外阴阴道念珠菌病的病因研究及体外药敏检测

目的了解福州地区阴道念珠菌病的病因、致病菌的菌种特征。方法采用科玛嘉念珠菌显色培养基和YBC鉴定卡及API-20C AUX酵母菌鉴定系统对门诊就诊661例患者阴道分泌物分离到的332株致病真菌进行鉴定,并采用ROSCO纸片扩散法对4种抗真菌药进行药物敏感检测。结果总感染率为69.45%共分离菌种6种。339株念珠菌,其中白念珠菌为288株占85%,光滑念珠菌23株占6.8%,热带念珠菌12株占3.54%,克柔念珠菌7株占2%,近平滑念珠菌4株占1.18%,光滑假丝酵母菌4株占1.18%,酿酒酵母菌1株占0.29%。结论本地区念珠菌性阴道炎主要的病原菌以白色念珠菌为主,其次是光滑念珠菌、热带念珠菌。     

复发性外阴阴道假丝酵母菌病菌种与药敏特征的研究

目的:了解假丝酵母菌在复发性外阴阴道假丝酵母菌病的菌种分布和药物敏感性,为临床治疗提供帮助。方法:收集108例复发性外阴阴道假丝酵母菌病阴道分泌物标本,应用法国生物梅里埃酵母菌鉴定试剂盒ID32C和药敏试剂盒ATBTM FUNGUS3进行鉴定和药敏试验。结果:108株假丝酵母菌中分离出光滑假丝酵母菌36例,白色假丝酵母菌35例,近平滑假丝酵母菌20例,热带假丝酵母菌7例,其他11例;对抗真菌药物AMB、5FC敏感性分别为96.30%、85.19%,对FCA、VRC、ITR耐药率分别为42.59%、50.93%、72.22%。有26株白色假丝酵母菌对3种三唑类药物均耐药。光滑假丝酵母菌对ITR耐药率高达83.33%。结论:复发性外阴阴道假丝酵母菌病的致病菌主要是光滑假丝酵母菌、白色假丝酵母菌,呈现非白假丝酵母菌占67.59%的分布特征,并且对AMB、5FC敏感性高,ITR耐药率高于VRC、FCA。     

念珠菌性阴道炎的菌种分布及耐药性分析

目的:分析念珠菌性阴道炎的菌种分布及耐药性情况,为临床提供诊断和合理用药的依据.方法:采用科玛嘉显色平板和梅里埃公司API和ATB试剂盒进行真菌菌株鉴定及药敏试验,回顾性分析我院527例念珠菌性阴道炎的检测结果.结果:共检出527株念珠菌.分别为白念珠菌412株(78.18%),光滑念珠菌47株(8.92%),热带念珠菌24株(4.54%),其他念珠菌44株(8.35%);念珠菌对抗真菌药物的敏感率分别为:两性霉素B 100%,伏立康唑91.4%,5-氟胞嘧啶89.5%,伊曲康唑84.4%,氟康唑78.20%.结论:念珠菌性阴道炎以白念珠菌感染为主,不同菌种对常用抗真菌药物的敏感性存在差异.临床应加强真菌的鉴定和药敏试验,合理使用抗真菌药物,以提高诊疗效果,减少耐药菌株的出现.     

阴道白念珠菌细胞外磷脂酶活力测定

目的　探讨白念珠菌细胞外磷脂酶活力与外阴阴道念珠菌病的关系。方法　随机选择外阴阴道念珠菌病患者和无症状携带者 ,采用卵黄平皿方法测定其阴道白念珠菌分离株的细胞外磷脂酶活力。结果　患者组细胞外磷脂酶阳性菌株的检出率及其磷脂酶的活力均显著高于携带者组 (P值均 <0 .0 0 1)。结论　白念珠菌细胞外磷脂酶可能是引起外阴阴道念珠菌病的重要毒力因子之一。     

