Perceived stress in women with recurrent vulvovaginal candidiasis

Objective. Recurrent vulvovaginal candidiasis (RVVC) has become very common. The aim of this study was to evaluate if women with RVVC perceive more signs of chronic stress than healthy control subjects.

Study design. Thirty-three women with RVVC and 28 healthy control subjects completed a questionnaire about perceived stress at work and in private life, and a health questionnaire. A comparison of the results was performed with the one-way ANOVA test.

Results. More women with RVVC than control subjects reported signs of burnout (p < 0.001), emotional symptoms of stress (p < 0.005), impaired balance between work and leisure time (p = 0.01), bodily symptoms of stress (p < 0.05), worrying factors at work (p < 0.05), and presented type D-personality (p < 0.05).

Conclusions. The results of this pilot study showed higher degree of perceived stress in women with RVVC compared with healthy controls. These results are in line with our earlier findings of blunted morning rise cortisol and lower mean levels of cortisol in women with RVVC compared with healthy controls.     

Perceived stress in women with recurrent vulvovaginal candidiasis

OBJECTIVE: Recurrent vulvovaginal candidiasis (RVVC) has become very common. The aim of this study was to evaluate if women with RVVC perceive more signs of chronic stress than healthy control subjects. STUDY DESIGN: Thirty-three women with RVVC and 28 healthy control subjects completed a questionnaire about perceived stress at work and in private life, and a health questionnaire. A comparison of the results was performed with the one-way ANOVA test. RESULTS: More women with RVVC than control subjects reported signs of burnout (p < 0.001), emotional symptoms of stress (p < 0.005), impaired balance between work and leisure time (p = 0.01), bodily symptoms of stress (p < 0.05), worrying factors at work (p < 0.05), and presented type D-personality (p < 0.05). CONCLUSIONS: The results of this pilot study showed higher degree of perceived stress in women with RVVC compared with healthy controls. These results are in line with our earlier findings of blunted morning rise cortisol and lower mean levels of cortisol in women with RVVC compared with healthy controls.     

Vaginal colonization by Candida in asymptomatic women with and without a history of recurrent vulvovaginal candidiasis

OBJECTIVE: The asymptomatic carriage of Candida in the vagina of women with a history of recurrent vulvovaginal candidiasis was compared with that of women with no such history. METHODS: Vaginal swabs from 50 women with a history of recurrent vulvovaginal candidiasis and 45 women with one or fewer episodes of candidal vaginitis within the past 12 months were evaluated for Candida by wet mount/Gram stain, culture, and polymerase chain reaction (PCR). All women were asymptomatic for at least 30 days. RESULTS: Candida was identified in 28 women by PCR, in 14 women by culture, and in 13 women by wet mount/Gram stain. Candida was identified by PCR in a similar proportion of patients with previous recurrent vulvovaginal candidiasis (30%) and in controls (28.8%). However, Candida was identified by culture in more women with previous recurrent vulvovaginal candidiasis (22%) than in controls (6.6%, P = .04); it also was identified by wet mount/Gram stain in more women with recurrent vulvovaginal candidiasis (22%) than in controls (4.4%, P = .01). For the recurrent vulvovaginal candidiasis patients, culture and wet mount/Gram stain had a sensitivity of 66.6% compared with PCR. For the controls, the sensitivity of the two former assays relative to PCR was only 15.3%. CONCLUSION: Women with a history of recurrent vulvovaginal candidiasis have more easily detectable Candida in their vagina, even when asymptomatic, than do other women. A relative inefficiency in regulating the proliferation of Candida in the vagina may increase susceptibility to periodic symptomatic recurrences.     

外阴阴道念珠菌病患者阴道局部甘露糖结合凝集素的检测及基因多态性分析

目的:探讨甘露糖结合凝集素(MBL)在外阴阴道念珠菌病(VVC)及复发性外阴阴道念珠菌病(RVVC)的发病及机体免疫防御机制中的临床意义。方法:选取2004年8月至2004年11月间的VVC患者51例、RVVC患者6例及正常体检女性54例。收集她们的阴道灌洗液,采用ELISA方法测定阴道灌洗液中MBL的浓度;PCR-PFLP方法进行MBL基因多态性分析。结果:VVC患者阴道灌洗液中MBL浓度(17.80 ng/m l)(P<0.01)和基因突变频率(33.33%)显著高于对照组(OR=2.93,95%CI,1.14~7.57,P<0.05)。RVVC患者阴道灌洗液中MBL浓度(0.30ng/m l)则低于对照组(1.28ng/m l)(P<0.05),基因突变频率(83.33%)显著高于对照组(15.69%)(OR=26.87,95%CI,2.76~261.65,P<0.01)。结论:阴道局部MBL的浓度在VVC时升高,可能参与了机体的免疫防御反应,并有助于感染微生物的清除。VVC和RVVC患者MBL基因的高突变率可能是其反复发作的易感因素之一。阴道局部的MBL在女性生殖道的局部免疫中可能发挥重要作用。     

