Microorganisms are at the heart of vaginal health, and with increasing pressure to improve antimicrobial stewardship it is important that pharmacy teams are able to help women manage vaginitis appropriately.

It is clear that the presence of a biofilm makes it difficult for drugs to break through to attack the infective microorganisms, and can therefore contribute to resistance problems.³ Researchers are starting to document a rise in prevalence of resistance among Candida spp, although not necessarily within the context of vulvovaginal thrush. However, there can be resistance even where the patient has not used a drug approach before. There appears to be less research on drug resistance in BV, but metronidazole and G vaginalis have been key areas of study.

Useful websites

• NICE Clinical Knowledge Summaries: http://cks.nice.org.uk/
• NHS Choices "Vaginal thrush": www.nhs.uk/conditions/Thrush/Pages/Introduction.aspx
• NHS Choices "Bacterial vaginosis": www.nhs.uk/conditions/bacterialvaginosis/Pages/Introduction.aspx
• Canesten "Intimate Health": www.canesten.co.uk/en/female/
• FPA Thrush and Bacterial vaginosis: www.fpa.org.uk/sexually-transmitted-infections-stis-help/thrush-and-bacterial-vaginosis