Recurrent vulvovaginal candidosis: focus on the vulva

Abstract

Recurrent vulvovaginal candidosis is a frequent disease with a serious impact on women's quality of life. Mostly, recurrences are caused by identical Candida strains suggesting C. albicans persistence in the female anogenital area. Objectives of the presented work were to identify the site of C. albicans persistence, to determine clinical symptoms and signs related to C. albicans positive vulvar cultures and to introduce a new therapeutic approach in women with RVVC. Women with an acute, culture-confirmed episode of RVVC at time of visit were included in this prospective case series. Swabs were obtained from both vagina and inter-labial sulcus. Women received a combined 20-day regimen of 100 mg oral fluconazole and ciclopiroxolamin cream topically. Follow-up visits were at 3, 6, 9 and 12 months. Of 139 women, 105 (76%) had at least one C. albicans positive culture from the external vulva. Vulvar positive cultures correlated with pruritus (OR 5.4; P < 0.001), vulvar edema (OR 3.8; P = 0.03) and fissures (OR 2.4; P = 0.03). Recurrence rates were 27%, 33% and 34% (at 6, 9, 12 months, respectively). The external vulva appears to represent a site of C. albicans persistence and source of endogenous re-infection in patients with RVVC. The combined treatment compared favorably with published fluconazole maintenance regimens.

Prevalence of Candida spp. in cervical-vaginal samples and the in vitro susceptibility of isolates

“…The recurrence rate is 40–50%, and approximately 5–8% develop recurrent vulvovaginal candidiasis (RVVC), which is characterized by four or more episodes of disease over a period of twelve months 6, 7, 8…”

Antifungal susceptibilities and identification of Candida species by using maldi-tof microbial identification system from cervicovaginal samples

“…in healthy women belongs to normal genital microflora up to 30%. 10 C. glabrata frequency was the highest (69.4%) of the four Candida species. Isolation rate of C. glabrata are similar to those of Oriel et al and Consolaro et al 11,12 It is normal for asymptomatic women to have a high isolation rate of non-albicans yeast.…”

“…17 Besides, C. albicans is reported as the most dominant species in many studies. 10,16,18,19 This difference in outcome is thought to be due to the fact that the incidence of Candida species varies according to the characteristics of the study group and the geographical region. 20 Because the variation of Candida species differs according to the geographical situation, it is thought that such studies should be repeated in different regions.…”

Antifungal activity of cathelicidin peptides against planktonic and biofilm cultures of Candida species isolated from vaginal infections

“…The standard treatment of uncomplicated VVC is principally based on oral or topically applied azoles, that are effective in more than 90% of C. albicans infections [1]. On the contrary, treatment of complicated VVC such as recurrent VVC and that caused by non-C. albicans species is still challenging mainly due to reduced azole susceptibility of non-C. albicans species and to persistence of C. albicans on the external vulva in patients with recurrent VVC after the cessation of treatment [1,6].…”