Longitudinal Clinical and Microscopic Findings After Dequalinium Chloride Treatment in Vulvovaginal Infections: A Retrospective Real-World Study from Mexican Gynecological Practice

Background: Vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection are among the most common infectious conditions encountered in gynecological practice. Although intravaginal dequalinium chloride exhibits broad antimicrobial activity, real-world longitudinal data describing treatment-associated clinical and microscopic changes remain limited, particularly in Latin American populations. Objective: We aimed to characterize the short-term longitudinal evolution of clinical manifestations, vaginal pH, and fresh wet-mount microscopic findings in women with vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection treated with intravaginal dequalinium chloride during routine outpatient gynecological care. Methods: This retrospective longitudinal study included non-pregnant women with vulvovaginal candidiasis, bacterial vaginosis, or mixed vaginal infection who received intravaginal dequalinium chloride as the sole anti-infective therapy. Patients were evaluated at baseline, treatment completion (Day 7), and post-treatment follow-up (Day 14). Longitudinal assessment included patient-reported symptoms, physician-assessed clinical findings, vaginal pH, and fresh wet-mount microscopic examination. To ensure consistent evaluation across study visits, predefined protocol-based standardized assessment criteria were applied uniformly to all patients. Repeated-measures non-parametric analyses were performed to compare longitudinal changes over time. Results: Sixty-nine women were included, comprising those with vulvovaginal candidiasis (n = 24), bacterial vaginosis (n = 31), and mixed vaginal infection (n = 14). Significant longitudinal improvement was observed in clinical manifestations, vaginal pH, and fresh microscopic findings across all diagnostic groups (all p < 0.0001). Median composite assessment scores decreased from 8 (IQR 6–10) at baseline to 3 (IQR 1–5) at treatment completion and to 1 (IQR 0–3) at post-treatment follow-up. Improvements in vaginal pH were accompanied by reductions in inflammatory and infection-associated microscopic findings and by increased predominance of Döderlein bacilli during follow-up. Intravaginal dequalinium chloride was generally well tolerated, with only mild transient adverse events documented. Conclusions: In this retrospective longitudinal study, intravaginal dequalinium chloride treatment was associated with short-term changes in clinical manifestations, vaginal pH, and fresh microscopic findings among women with vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection. These findings describe short-term treatment-associated changes observed in routine clinical practice but do not establish comparative efficacy, causality, or microbiological cure. Prospective controlled studies incorporating standardized microbiological endpoints and longer follow-up are warranted to confirm these observations.