Vaginal Infections: Polygynax, Yeast, Vaginosis | Morocco

01Yeast, bacterial vaginosis, trichomoniasis: three infections, three treatments#

Article reviewed and validated by Dr. Hayat Bennis, gynaecologist-obstetrician (Annakhil Clinic, Casablanca — 19 years' experience). Informational content, not a substitute for medical consultation.

Vaginal infections are among the most common reasons for gynaecological consultation in Morocco. Roughly three women in four will develop at least one episode of vaginitis during their lifetime. Confusion between yeast infection, bacterial vaginosis and trichomoniasis accounts for a large share of treatment failures.

Vulvovaginal candidiasis is caused in 85-90% of cases by Candida albicans. Symptoms: intense intimate itching, burning, thick white discharge described as "cottage cheese-like", no odour. Treatment: topical azole antifungals — econazole, miconazole, fenticonazole.

Bacterial vaginosis is a disturbance of the vaginal flora, not strictly a sexually transmitted infection. Döderlein lactobacilli drop in favour of Gardnerella vaginalis. Discharge is grey or yellowish, thin, with a stale-fish odour that worsens after intercourse. Itching is uncommon. Worldwide prevalence 23-29%. Reference treatment: metronidazole (Flagyl).

Trichomoniasis is a true sexually transmitted infection caused by Trichomonas vaginalis. Abundant, frothy, greenish or yellow discharge, intense vulvitis. The partner must be treated. Reference treatment (WHO 2021, CDC): metronidazole 500 mg twice daily for seven days in women (Kissinger et al., Lancet Infectious Diseases 2018). A 2 g single dose remains an option where adherence is uncertain.

02Polygynax: triple action of neomycin, polymyxin, nystatin#

Polygynax (Pharma 5 under Innotech licence) combines: 35,000 IU neomycin (an aminoglycoside), 35,000 IU polymyxin B, 100,000 IU nystatin (an antifungal). It targets Gram-positive and Gram-negative bacteria, and Candida. Fact sheet: Polygynax vaginal capsule.

The rationale is to simultaneously cover mixed vaginitis. Limits: not active against Trichomonas, nor against typical Gardnerella bacterial vaginosis (metronidazole is required). Not indicated for uncomplicated isolated yeast infection (Gynopévaryl econazole or Lomexin fenticonazole suffice).

Systemic absorption is low on intact mucosa but may increase in the presence of lesions, ulcerations, bleeding, the immediate post-partum period, or prolonged use → risk of ototoxicity and nephrotoxicity (because neomycin is an aminoglycoside).

03Dosing: what the official SPC stipulates#

The French SPC allows two regimens, the choice of which rests strictly with the prescriber:

• Standard 12-day: 1 vaginal capsule per day at bedtime, after gentle cleansing without antiseptic.
• Short 6-day: 1 capsule per day according to clinical assessment.

Insert deeply while lying down. During menstruation, do not interrupt. Tampons are strictly discouraged (they absorb the active ingredient). Intercourse must be suspended or imperatively protected with a condom. Polygynax weakens latex in condoms and diaphragms.

### ⚠️ Safety box — Metronidazole and alcohol

Metronidazole produces a severe disulfiram-like effect with alcohol. Oral form: no alcohol during treatment and for 48 hours after. Vaginal pessary: systemic passage is lower but real — no alcohol during treatment and for 72 hours after the last dose.

04Pregnancy, breastfeeding, children#

Polygynax in the 2nd and 3rd trimesters is acceptable only if the indication is clearly established (CRAT); topical antifungals alone are preferred when the issue is isolated yeast.

In the first trimester, an antifungal alone is preferred. Oral metronidazole is authorised from the first trimester per the 2023 CRAT update. Oral fluconazole is strictly contraindicated in the first trimester (documented teratogenic risk — ANSM 2019, EMA).

Breastfeeding: Polygynax is compatible.

Polygynax is strictly contraindicated in pre-pubertal girls. Absolute contraindications: allergy to aminoglycosides, polymyxin, nystatin. Caution if hypersensitivity to peanut or soy (excipients).

05Recurrence, partner, STIs#

Recurrence within 3 months → the diagnosis must be reconsidered. Yeast > 4x/year = recurrent vulvovaginal candidiasis (RVVC) affecting ~9% of women of reproductive age (Denning et al., Lancet ID 2018). The Sobel regimen: oral fluconazole 150 mg once weekly for 6 months.

⚠️ Critical: this fluconazole regimen must be discontinued if pregnancy is confirmed in the first trimester.