Vulvovaginal carriage of yeasts other than Candida albicans

AIMS: We investigated the spectrum of yeasts isolated, and compared the epidemiological and laboratory characteristics of women carrying vulvovaginal Candida albicans with those carrying yeasts other than C. albicans. METHOD: Between April and June 2001, 5802 consecutively received genital swabs from women were plated onto Candida ID chromogenic media (BioMerieux). Blue colonies were reported as C. albicans; all other colonies (white and pink) were identified to species level using the Vitek YBC card (BioMerieux). In vitro susceptibility to amphotericin (AMB), fluconazole (FLU), itraconazole (ITZ), and voriconazole (VOR) was determined for approximately 40% of non-C. albicans yeasts using a standardised microdilution method. RESULTS: Yeast was isolated from 1221 women (21%). Of these, C. albicans only was isolated from 1087 (89%) and yeasts other than C. albicans from 129 (11%) women. C. glabrata comprised 89 (69%) of the latter. Women in whom other yeasts were recovered were older than those with C. albicans (mean 43, versus 33 years, p <0.001). All isolates tested (n=53) were susceptible to AMB and VOR. Seven (24%) C. glabrata strains were susceptible to FLU with 21 (72%) testing susceptible-dose dependent. CONCLUSION: Yeasts other than C. albicans are common vaginal isolates even in a primary care population. The species isolated are less susceptible to FLU than most C. albicans.     

Clinical and microbiological characteristics of symptomatic vulvovaginal candidiasis in HIV-seropositive women.

OBJECTIVES--To evaluate the clinical and microbiological characteristics of symptomatic vaginal candidiasis in Human Immunodeficiency Virus (HIV)-seropositive women attending a gynaecologic outpatient clinic for sexually transmitted diseases (STDs). DESIGN--Vaginal, rectal and oral specimens from cases and controls were cultured for Candida spp. SUBJECTS--Eighty-four consecutive HIV-seropositive and 384 HIV-seronegative women with clinical signs of vulvovaginitis. SETTING--A gynaecological out-patient clinic in Pavia, Italy. RESULTS--The overall prevalence of vaginal candidiasis was 61.9% (52/84) in the cases and 32.3% (124/384; p < .001) in the controls. After adjustment by logistic regression analysis for confounding factors (age at first intercourse, lifetime sex partners, new partner/s in the last 6 months, type of contraceptive used), HIV-seropositive patients were at higher risk for both Candida albicans (odds ratio = 2.5; 95% confidence interval 1.31-4.69; p = 0.006) and Torulopsis glabrata vaginitis (OR = 3.5; 95% CI = 1.05-11.60; p = 0.04) than controls. HIV-seropositive subjects had also increased rates of oral and rectal colonisation with Candida spp. Finally, the time to recurrence of vaginal infection was significantly shorter in HIV-seropositive patients than controls and was correlated with the severity of HIV-induced immunodepression. CONCLUSIONS--Vulvovaginal candidiasis is very common in HIV-seropositive women and its prevalence is correlated with the immunological status of the host. These patients have higher frequencies of Torulopsis glabrata vaginal infection and are more prone to recurrence than HIV-seronegative controls.     

Fungal infections of urogenital system

We analyzed the frequency of isolation of individual fungal species in the samples of urine, vaginal and cervical swabs from 107 patients (72% women and 28% men) aged 16-82 years, who were treated in primary care for cystitis, vulvovaginitis, and cervicitis. The samples were analyzed at the Microbiological Laboratory of Zagreb Institute of Public Health, Croatia, between September 1, 2002 and June 31, 2003. Eight species of yeast were isolated from the samples. Candida (C.) albicans, C. glabrata, and C. krusei were the most common isolates, with the frequency of 61.7%, 10.3% and 8.4%, respectively. Other species (C. guilliermondii, C. famata, C. tropicalis, C. parapsilosis, and C. kefyr) were less frequently isolated, between 0.9% and 7.5%. In women, the frequency of isolation of C. albicans species from urine samples ranged from 83.3% to 30.8%, and from uterine cervical swabs from 85.7% to 50%, showing a decreasing trend with patients' age. The frequency of C. albicans isolates from vaginal swabs was equal in younger (<30 years) and older women (?51 years), but twice less frequent in middle-aged women. In men, the frequency of C. albicans species isolated from urine samples decreased with age from 100% to 52.4%. In the 107 analyzed samples with positive fungal culture, yeast isolations were significantly more frequent than pure culture (93.5%) and had a larger number of colony counts (57%). This suggested that these yeast species might have a pathogenic role in the causation of urogenital system infections.     

The value of prophylactic (monthly) clotrimazole versus empiric self-treatment in recurrent vaginal candidiasis.