Characterization of women with a history of recurrent vulvovaginal candidosis

BACKGROUND: To characterize history, signs, and symptoms in women with a history of recurrent vulvovaginal candidosis (RVVC) and who had consulted with symptoms generally associated with the condition. METHODS: Eighty-three women with a history consistent with RVVC were interviewed regarding 32 parameters and 10 signs found at the clinical examination were noted. Candida cultures were made from the introitus and the posterior vaginal fornix. RESULTS: Only in a few of the 43 women with and the 40 without a positive yeast culture could any of the many etiological factors that have been associated with RVVC be traced. Only two factors differed between the groups, namely yogurt intake, which was reported by 28 (68%) and 38 (95%) women in these groups, respectively. Vaginal douching was performed by 10 (23%) women in the Candida-positive group and by 17 (42%) women in the Candida-negative group. Pruritis and burning occurred in 31 (72%) and 22 (51%) of culture-positive patients, which was less frequent than in the culture-negative group, i.e. reported by 19 (47%) and 9 (22%) patients, respectively (p = 0.022 and p = 0.007). Edema (p = 0.026) of the vulva as well as erythema (p = 0.019) and edema (p = 0.008) of the vaginal mucosa, caseous discharge (p = 0.016), were found more often in the Candida culture-positive cases. CONCLUSIONS: History and results of clinical examination of patients with RVVC are not enough to distinguish those who are culture-positive from those who are culture-negative for Candida from the genital tract.     

Prevention and treatment of vulvovaginal candidiasis using exogenous Lactobacillus

OBJECTIVE: To review literature examining exogenous Lactobacillus therapy for vulvovaginal candidiasis and to discuss recommendations for clinical practice and future research. DATA SOURCES: Computerized searches on MEDLINE and CINAHL November 2000, September 2001, and March 2002, with search terms including Lactobacillus, acidophilus, Candida, and yeast infections. STUDY SELECTION: Relevant English-language articles from the past 10 years. Unique or seminal studies included where pertinent. DATA EXTRACTION AND SYNTHESIS: Data organized under the following headings: endogenous Lactobacillus, exogenous Lactobacillus, Candida, studies of intravaginal Lactobacillus therapy for vulvovaginal candidiasis, studies of oral Lactobacillus therapy for vulvovaginal candidiasis. CONCLUSIONS: Vaginally administered or orally ingested Lactobacillus is able to colonize the vaginal ecosystem. Controlled intervention studies regarding the effect of such colonization on vulvovaginal candidiasis are promising but few. These studies had small numbers of participants, were inconsistent in the form of Lactobacillus used, and reported conflicting results. Further randomized controlled trials involving large numbers of women are imperative. In the meantime, health care providers should discuss potential benefits with affected patients while clarifying the current lack of conclusive evidence. Without further research into currently available sources and brands of Lactobacillus and without governmental regulation of supplements and their contents, however, it is difficult to make recommendations regarding appropriate product choice.     

Relationship between clinical diagnosis of recurrent vulvovaginal candidiasis and detection of <Emphasis Type="Italic">Candida</Emphasis> species by culture and polymerase chain reaction

Background  Recurring vulvovaginal candidiasis (RVVC) is a common vaginal discharge affecting 75% of all women at least once in their life. In 5% of these women, infection is recurring. Aim of the study was to determine the sensitivity of detecting Candida species by culture and polymerase chain reaction (PCR) in women with a clinical diagnosis of RVVC. Methods  A total number of 104 patients referred with a clinical diagnosis of RVVC and therefore at least four episodes in the previous year were evaluated. In order to detect Candida, vaginal swabs were cultured on Sabouraud and chromagar. Furthermore, the supernatant from the vaginal lavage was examined for the presence of Candida by PCR. Results  When the culture was analyzed, only 31 (29.8%) of the 104 patients diagnosed with RVVC were positive for Candida species in their vagina. Candida albicans was identified in 25 women and six were positive for Candida glabrata. When analyzed by PCR, 44 (42.3%) patients were positive for Candida species. In 13 women (12.5%) only the PCR was positive, while in 31 patients both culture and PCR were positive. Conclusion  The diagnostic method of PCR is more sensitive than culture in detecting Candida species in the vagina. The results also suggest further investigation to verify the complaints of the negative tested patients.     

