Chlorhexidine a safe, reasonable option for vaginal antisepsis

Vaginal antisepsis with chlorhexidine proves noninferior to that with iodine in terms of the incidence of gynaecologic surgery-associated urinary tract infection (UTI) and vaginal irritation, as reported in a study.

The study randomized 119 women undergoing urogynaecologic surgery to receive either chlorhexidine (n=61) or iodine (n=58) as presurgical vaginal antiseptic solutions. Researchers evaluated the risk of developing symptomatic UTI within 2 weeks after the surgery as the primary outcome. They also looked at culture-proven UTI at 2 and 6 weeks after surgery, symptomatic UTI at 6 weeks after surgery, any surgical site infection at 2 weeks after surgery, and patient-reported vaginal irritation after surgery.

Demographic characteristics, medical history, operations performed, or perioperative factors at baseline were similar in the two treatment groups. The incidence of symptomatic UTI at 2 weeks following surgery did not significantly differ between the chlorhexidine and iodine groups (10 percent vs 17 percent), establishing the noninferiority of the former to the latter (relative risk, 0.6, 95 percent confidence interval, -∞ to 1.3).

Likewise, there were no between-group differences seen in the secondary UTI outcomes, such as culture-proven UTI at 2 and 6 weeks after surgery and symptomatic UTI at 6 weeks after surgery.

Finally, the chlorhexidine and iodine groups had similar rates of surgical site infection (three out of 119, 2.5 percent) and presence of any vaginal irritation (four out of 54, 7.4 percent).

The findings suggest that chlorhexidine is a safe and reasonable option for vaginal antisepsis in women undergoing urogynaecological procedures. More studies are needed to further examine surgical site infection.