OBJECTIVE--To determine the comparative efficacy and cost benefit of prophylactic monthly (perimenstrual) clotrimazole, versus empiric self-treatment with the same agent at the onset of symptoms in recurrent vulvovaginal candidiasis. DESIGN--Prospective, randomised, open cross-over study of women with proven recurrent vulvovaginal candidiasis. Clinical and microbiological assessments were done every two months for 12 months. SETTING--Women's Clinic of a University Teaching Hospital. SUBJECTS--Twenty-three otherwise healthy, non-pregnant women with greater than four proven episodes of candida vaginitis in the last year were enrolled into the study. INTERVENTION--Patients were randomised to receive: (1) a single dose of prophylactic clotrimazole 500 mg ovule just before or on the last day of the menses each month for 6 months; (2) or a single dose of clotrimazole 500 mg ovule empirically at the onset of symptoms for 6 months. After the first 6 months patients were crossed-over to the opposite regimen. MAIN OUTCOME MEASURES--Symptoms of recurrent vulvovaginitis during each period, and number of clotrimazole ovules used for each 6 month period. The personal preference of the patients for the two different regimens were assessed at the end of study. RESULTS--During the prophylactic 6 months period of the study, 23 patients had 50 episodes of symptomatic vaginitis (mean 2.2 episodes per patient), versus 86 episodes (mean 3.7 episodes/patient) during the empiric self-treatment 6 months period (P = 0.05). However, during the prophylactic period a total of 168 clotrimazole ovules were used (mean 7.3 per patient), versus 84 ovules (mean 3.6 per patient) during the empiric self-treatment period, p < 0.001. The personal preference of the patients for the type of regimen employed were 17 (73.9%) in favour of the empirical treatment, versus 4 (17.4%) in favour of the prophylactic treatment and 2 (8.7%) no personal preference, p < 0.01. CONCLUSION--Empiric self-treatment is more cost-effective and preferable to patients than cyclical monthly prophylactic use of 500 mg clotrimazole vaginal ovules.     

Vaginal yeast colonisation, prevalence of vaginitis, and associated local immunity in adolescents

OBJECTIVES: To evaluate point prevalence vaginal yeast colonisation and symptomatic vaginitis in middle adolescents and to identify relation of these yeast conditions with reproductive hormones, sexual activity, sexual behaviours, and associated local immunity. METHODS: Middle adolescent females (n = 153) were evaluated for sexually transmitted infections (STIs), asymptomatic yeast colonisation, and symptomatic vulvovaginal candidiasis (VVC) by standard criteria. Also evaluated were local parameters, including vaginal associated cytokines, chemokines, and antibodies, vaginal epithelial cell antifungal activity, and Candida specific peripheral blood lymphocyte responses. Correlations between yeast colonisation/vaginitis and local immunomodulators, reproductive hormones, douching, sexual activity, condom use, and STIs were identified. RESULTS: Rates of point prevalence asymptomatic yeast colonisation (22%) were similar to adults and similarly dominated by Candida albicans, but with uncharacteristically high vaginal yeast burden. In contrast with the high rate of STIs (18%), incidence of symptomatic VVC was low (<2%). Immunological properties included high rates of Candida specific systemic immune sensitisation, a Th2 type vaginal cytokine profile, total and Candida specific vaginal antibodies dominated by IgA, and moderate vaginal epithelial cell anti-Candida activity. Endogenous reproductive hormones were in low concentration. Sexual activity positively correlated with vaginal yeast colonisation, whereas vaginal cytokines (Th1, Th2, proinflammatory), chemokines, antibodies, contraception, douching, or condom use did not. CONCLUSION: Asymptomatic vaginal yeast colonisation in adolescents is distinct in some ways with adults, and positively correlates with sexual activity, but not with local immunomodulators or sexual behaviours. Despite several factors predictive for VVC, symptomatic VVC was low compared to STIs.     

阴道乳酸杆菌对白念珠菌生长抑制的作用

目的比较外阴阴道念珠菌病患者与健康妇女阴道乳酸杆菌检出阳性率、菌种分布及产H2O2能力的异同,初步探讨阴道内不同乳酸杆菌对白念珠菌生长抑制能力的差异。方法采用生物化学的方法对乳酸杆菌进行鉴定,并将鉴定到种的乳酸杆菌接种在H2O2鉴定培养基,观察是否产H2O2;挑选健康组嗜酸乳酸杆菌、干酪乳酸杆菌、唾液乳酸杆菌、詹氏乳酸杆菌,用纸片法测其对白念珠菌抑菌圈直径。结果两组在乳酸杆菌阳性率及分布上差异无统计学意义(P0.05);患者组乳酸杆菌产H2O2阳性率明显低于健康组,差异有统计学意义(P0.05);四种乳酸杆菌分别对白念珠菌生长抑制作用强弱不同,其中嗜酸乳酸杆菌抑制白念珠菌生长作用最明显。结论外阴阴道念珠菌病患者阴道内乳酸杆菌阳性率及分布与健康者阴道内相似,但产H2O2乳酸杆菌减少;不同乳酸杆菌对念珠菌的生长抑制作用不同。     