复发性外阴阴道假丝酵母菌病药物敏感性与耐药基因表达的相关性分析

目的:探讨复发性外阴阴道假丝酵母菌病(RVVC)患者的致病白假丝酵母菌对6种抗真菌药物(两性霉素B、制霉菌素、咪康唑、益康唑、伊曲康唑、氟康唑)敏感性与耐药基因MDR1、CDR1、CDR2和PDR1表达水平的关系。方法:菌株取自昆明医科大学第一附属医院妇产科门诊外阴阴道假丝酵母菌病患者,经菌种鉴定取白假丝酵母菌213株(RVVC 76株,VVC 137株)后做体外药敏试验;荧光定量PCR对已确定敏感、中敏或耐药的菌株进行耐药基因表达检测。结果:PDR1基因仅在部分菌株中有表达,RVVC组的PDR1基因表达率明显低于VVC组(P<0.05);两性霉素B的VVC-耐药组高于VVC-中敏组(P<0.05),伊曲康唑的RVVC-耐药组高于VVC-敏感组、VVC-耐药组和RVVC-敏感组(P<0.05),即对两性霉素B耐药的VVC菌株、对伊曲康唑耐药的RVVC菌株PDR1表达均升高;CDR1、CDR2、MDR1在所有白假丝酵母菌中均有表达,仅CDR1基因表达量存在差异咪康唑VVC-中敏+耐药组高于VVC-敏感组(P<0.05),氟康唑VVC-中敏组表达高于VVC-敏感组和VVC-耐药组(P<0.05),即对咪康唑耐药的VVC菌株表达高于其敏感菌株,对氟康唑中敏菌株表达高于其敏感和耐药组。结论:RVVC的治疗可优选制霉菌素。致RVVC菌株对伊曲康唑明显耐药,且与PDR1基因高表达有关。致VVC菌株对咪康唑、氟康唑产生耐药可能与CDR1高表达有关。PDR1和CDR1可能同时参与RVVC的耐药机制,而与CDR2和MDR1关系不大。     

Evaluation of sexual function in Brazilian women with recurrent vulvovaginal candidiasis and localized provoked vulvodynia

IntroductionRecurrent vulvovaginitis is an important trigger for inflammatory processes that in many cases may result in vulvovaginal pain. Vulvodynia, a vulvar disorder, can also cause a lot of pain in the female genitals. The sexual function in women with vulvodynia or recurrent vulvovaginitis will possibly be negatively affected and therefore should be evaluated.AimTo assess sexual function in women with recurrent vulvovaginal candidiasis (RVVC) and localized provoked vulvodynia (LPV) in comparison with women without lower genital tract dysfunction.MethodsA 1‐year cross‐sectional study evaluated sexual function in 58 women (11 with RVVC, 18 with LPV, and 29 controls) seen at a university outpatient clinic. Sexual function was assessed by taking into account the results obtained from the application of the Female Sexual Function Index (FSFI) questionnaire. Kruskal–Wallis, Mann–Whitney, chi‐square, and Fisher's tests were used for statistical analysis.Main Outcome MeasureFSFI, a validated questionnaire in Portuguese.ResultsThere were no significant differences in the three groups with respect to age, marital status, schooling, race, body mass index, contraceptive method, and parity. The FSFI questionnaire total score found was 25.51 (±5.12), 21.17 (±5.15), and 29.56 (±3.87) for the RVVC, LPV, and control groups, respectively. The scores were significantly statistically lower in the study groups compared with the control group (P < 0.05). Women with RVVC and LPV also had lower total scores compared with 26.55 values, considered a cutoff score for sexual dysfunction in literature. The LPV group showed a significant difference and scored worse in the domains of arousal, lubrication, orgasm, satisfaction, and pain but not in the domain of sexual desire. The same occurred with the RVVC group but only for the domains of orgasm and satisfaction.ConclusionWomen with RVVC and LPV had significantly more symptoms of sexual dysfunction than women without lower genital tract diseases. Giraldo PC, Polpeta NC, Juliato CRT, Yoshida LP, Amaral RLG, and Junior JE. Evaluation of sexual function in Brazilian women with recurrent vulvovaginal candidiasis and localized provoked vulvodynia. J Sex Med 2012;9:805–811.     

