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Great Book Reivew about VulvoVaginal Infections
Gary P. Wormser, Section Editor
Clinical Infectious Diseases 2007; 45:1406–7
2007 by the Infectious Diseases Society of America.
Allrights reserved. For permission to reuse, please contact
DOI: 10.1086/522768

Vulvovaginal Infections
By William J. Ledger
and Steven S. Witkin
London: Manson Publishing, 2007
128 pp., illustrated. $69.95 (hardcover).
Vulvovaginal infection remains one of the
most likely complaints in the medical office.
Unfortunately, many women experience
perpetual or recurrent symptoms
that may have a profoundly adverse impact
on their lifestyle. In this short text of
only 128 pages, 2 top medical experts
share their career experience in treating
chronic vulvovaginitis. Drs. Ledger and
Witkin have a long legacy of collaboration
in the area of vulvovaginitis research. This
is not just another picture atlas, but rather
a text that provides extensive insight into
the resolution of real-life clinical dilemmas.
Dr. Ledger shares his clinical experience
from a highly successful career. He
outlines the correct testing methods and
therapeutic approaches for difficult cases.
Dr Witkin, a widely recognized gynecologic
immunologist, clarifies the immune
mechanisms of the various disorders.
Chronic vulvovaginitis remains one of the
clinically important frontiers in medicine,
with unanswered questions for which the
authors of this text provide many of the
needed answers.
This book is intended for both the medical
scientist and the clinical worker. The
clinician will find helpful guidance even
for common conditions, such as bacterial
vaginosis and Candida infection, for
which the resolution too frequently has
been unsatisfactory and the treatments
have sometimes been ineffective. For issues
regarding less common conditions
and misdiagnosis, this book will be of
value for any health care provider who is
involved with gynecologic care. For the
scientist, the authors provide a thoughtful,
in-depth review of known research. Of
course, this book will be of great value for
the millions of women who experience
vulvovaginal discomfort but find little relief
with the often superficial attempts for
medical treatment. This book should be
reviewed and maintained as a reference by
all health care providers who work in the
outpatient setting or in the subject of gynecologic
clinical research.
The traditional clinical approach to
chronic vulvovaginitis may too frequently
be characterized by a legacy of medical
folklore mingled with some elements of
science. This text represents a major effort
to replace empirical therapy with real science.
All diseases have an element of genetics
and immunologic characteristics;
thus, an understanding of the application
of these topics to the subject of chronic
vulvovaginitis is important. The chapter
on immunologic characteristics provides
a brief but excellent and understandable
overview of the immunologic characteristics
of the vagina. This overview is expanded
in detail in each separate chapter,
showing the immunologic and genetic basis
of the chapter’s focus issue.
The chapter on the microbiologic characteristics
of the vagina clearly discloses
the current understanding of the complexity
of the vaginal microenvironment
and shows that Lactobacillus acidophilus
may not be as exclusively important as
traditionally has been suggested. The
chapter on Candida infection is possibly
the best published review of this topic. It
is well written, with excellent discussion
of all of the clinical issues. The authors
lament the unfortunate decline in the art
of office microscopic examination and remind
the clinician of the value of basic
microscopic and microbiologic examination
The only weakness of this short textbook
is that it may require too much of
the casual clinician who believes that vaginitis
is simply a matter of yeast, bacterial
vaginosis, or trichomonas, forcing him or
her to rethink and expand his or her diagnostic
strategy. A topic previously given
only brief coverage in the typical gynecologic
text is proven here to be a much
more complex matter that requires a significant
degree of investigative skill, as well
as applied basic scientific knowledge. This
book could annoy the clinician who is
satisfied with the traditional superficial
knowledge of the subject. For other clinicians,
it will provide a leap forward in
the understanding and management of
vulvovaginal disease.

Paul R. Summers
Department of Obstetrics and Gynecology,
University of Utah School of Medicine,
Salt Lake City, Utah
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