Efficacy and Safety of a Vaginal Ovule Medical Device for Bacterial Vaginosis and Candidal Vaginitis (ROVUL25).

INTIMIQUE OVULI is a Class IIa vaginal medical device supplied as vaginal ovules (7 ovules per pack, 2 g each), intended as an adjuvant in the prophylaxis, and prevention of vaginal infections and their recurrence (fungal vaginitis and bacterial vaginosis), and for vaginal environment alterations. Each ovule contains tyndallized Lactobacillus rhamnosus LRH020, sodium hyaluronate, lactic acid, essential oils (Melaleuca alternifolia and white thyme), galactoarabinan, vitamin E acetate, vitamin A palmitate, and semisynthetic triglycerides. The device is intended to restore the vaginal environment and physiological pH, counteract vaginal dryness, and protect the mucosa, reducing irritative symptoms (itching, redness, burning, edema, pain).

Device safety has been previously assessed through preclinical testing: an in vitro cytotoxicity test (NRU assay, ISO 10993-5), a skin sensitization test (Local Lymph Node Assay in mice, ISO 10993-10/OECD TG 429), and a vaginal irritation test in rabbits (ISO 10993-10), all with favorable (non-cytotoxic, non-sensitizing, non-irritant) results.

Clinical diagnosis of BV or VVC will be established at the screening visit based on clinical history, vaginal pH, and characteristics of vaginal discharge, with microbiological confirmation by vaginal swab for VVC. Treatment duration is 7 consecutive days (T-7d), followed by a 3-week washout, a second 4-day treatment, a further washout of 3 weeks and 3 days, a third 3-day treatment, and a 2-month follow-up period (T-112d). Efficacy will be assessed in the overall population and, post-hoc, in the two diagnostic subgroups (BV and VVC).

• Class IIa vaginal medical device supplied as vaginal ovules, intended as an adjuvant in prevention of vaginal infections and symptoms. (Device): Placebo.
• Placebo. (Other): placebo ovules (inert lipid base, free of active functional substances - no lactic acid, tyndallized probiotics, or sodium hyaluronate)

Primary outcomes

• Change in Vaginal Health Index (VHI) score. [Baseline (T0), end of first treatment cycle (T-7 days), end of first month (T-28 days), end of follow-up (T-112 days).]: Composite score assessed by the investigator across 5 clinical parameters (vaginal elasticity, vaginal secretions, pH, epithelium, moisture), each scored 1-5 (total range 5-25).

Secondary outcomes

• Vaginal pH [Baseline (T0), end of first treatment cycle (T-7 days), end of first month (T-28 days), end of follow-up (T-112 days)]: Vaginal pH measured by rapid semiquantitative dry chemical method.
• Subjective symptoms [Baseline (T0), end of first treatment cycle (T-7 days), end of first month (T-28 days), end of follow-up (T-112 days).]: Subjective symptoms (itching, burning, pain) via Visual Analog Scale (VAS 0-10) using daily diary.
• Quality of life SF-12 [Baseline (T0), end of first treatment cycle (T-7 days), end of first month (T-28 days), end of follow-up (T-112 days).]: Quality of life short form questionnaire SF-12 (5 domains: sleep quality, daily activities, emotional wellbeing, sexual activity, social interactions; 0-10 scale each, referring to the previous 7 days)
• Tollerability [Baseline (T0), end of first treatment cycle (T-7 days), end of first month (T-28 days), end of follow-up (T-112 days).]: All treatment-related adverse reactions (mild, moderate, severe) over the three treatment phases (7+4+3 days) will be recorded.

Sex: Female, ages: 18 Years to 60 Years

Inclusion Criteria:

* Female sex
* Age 18 to 60 years
* Able to understand and sign informed consent
* Able to understand and comply with protocol requirements
* Negative pregnancy test
* Negative HIV test
* Not taking, and agreeing not to take, any other medication or medical device for the duration of the study, except the elective antibacterial or antifungal treatment for BV or VVC
* Presenting symptoms suggestive of BV or VVC at screening (leukorrhea, itching, burning)
* Confirmed clinical diagnosis of bacterial vaginosis (yellow-green or gray vaginal discharge; vaginal pH > 4.5; positive whiff test/fishy odor with potassium hydroxide), OR
* Confirmed clinical diagnosis of vulvovaginal candidiasis (gynecological examination with itching, burning, thick white discharge; vaginal pH typically < 4.5; vaginal swab confirmation of *Candida* spp.)

Exclusion Criteria:

* Male sex
* Age < 18 or > 60 years
* Pregnant, suspected pregnant, or planning pregnancy during the study period
* Breastfeeding
* Not self-sufficient
* Unwilling/unable to cooperate with study procedures
* Unable to attend the study site within the required timeframe
* Judged unsuitable by the investigator due to other conditions incompatible with enrollment requiring pharmacological treatment
* HIV-positive / acquired immunodeficiency
* Known allergy to components of the investigational products (active or placebo)
* Presence of vaginal infections other than BV or VVC
* Alcohol, drug, nicotine, or excessive caffeine/theine abuse
* Use of vaginal or systemic antifungal/antibiotic treatment within the 7 days prior to enrollment
* Taking any other medication or medical device during the study period, except the elective treatment for BV/VVC*
* Systemic or immunosuppressive conditions interfering with symptom interpretation
* Participation in another clinical study within the previous 30 days

  * If pharmacological treatment becomes necessary, this must be reported to the Principal Investigator, who will assess on a case-by-case basis whether the subject should be excluded.