACIATO.
Information about XACIATO, and the eVoucher instant savings coupon for eligible patients, can be found at XACIATO.Com.
About BV
BV is the most common vaginal condition in women of reproductive age in the United States, affecting approximately 21 million women.1,5 The condition results from an overgrowth of certain bacteria, which upsets the balance of the natural vaginal microbiome and can lead to symptoms of odor or discharge.3 BV may self-resolve in up to 30% of women, but most symptomatic women require treatment.6,11 If left untreated, BV may lead to serious complications.2,11 BV has also been shown to disproportionately affect non-Hispanic Black and Mexican American women.4,5
About XACIATO
XACIATO is indicated for the treatment of bacterial vaginosis in females 12 years and older. A single-dose user-filled disposable applicator delivers 5g of vaginal gel containing 100mg of clindamycin.
Selected Safety Information
XACIATO is contraindicated in individuals with a history of hypersensitivity to clindamycin or lincomycin.
Clostridioides difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including clindamycin, and may range in severity from mild diarrhea to fatal colitis. Careful medical history is necessary since CDAD has been reported to occur over 2 months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibacterial use not directed against C. Difficile may need to be discontinued.
Polyurethane condoms are not recommended during treatment with XACIATO or for 7 days following treatment. During this time period, polyurethane condoms may not be reliable for preventing pregnancy or for protecting against transmission of HIV and other sexually transmitted diseases. Latex or polyisoprene condoms should be used.
XACIATO may result in the overgrowth of Candida spp. In the vagina resulting in vulvovaginal candidiasis, which may require antifungal treatment.
The most common adverse reactions reported in >2% of patients and at a higher rate in the XACIATO group than in the placebo group were vulvovaginal candidiasis and vulvovaginal discomfort.
XACIATO has not been studied in pregnant women. However, based on the low systemic absorption of XACIATO following the intravaginal route of administration in nonpregnant women, maternal use is not likely to result in significant fetal exposure to the drug.
There are no data on the effect of clindamycin on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for clindamycin and any potential adverse effects on the breastfed child from clindamycin or from the underlying maternal condition.
Please see the Prescribing Information, Patient Information, and Instructions for Use.
About Organon
Organon is a global healthcare company formed to focus on improving the health of women throughout their lives. Organon offers more than 60 medicines and products in women's health in addition to a growing biosimilars business and a large franchise of established medicines across a range of therapeutic areas. Organon's existing products produce strong cash flows that support investments in innovation and future growth opportunities in women's health and biosimilars. In addition, Organon is pursuing opportunities to collaborate with biopharmaceutical innovators looking to commercialize their products by leveraging its scale and presence in fast growing international markets.
Organon has a global footprint with significant scale and geographic reach, world-class commercial capabilities, and approximately 10,000 employees with headquarters located in Jersey City, New Jersey.
For more information, visit http://www.Organon.Com and connect with us on LinkedIn, Instagram, X (formerly known as Twitter) and Facebook.
Forward-Looking Statements
Some statements and disclosures in this press release are "forward-looking statements" within the meaning of the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995, including, but not limited to, statements regarding product development and commercialization plans for XACIATO. Forward-looking statements include all statements that do not relate solely to historical or current facts and can be identified by the use of words such as "may," "expects," "intends," "anticipates," "plans," "believes," "seeks," "estimates," "will," or words of similar meaning. These forward-looking statements are based on our current plans and expectations and are subject to a number of significant risks and uncertainties. If underlying assumptions prove inaccurate or risks or uncertainties materialize, actual results may differ materially from the forward-looking statements.
Risks and uncertainties that may affect our future results include, but are not limited to, an inability to fully execute on the nationwide commercialization plans for XACIATO; our product development and commercialization plans within the United States or internationally; an inability to adapt to the industry-wide trend toward highly discounted channels; changes in tax laws or other tax guidance which could adversely affect our cash tax liability, effective tax rates, and results of operations and lead to greater audit scrutiny; an inability to execute on our business development strategy or realize the benefits of our planned acquisitions; efficacy, safety, or other quality concerns with respect to marketed products, including market actions such as recalls, withdrawals, or declining sales; political and social pressures, or regulatory developments, that adversely impact demand for, availability of, or patient access to contraception and fertility products; general economic factors, including recessionary pressures, interest rate and currency exchange rate fluctuations; general industry conditions and competition; the impact of the ongoing COVID-19 pandemic and emergence of variant strains; the impact of pharmaceutical industry regulation and health care legislation in the United States and internationally; global trends toward health care cost containment; technological advances; new products and patents attained by competitors; challenges inherent in new product development, including obtaining regulatory approval; the company's ability to accurately predict its future financial results and performance; manufacturing difficulties or delays; financial instability of international economies and sovereign risk; difficulties developing and sustaining relationships with commercial counterparties; dependence on the effectiveness of the company's patents and other protections for innovative products; and the exposure to litigation, including patent litigation, and/or regulatory actions.