Partner treatment depends on the pathogen:

• Trichomoniasis: the partner must be treated with oral metronidazole, even if asymptomatic.
• Bacterial vaginosis: WHO and CDC — no demonstrated clinical benefit, not recommended.
• Yeast: only if symptomatic candidal balanitis (redness, itching, white deposits). Treatment: topical antifungal cream — clotrimazole 1% or econazole 1%, twice daily for 7 days.

Prescribing oral metronidazole to an asymptomatic male partner for plain bacterial vaginosis exposes him to side effects without benefit and fuels antibiotic resistance.

06Probiotics and flora restoration#

Vaginal probiotics restore Lactobacillus crispatus/jensenii. In Morocco, 70-180 MAD per pack depending on brand. Cochrane 2022: modest but real benefit on bacterial vaginosis recurrence, particularly as immediate maintenance after a 7-day metronidazole course, continued for 4-6 weeks.

The vaginal route is more effective than the oral route. Physiological vaginal pH sits between 3.8 and 4.5. To avoid: internal vaginal douching, prolonged use of antiseptic soaps, tight synthetic underwear, perfumed panty liners.

07Prices in Morocco and AMO status#

Polygynax PPM is set by the authorities and can be checked on medicament.ma. Important: status on the AMO reimbursable medicines list must be verified against the current ANAM reference at the time of purchase. For up-to-date detail, see the Polygynax fact sheet.

Single antifungals (Gynopévaryl, Lomexin, generic metronidazole) are cheaper. Private gynaecological consultation: 300-500 MAD depending on the city, partly reimbursed by AMO.

08When to consult without delay#

• Pregnant woman with abnormal discharge → consult within 48 hours (risk of premature rupture of membranes, preterm birth, post-partum endometritis).
• Fever > 38 °C with unilateral lower pelvic pain → upper genital tract infection (salpingitis, endometritis, or ectopic pregnancy in an STI context).
• Abnormal bleeding, persistent pain during intercourse, ulcerated vulvar lesions → differential diagnosis (herpes, syphilis, condylomata).
• Treatment failure at 7-14 days → vaginal swab (150-300 MAD) or multiplex PCR (400-700 MAD) in the larger cities.

09Intimate hygiene: do's and don'ts#

Internal vaginal douching is to be strictly avoided. Wash externally with lukewarm water, using a pH-neutral or mildly acidic intimate gel (4.5-5.5), once daily.

Choose cotton underwear. Avoid tight trousers, leggings, wet swimwear. Panty liners should be reserved for the tail end of periods. Perfumed toilet paper, perfumed wipes, and bubble baths are frequently implicated in irritative vulvitis.

Tight glycaemic control in diabetic women is preventive of candidiasis.

### 📋 Pharmacovigilance

Any adverse effect can be reported to the Moroccan Poison Control and Pharmacovigilance Centre (CAPM): www.capm.ma.

10Recurrent disease: dissect the causes before retreating#

Recurrent vulvovaginal candidiasis is defined as at least four documented episodes over twelve months (HAS 2019, CDC STI 2021). Before repeating antifungals, predisposing factors must be explored: unbalanced diabetes (systematic fasting glucose and HbA1c testing on any recurrence after age 35), prolonged corticosteroid therapy, recent broad-spectrum antibiotic exposure, oestrogen-dominant combined contraception, immunosuppression (notably undiagnosed HIV), pregnancy, peri-menopausal vaginal dryness. Identifying a non-albicans species (C. glabrata, C. krusei) by mycological culture with susceptibility testing is critical: these strains are partially fluconazole-resistant and require an adapted regimen (boric acid 600 mg vaginal capsule for 14 days for C. glabrata, prolonged intravaginal nystatin for C. krusei) — ESCMID 2018 guidance.

Recurrent bacterial vaginosis exceeds 30% at 3 months after a short 7-day metronidazole course, which in 2026 justifies several validated alternatives: intravaginal metronidazole 0.75% gel twice weekly for 4-6 months as maintenance (Sobel NEJM 2006), dequalinium chloride (Fluomizin 10 mg pessary), which rebalances the flora without destroying lactobacilli, and L. crispatus CTV-05 vaginal probiotics documented in the NEJM 2020 trial (Cohen), which reduced recurrence at 12 weeks. None of these regimens replaces a gynaecological consultation in Morocco, but they are worth knowing to discuss with a doctor at the time of recurrence.