外阴阴道假丝酵母菌病的临床特征及相关危险因素分析

目的:探讨外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)的临床特征及相关危险因素。方法:采用前瞻性研究方法,对230例阴道假丝酵母菌培养阳性者及200例真菌培养阴性者,进行病例对照研究。结果:VVC主要发生于性活跃期育龄妇女,平均年龄31.01±8.43岁。单纯性VVC多见,占64.7%(149/230),复杂性VVC占35·3%(81/230)。外阴瘙痒、白带增多、性交痛是VVC的主要症状(OR分别为158.35、16.88、32.59,95%CI分别为68.38~366.73、6.03~47.28、5.97~177.90)。VVC的相关危险因素有口交、非月经期护垫的应用、口服避孕药、既往有VVC病史、抗生素应用(OR分别为5.85、12.05、1.41,6.47,4.07;95%CI分别为2.82~12.14,5.39~26.98,0.71~2.79,3.51~11.98,1.35~12.27);避孕套的应用是保护性因素(OR=0.67,95%CI0.58~0.79)。58.7%VVC阴道pH值通常在正常范围内(3.8~4.5),92.6%的患者阴道清洁度通常为Ⅰ度~Ⅱ度。结论:VVC主要发生于性活跃期育龄妇女,以单纯性VVC多见。VVC阴道pH值通常在正常范围内,清洁度一般在Ⅰ度~Ⅱ度。口交、非月经期护垫的应用、避孕药的应用、既往有VVC病史、抗生素的应用是VVC发生的高危因素。避孕套的应用是VVC的保护性因素。     

Clinical aspects and luteal phase assessment in patients with recurrent vulvovaginal candidiasis

OBJECTIVE: This study was undertaken to characterize the patients with recurrent vulvovaginal candidiasis. STUDY DESIGN: Basic data of personal history and history of recurrent vulvovaginal candidiasis, lower genital tract symptoms and signs in 50 patients were analyzed in this longitudinal follow-up study including the determination of midluteal serum progesterone and urinary pregnanediol levels during the luteal phase in 84 cycles (recurrent vulvovaginal candidiasis) and 60 cycles (healthy controls). RESULTS: All patients suffered primary idiopathic form of recurrent vulvovaginal candidiasis. Frequently, there was a striking discrepancy between severe symptoms and clinical finding, which was often negligible or normal. There was no redness and no or minimum discharge in 52% of culture documented attacks. In contrast to the healthy controls, the patients had significantly lower levels of progesterone (p<0.01) as well as those of urinary pregnanediol (p<0.05). CONCLUSION: Culture positive attacks in patients with recurrent vulvovaginal candidiasis represented rather a form of vulvovaginal discomfort than attacks of vulvovaginal candidiasis with typical inflammatory changes. Significantly lower progesterone levels in the RVVC patients as compared to the healthy controls suggest a link between an altered hormonal status and one of possible causes of RVVC in these women.     

Late miscarriage and intraamniotic candidiasis in a woman with a retained intrauterine contraceptive device

Summary We present a case of mid-pregnancy miscarriage with a retained intrauterine contraceptive device and asymptomatic intraamniotic Candida infection.     

外阴阴道假丝酵母菌病临床分离株的基因型和药物敏感性分析

目的:探讨外阴阴道假丝酵母菌病(VVC)患者阴道白假丝酵母菌分离株的基因型别特征及不同基因型别的阴道白假丝酵母菌的药物敏感情况。方法:(1)对211株阴道白假丝酵母菌进行25S rDNA基因分型;(2)采用NCCLS推荐的M27-A微量法测定阴道白假丝酵母菌对5-氟胞嘧啶、咪康唑、伊曲康唑、克霉唑、氟康唑和制菌霉素等6种药物的敏感性。结果:(1)211株阴道白假丝酵母菌分为3种基因型,A型189株(89.6%),B型19株(9.0%),C型3株(1.4%);(2)不含内含子组(A型)白假丝酵母菌对5-氟胞嘧啶、咪康唑、伊曲康唑、克霉唑和氟康唑的最低抑菌浓度值(MIC)高于含内含子组(B、C型)(P0.05);不含内含子组(A型)与含内含子组(B、C型)白假丝酵母菌对5-氟胞嘧啶和咪康唑的敏感率有显著差异(P0.01),前者显著低于后者。结论:不同基因型别的白假丝酵母菌在阴道内的分布具有独特性,A型为主要基因型;VVC白假丝酵母菌基因型别对不同药物的敏感率和MIC有影响。