The company undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events or otherwise. Additional factors that could cause results to differ materially from those described in the forward-looking statements can be found in the company's filings with the Securities and Exchange Commission ("SEC"), including the company's Annual Report on Form 10-K for the year ended December 31, 2022 and subsequent SEC filings, available at the SEC's Internet site (www.Sec.Gov).
1 Bacterial vaginosis statistics. Centers for Disease Control and Prevention. Last reviewed February 10, 2020. Accessed October 19, 2023. Https://www.Cdc.Gov/std/bv/stats.Htm
2 Understanding women's experiences with bacterial vaginosis. American Sexual Health Association. Accessed October 19, 2023. Https://www.Ashasexualhealth.Org/understanding-womens-experiences-with-bacterial-vaginosis/
3 Bacterial vaginosis - CDC basic fact sheet. Centers for Disease Control and Prevention. January 5, 2022. Accessed October 19, 2023. Https://www.Cdc.Gov/std/bv/stdfact-bacterial-vaginosis.Htm
4 Mauck C, Hillier SL, Gendreau J, et al. Single-dose bioadhesive clindamycin 2% gel for bacterial vaginosis. Obstet Gynecol. 2022;00:1–11. DOI: 10.1097/AOG.0000000000004805.
5 Koumans EH, Sternberg M, Bruce C, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007;34(11):864-9.
6 Bacterial vaginosis. Centers for Disease Control and Prevention. July 19, 2021. Accessed October 19, 2023. Https://www.Cdc.Gov/std/treatment-guidelines/bv.Htm
7 Muzny CA, Kardas P. A Narrative Review of Current Challenges in the Diagnosis and Management of Bacterial Vaginosis. Sex Transm Dis. 2020 Jul;47(7):441-446. Doi: 10.1097/OLQ.0000000000001178. PMID: 32235174; PMCID: PMC7294746.
8 Mondal P, Hemant AH, Johnston TP. Evaluation of TRI-726 as a drug delivery matrix. Drug Dev Ind Pharm. 2011;37(8):995-1001. Doi:10.3109/03639045.2011.555913
9 Paladine HL, Desai UA. Vaginitis: diagnosis and treatment. Am Fam Physician. 2018;97(5):321-329.
10 Chavoustie SE, Eder SE, Koltun WD, et al. Experts explore the state of bacterial vaginosis and the unmet needs facing women and providers. Int J Gynaecol Obstet. 2017;137(2):107-109.Doi: 10.1002/ijgo.12114.
11 Kairys N, Garg M. Bacterial vaginosis. NCBI Bookshelf. Updated July 4, 2023. Accessed October 5, 2023. Https://www.Ncbi.Nlm.Nih.Gov/books/NBK459216/
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9 Best CBD Arthritis Creams For 2024
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Some early evidence suggests topical cannabidiol (CBD) cream may help with arthritis, inflammation, and chronic pain. The best CBD creams for arthritis are easy to apply, affordable, and quick to work.
The Arthritis Foundation states research on CBD for arthritis is promising but inconclusive. While several animal studies show potential, no well-designed trials prove CBD cream benefits people with this condition.
Recent research into the effects of CBD on arthritis in humans is limited. No research exists on the use of CBD cream specifically.
This article discusses the use of CBD cream to treat arthritis, its effectiveness, products to consider, and other natural remedies.
Is CBD legal?The 2018 Farm Bill removed hemp from the legal definition of marijuana in the Controlled Substances Act. This made some hemp-derived CBD products with less than 0.3% THC federally legal. However, CBD products containing more than 0.3% THC still fall under the legal definition of marijuana, making them federally illegal but legal under some state laws. Be sure to check state laws, especially when traveling. Also, keep in mind that the FDA has not approved nonprescription CBD products, and some products may be inaccurately labeled.