11Trichomoniasis and associated STIs: screen broadly#

Trichomoniasis is a genuine sexually transmitted infection that warrants a full STI workup: HIV, syphilis, hepatitis B and C serologies, Chlamydia trachomatis and Neisseria gonorrhoeae testing by vaginal or urinary PCR (Aptima, Hologic — available in reference laboratories in Rabat, Casablanca and Marrakech, 400-700 MAD). A 2018 CDC-WHO collaborative study (Bulletin WHO) showed that *75% of women positive for T. vaginalis carry at least one other STI, of which 15-20% are silent chlamydial infections with a major tubal risk. The current partner must be treated concurrently* with metronidazole 2 g single dose or 500 mg twice daily for 7 days, and all partners from the previous 3 months notified for workup and treatment.

Sexual abstinence or protected intercourse is imperative throughout the 7 days of treatment and for an additional 7 days after the last dose, the time needed for parasitological cure. A test-of-cure by PCR at 3 months is recommended in treated women (CDC STI 2021, Kissinger Lancet Infectious Diseases 2018) given the high reinfection rate. Metronidazole in pregnancy has been reassessed: it is now authorised from the first trimester (CRAT 2023, ACOG Committee Opinion 2017), lifting an old dogma founded on mutagenic concerns that were never confirmed in humans.

12Yeast, vaginosis and trichomoniasis in adolescents#

The appearance of vaginal discharge in Moroccan adolescents is a rising motive for gynaecological consultation according to 2024 data from the Moroccan Association of Adolescent Gynaecology. It is important to distinguish physiological pubertal leucorrhoea (clear or milky, without itching, linked to oestrogen stimulation) from true infection. Yeast infection in a girl prior to first sexual intercourse is possible (tight synthetics, antibiotics, atopic background) and is treated as in adults. Trichomoniasis or any STI diagnosed in a minor must trigger a careful medico-social evaluation: sexual violence must be systematically ruled out, within a protective legal framework (Law 103-13 on violence against women).

The gynaecological examination of an adolescent in Morocco remains culturally sensitive. Most gynaecologists proceed by external vulvar inspection without instrument introduction in virgin girls, with a self-introduced or perineal swab. Multiplex PCR on first-pass urine (Aptima Combo 2) allows STI diagnosis without invasive examination. Medical confidentiality applies fully to an adolescent patient capable of understanding.

13Pregnancy, post-partum, peri-menopause: three windows of risk#

During pregnancy, the vaginal ecosystem changes under oestrogen saturation and elevated epithelial glycogen: candidiasis multiplied by 2-3 across pregnancy, bacterial vaginosis associated with increased risk of preterm birth (Lancet 2018 meta-analysis, Leitich), premature rupture of membranes and post-partum endometritis. Any abnormal vaginal symptom in a pregnant woman in Morocco justifies consultation within 48 hours and a systematic vaginal swab with antibiogram — covered by AMO on prescription.

The immediate post-partum period carries an elevated infectious risk: tears, episiotomy, lochia, intercourse resumed too early, fatigue. Polygynax finds a classical indication here, but only under prescription and after speculum examination. Any fever > 38.5 °C, pelvic pain, malodorous discharge or abnormal bleeding within 6 weeks of delivery requires urgent obstetric consultation.

At peri-menopause and beyond, the drop in oestrogens leads to vaginal atrophy, dryness, dyspareunia, and a rise in pH above 5.5 favouring bacterial vaginosis. Treatment relies on low-dose topical oestrogens (estradiol 10 µg pessary, promestriene cream), often combined with vaginal moisturisers (hyaluronic acid). This age group is also when recurrent cystitis linked to peri-urethral atrophy frequently appears — and is often mistakenly confused with vaginitis.

14Conclusion#

Polygynax remains a reference for documented mixed vaginitis or in the post-partum setting. Modern targeted strategies: single antifungal for isolated yeast, metronidazole for vaginosis or trichomoniasis (7-day course in women), bacteriological sampling on failure. The key references cited in this article (HAS 2019, CDC STI Treatment Guidelines 2021, WHO Guidelines on STIs 2021, ACOG Committee Opinion on metronidazole in pregnancy, Kissinger Lancet Infectious Diseases 2018, Sobel NEJM 2006, Cohen NEJM 2020 on L. crispatus probiotics) form the foundation of 2026 recommendations.

This article is informational and in no way replaces the advice of a qualified healthcare professional. For rapid medical guidance, gynaecological teleconsultation with Sahha Live or book an appointment via the gynaecologist directory in Morocco.