外阴阴道假丝酵母菌病临床特征和抗真菌药物敏感性研究

目的：探讨外阴阴道假丝酵母菌病（VVC）的临床特征和抗真菌药物敏感性。方法：对1120例VVC患者进行临床特征分析,阴道分泌物标本采集、真菌培养及体外药敏实验。结果：单纯型VVC占36．79％,重度VVC占37．77％,RVVC占14．38％,非白假丝酵母菌VVC占11．07％。重度VVC的特征最为严重（P均=0．000）,以白假丝酵母菌最多见（P=0．000）。抗菌药物的敏感性依次为制霉菌素、克霉唑、氟康唑、伊曲康唑、益康唑、咪康唑及酮康唑,差异有统计学意义（P〈0．01）。结论：白假丝酵母菌是VVC主要的病原体,复杂型VVC临床较为常见且临床特征较单纯型VVC严重。白假丝酵母菌对唑类抗真菌药物仍有较高敏感性,制霉菌素、克霉唑抗真菌敏感性较高,可以供临床治疗选用。     

念珠菌性外阴阴道炎患者阴道分泌物中白念珠菌分泌型天冬氨酸蛋白酶表达

目的 探讨白念珠菌分泌型天冬氨酸蛋白酶(SAP)家族在白念珠菌无症状性阴道寄居向症状性阴道炎发展过程中的表达.方法 分别从10例无症状携带者、14例念珠菌性外阴阴道炎患者和10例复发性念珠菌性外阴阴道炎患者的阴道分泌物标本中直接提取RNA,逆转录成cDNA后进行RT-PCR.结果 所有无症状携带者和患者均表现出对SAP2和SAP4-6的阳性扩增.10例无症状携带者中无一个标本表现出对SAP1和SAP3的阳性扩增,而念珠菌性外阴阴道炎患者和复发性念珠菌性外阴阴道炎患者阴道分泌物标本提取的RNA可见9个SAP基因的不同表达,并且均不同程度地表现出对SAP1和SAP3的阳性扩增.结论 念珠菌性外阴阴道炎的发病可能与SAP基因的不同表达有关.     

阴道分离的念珠菌体外抗真菌药物敏感性分析

目的 探讨念珠菌在女性阴道黏膜所致的不同表现与其对抗真菌药物敏感性之间的关系。方法 应用NCCLSM27-A方案推荐的微量液体稀释法,测定对来自外阴阴道念珠菌健康携带者、外阴阴道念珠菌病和复发性外阴阴道念珠菌病的念珠菌对抗真菌药物的敏感性。结果 8种抗真菌药对光滑念珠菌和克柔念珠菌的MIC值几乎均比白念珠菌高。来自复发性外阴阴道念珠菌病患者的菌株MIC值较高,而健康带菌者菌株的MIC值较低。耐药菌株主要来源于复发组,健康带菌者来源的白念珠菌菌株对伊曲康唑、氟康唑、酮康唑和制霉菌素未见有耐药菌株出现。结论 外阴阴道念珠菌病治疗中应重视非白念珠菌的耐药性,长期或间断应用抗真菌药物治疗,可能诱导耐药株的产生。     

Torulopsis glabrata and Candida albicans in female genital infections in the Sudan.

Four hundred and seventy Sudanese women with vaginal discharge were investigated for yeast-like fungi. High vaginal specimens were cultured and isolates fully identified according to standard mycological techniques. All patients were married and some were pregnant. Of 138 yeast-like fungi identified, Torulopsis glabrata (34.1%) was the commonest followed by Candida albicans (25.4%) and Candid krusei (14.5%). Differing social and economic factors may be responsible for the higher prevalence of T glabrata in the Sudan. Although its pathogenicity is not well established, its association with vulvovaginitis should not be overlooked.     