The following products may be suitable for people with arthritis. A person can contact a doctor if they have concerns about using particular CBD products.
Some products have been reviewed by our testers. All opinions are their own.
This cooling cream in a balm stick contains moisturizing mango butter and beeswax, which may make it suitable for dry or irritated skin.
In addition to 800–3,600 milligrams (mg) of CBD per stick, it includes mint to help soothe and cool the skin.
The product is third-party tested and certified free from heavy metals.
Pros & consUse code "healthline" for 20% off sitewide or choose the subscription option for 20% off the first 2 subscription orders and 25% off the 3rd order.
MNT's reviewWith 300 mg of CBD per 1.7-ounce (oz) tube, this warming cream contains 2 mg of CBD per pump.
Rich in moisturizing ingredients such as shea butter, the product offers a subtle warming sensation to help ease muscle tension and soothe inflammation.
CBDistillery tests this product for potency, dangerous chemicals, and heavy metals.
Pros & consUse code "HEALTHLINE" for 20% off.
MNT's reviewThis high potency formula product offers 1,000 mg of CBD per 1.7-oz bottle.
It contains caffeine and menthol to stimulate blood flow and provide a cooling sensation.
The added white willow bark may also help soothe inflammation.
The product is vegan and certified cruelty- and solvent-free.
Pros & consUse code "healthcbd" for 20% off.
MNT's reviewThis CBD cream uses broad-spectrum CBD that can help hydrate the skin and soothe aching joints. The company states that the plant-based molecules in the cream support healthy skin and can provide relief for post-workout soreness.
This product does not contain any THC. The company does not test on animals. Joy Organics also uses a carbon-neutral shipping process.
Pros & consThe company states that this product can help manage swelling, reduce inflammation, and provide targeted pain relief to sore muscles. It includes arnica for extra pain relief.
Additional ingredients include vitamin E oil, shea butter, and coconut oil. The inclusion of coconut oil means this product is not suitable for people who have a coconut allergy.
Pros & cons3Chi states that this product is thicker than other similar CBD lotions. The thicker lotion and higher concentration of CBD may provide longer-lasting and faster relief from aching muscles and joints.
Additional ingredients include menthol, tea tree, camphor, and peppermint oil.
The company directs people to use this lotion on clean skin and massage it into the skin until it is fully absorbed. People can leave the skin uncovered for an hour after application.
Pros & consUse code "HEALTH40" for 40% off.
MNT's reviewLevel Select states this cream is effective daily, promoting muscle relaxation and relieving soreness. Its main ingredients are hemp extract and menthol to provide cooling relief.
The cream is available in 900, 1,200, or 1,800 mg CBD concentrations per container.
Level Select recommends applying a thin layer of the cream to the affected area and reapplying or applying more as needed.
Pros & consThis CBD lotion targets aches and pains and dry, irritated skin. The hemp extract, arnica, ginger, wild mint, jojoba, and coconut oil may provide a warming and cooling effect and may help soothe irritated skin, according to the company.
The company is certified cruelty-free and states that this product does not contain preservatives, sulfates, parabens, or phthalates.
Bluebird recommends massaging a dime-sized amount of lotion on the skin up to twice daily. For best results, the company says people can use this lotion daily.
Pros & consUse code "HEALTHLINE30" for 30% off.
MNT's reviewThis cream contains menthol and 1,500 mg of CBD isolate, both of which may have an anti-inflammatory effect.
The cream contains CBD isolate, which means it does not contain any THC. This makes the cream a good choice for people who do not wish to use products that contain THC.
Other ingredients include shea butter, camphor oil, and emulsifying wax, which can help soften and moisturize the skin.
What our tester says"I used this CBD cream on a tight hip and lower back for some sciatic pain. The product comes in a nice bottle with a dispenser pump, so it was easy to apply. It's not greasy or sticky and rubs in nicely.
"It smells strongly of menthol. Like toothpaste, really. The scent lingered for a while, just a heads up for anyone who is sensitive to strong scents.
"I noticed a cooling sensation from the menthol and some reduction in pain.
"I would recommend this product as the best THC-free topical option. However, there are stronger CBD creams out there. I would recommend going with a more potent and full-spectrum option if people are looking for more intense pain relief."
– Christy Snyder, Healthline editor.