Genital candidosis in heterosexual couples

Background Evidence suggests that Candida can be sexually transmitted; however, the contribution of sexual transmission to the pathogenesis of genital candidosis needs further elucidation. Objective The aim was to evaluate genital candidosis and its transmissibility in heterosexual couples. Methods Heterosexual couples were recruited among attendees of an Sexually Transmitted Diseases clinic. Specimens for yeast culture were collected from the glans penis and inner preputial layer using direct impression on CHROMagar Candida medium; vaginal exudates were collected using a cotton swab with subsequent inoculation on CHROMagar Candida medium. Mitochondrial DNA restriction analysis was performed to compare Candida isolates from both partners. Results A total of 64 couples were enrolled in the study. Frequency of sexual intercourse was significantly higher in couples where both partners yielded positive cultures and with at least one having genital candidosis (Odds ratios: 6.844; 95% CI 1.408–33.266). The same Candida species was found in both partners in 25% (16/64) of all couples but only 17.2% (11/64) were genetically similar. In total 12 of the 34 women suffering from vulvovaginal candidosis (VVC) had recurrent VVC (RVVC); two sexual partners of RVVC women (16.7%) had candida positive cultures, compared with 15 (68.2%) sexual partners of non RVVC women (Odds ratios: 0.093; 95% CI 0.016–0.544). Conclusions Only in a few heterosexual couples a genetic similarity of Candida species recovered from both partners was found. RVVC women were more likely to have an asymptomatic candida negative sexual partner. This study suggests that male genitalia do not represent a relevant reservoir for RVVC; thus, the relevance of sexual transmission should not be emphasized.     

Efficacy of fluconazole and nystatin in the treatment of vaginal Candida species

The aim of this study was to determine and compare the efficacy of treatment with fluconazole and nystatin in Brazilian women with vaginal Candida. In a population of 932 women, vaginal cultures were performed for yeasts, whether or not the women showed signs and symptoms of vulvovaginal candidiasis. Yeasts were isolated from 12.2% of the women (114/932): 53.2% of the yeasts were Candida albicans, 27.0% C. glabrata, 13.5% C. tropicalis and 6.3% C. parapsilosis. Treatment was carried out with both drugs. The overall mean cure rates with fluconazole (87.0%) and nystatin (74.0%) were similar; among women with non-albicans, the cure rate with fluconazole was 100%, whereas that with nystatin was 44.4%. The cure rate for women with C. albicans was high with both fluconazole and nystatin; however, for those with non-albicans species the cure rate was excellent with fluconazole and very low with nystatin, differing from the majority of in vitro studies.     

复发性外阴阴道念珠菌病病原学及药敏的研究

目的从病原学方面探讨VVC和RVVC病原菌和药敏的差异,指导临床治疗。方法对VVC和RVVC的病原菌进行了鉴定并加以比较,并参照美国国家临床实验标准化委员会（NCCLS）推荐的M-27A方案,采用微量稀释法进行了分离菌株对常用抗真菌药物氟康唑、伊曲康唑及两性霉素B的体外药物敏感研究。结果VVC、RVVC组共分离出125株念珠菌,其中RVVC组67株,VVC组58株;在125株念珠菌中白念珠菌98株,占78.40%,非白念珠菌27株,占21.60%。RVVC组67株中有47株为白念珠菌,占68.66%（47/67）;VVC组58株中有51株为白念珠菌,占87.93%（51/58）。RVVC组非白念珠菌所占比例与VVC组差异有统计学意义（P〈0.05）,RVVC组非白念珠菌比例较高。念珠菌对三种药物敏感性依次为两性霉素B〉伊曲康唑〉氟康唑。非白念珠菌唑类药物敏感性低于白念珠菌。结论白念珠菌仍是VVC、RVVC的主要致病菌,RVVC组非白念珠菌比例高于VVC组,非白念珠菌中以光滑念珠菌比例最高。非白念珠菌对氟康唑的敏感率明显低于白念珠菌。     

The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketoconazole.

OBJECTIVE--To determine whether treatment of the sexual partners of women with chronic vulvovaginal candidiasis with oral ketoconazole can reduce the recurrence rate of candida vaginitis. DESIGN--Single blind randomised study where all the women were treated with ketoconazole 400 mg daily for 7 days after an acute episode of candida vaginitis and half the male partners were treated with ketoconazole 200 mg daily for 5 days. SETTING--Women's Candida Clinic of St. Michael's Hospital, a University of Toronto teaching Hospital, Toronto, Ontario, Canada. SUBJECTS--Fifty-four women attending the clinic with at least four proven episodes of candida vaginitis and their male sex partners (stable monogamous relationships) were enrolled in the study. MAIN OUTCOME MEASURES--Clinical recurrence of candida vaginitis with confirmation by smear and culture. Follow-up was obtained one to two weeks after initial treatment, then monthly for one year. RESULTS--In the control group (untreated partners), 20 of 28 (71%) patients had recurrences in six months, versus 17 of 26 (65%) patients in the treated group (treated partners) (95% Confidence Interval (CI) for the difference in recurrence rate = -19% to 31%). At one year, 23 of 28 (82%) patients in the control group had recurrences, versus 22 of 26 (85%) in the treated group (CI = -23% to 17%). CONCLUSION--Treatment of the male partners, with a brief course of ketoconazole, is not of value in reducing the incidence of relapse in women with recurrent vaginal candidiasis. It is unlikely that a larger study would show a clinical important difference.     

A comparison of yield from cervix versus vagina for culturing Candida albicans and Trichomonas vaginalis.

OBJECTIVE--To determine the agreement of culture results of Candida albicans and Trichomonas vaginalis from the cervix versus posterior fornix in women with vaginal symptoms. DESIGN--Same patient comparison of culture results from two sample sites. SETTING--Twenty one general practices in Amsterdam and the east of the Netherlands. SUBJECTS--Six hundred and eighty two women aged 15 to 55 years with vaginal symptoms, seen between 1 October 1987 and 31 May 1990. MAIN OUTCOME MEASURES--For each site (cervix and posterior fornix) the proportion of detected C albicans and T vaginalis. The sensitivity of the cervical swab related to the vaginal one. The percentage of concordance for both microorganisms. RESULTS--In 248 (34%) women C albicans was diagnosed and in 38 (6%) T vaginalis. In 99% of the proven C albicans cases, the yeast was found in the vagina. In 94% C albicans was isolated from the cervix. Sensitivity of the cervical swab was 94%. In 98% of the patients a concordant observation was made regarding detection of yeast. In 97% of the proven T vaginalis cases the protozoon was found in the vagina. In 91% T vaginalis was detected from the cervical swab. Sensitivity of the cervical swab was 92%. The culture results were concordant in 99%. CONCLUSION--The yield from the vaginal source was slightly better than that from the cervix for culture of both microorganisms. For screening purposes, specimen-collection for culture of N gonorrhoeae, C albicans and T vaginalis can be combined in one swab taken from the cervix.     

Immunohistochemical study of in vivo and in vitro IgA coating of candida species in vulvovaginal candidiasis.

OBJECTIVE--To evaluate whether quantitative or qualitative IgA deficiencies in cervicovaginal secretions can be identified in patients with recurrent vulvovaginal candidiasis. DESIGN--Prospective and controlled study. SETTING--Department of Dermatology, University of Vienna. SUBJECTS--30 patients with symptomatic and recurrent vulvovaginal candidiasis at the time of their presentation. 30 healthy women as a control group. INTERVENTION--Blood samples were drawn for measurement of serum IgA levels. Smears of the cervix and vagina were taken for direct microscopy and microbiological culture. Lavage of the vagina and ectocervix was performed with sterile saline solution for measurement of cervicovaginal IgA levels. MAIN OUTCOME MEASURES--IgA levels of serum and cervicovaginal secretion evaluated by Single Radial Immunodiffusion. IgA labelling was demonstrated on fungal elements in vaginal smears and subcultured blastospores after incubation with vaginal secretions by immunohistochemistry. RESULTS--We could not find any significant difference of IgA levels in serum and cervicovaginal secretions between the symptomatic group and healthy controls (p value for serum = 0.5796, p value for secretion = 0.2381). In vaginal smears yeasts revealed IgA coating on their surfaces, whereas three of the 61 subcultures were negative. Negative subcultures were assigned to three patients with recurrent candidiasis. No correlation was found between IgA levels of cervicovaginal secretions and staining intensity of subcultured blastospores after incubation with vaginal secretions (r = -0.0578). IgA levels of serum and vaginal secretion showed no correlation (r = -0.00012). CONCLUSION--Recurrent vulvovaginal candidiasis cannot be attributed to IgA deficiency. In some cases an IgA coating defect of yeasts might be involved. In addition inactivation of the IgA molecule by candida proteases might be of pathogenetic importance.