"I used this CBD cream on a tight hip and lower back for some sciatic pain. The product comes in a nice bottle with a dispenser pump, so it was easy to apply. It's not greasy or sticky and rubs in nicely.
"It smells strongly of menthol. Like toothpaste, really. The scent lingered for a while, just a heads up for anyone who is sensitive to strong scents.
"I noticed a cooling sensation from the menthol and some reduction in pain.
"I would recommend this product as the best THC-free topical option. However, there are stronger CBD creams out there. I would recommend going with a more potent and full-spectrum option if people are looking for more intense pain relief."
– Christy Snyder, Healthline editor.
Pros & consThe Arthritis Foundation states CBD may help reduce symptoms such as pain, anxiety, and sleeplessness.
One of CBD's primary benefits is helping reduce inflammation, especially in collagen-induced arthritis, as this compound helps stop the body from producing so many inflammatory markers.
In a 2022 review, researchers looked at the use of CBD for rheumatic conditions. They found that a 300 microgram dose of topical CBD reduced joint inflammation in rats with an early stage of knee osteoarthritis.
A 2022 study on humans found that twice-daily application of 1 mL of topical CBD with shea butter helped reduce pain in people with thumb basal joint arthritis.
CBD creams and other products are not a replacement for the medication people with arthritis may need to take for their condition.
At moderate doses, CBD is safe for most people and should not cause serious side effects. However, like all medications, the substance may interact with other drugs and trigger adverse effects, including some serious ones.
Common side effects include:
CBD may also interact with other sedating substances, such as alcohol and opioids. Experts have not identified all drug interactions, so it is best to consult a healthcare professional before using CBD alongside other medications.
Similar to other drugs, CBD may cause an allergic reaction, particularly in people with tree or nut allergies.
It is also of note that researchers cannot confirm the long-term effects of using CBD.
People can always discuss using CBD products with a healthcare professional to ensure the product will not interact with any existing prescription and nonprescription medication or health conditions.
What strength of CBD is best for arthritis?There have not been any studies on the best strength of CBD for arthritis pain. Optimal dosages will vary due to people's tolerability thresholds.
People can use the lowest possible dose and increase it gradually to find the strength that best suits their needs.
There have not been any studies on the best strength of CBD for arthritis pain. Optimal dosages will vary due to people's tolerability thresholds.
People can use the lowest possible dose and increase it gradually to find the strength that best suits their needs.
Is CBD pain cream worth it?There is insufficient research to confirm which CBD is best for arthritis pain. Full-spectrum CBD contains all of the compounds in the cannabis plant, so it may have more potent effects. However, people may speak with a doctor if they want to try CBD for arthritis.
There is insufficient research to confirm which CBD is best for arthritis pain. Full-spectrum CBD contains all of the compounds in the cannabis plant, so it may have more potent effects. However, people may speak with a doctor if they want to try CBD for arthritis.
Does CBD cream reduce arthritis inflammation?Very limited reliable research confirms that topical CBD is effective for arthritis. Most research involves animal studies, which may not produce results applicable to humans.
However, some of these animal studies have found that topical CBD can reduce the inflammation and pain associated with osteoarthritis.
Studies with mice have shown that CBD may help reduce arthritis pain by limiting the inflammatory response. A study on rats with osteoarthritis also made this conclusion.
Very limited reliable research confirms that topical CBD is effective for arthritis. Most research involves animal studies, which may not produce results applicable to humans.
However, some of these animal studies have found that topical CBD can reduce the inflammation and pain associated with osteoarthritis.
Studies with mice have shown that CBD may help reduce arthritis pain by limiting the inflammatory response. A study on rats with osteoarthritis also made this conclusion.
Does CBD cream help with arthritis pain?Yes, CBD cream may help with arthritis pain. A 2022 study found that CBD may help reduce pain, although it is more effective against osteoarthritis pain than rheumatoid or other autoimmune arthritis.
Yes, CBD cream may help with arthritis pain. A 2022 study found that CBD may help reduce pain, although it is more effective against osteoarthritis pain than rheumatoid or other autoimmune arthritis.
CBD may help relieve arthritis inflammation, although further research is necessary. CBD cream is a possible option for people who wish to try a natural remedy for joint pain.
However, every case of arthritis is different. What works well for one person might not be effective for others. A person can consult a qualified healthcare professional to find a suitable combination of natural and medical remedies for arthritis relief.
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