Symptomatic candidiasis: Using self sampled vaginal smears to establish the presence of Candida, lactobacilli, and Gardnerella vaginalis

Abstract

In a prospective cohort study, 10 symptomatic women with recurrent vulvovaginal candidiasis were taught how to prepare vaginal smears of their own vaginal fluids on days 7, 14, 21, and 28. The 40 smears were stained with the PAS-method and examined by three different cytopathologists for presence of Candida. Thereafter, the smears were restained with Giemsa-stain to determine presence of lactobacilli, Gardnerella vaginalis ("clue cells") and neutrophils. All three cytopathologists unequivocally established Candida blastospores and (pseudo)hyphae in 27 out of the 40 PAS-stained vaginal smears, whereas in the remaining 13 smears Candida was not found. All 10 patients had Candida in their smears during the second half of their menstrual cycle.Self sampled smears prove to be reliable for establishing the presence of Candida in symptomatic patients with candidiasis. Candida is associated with a lactobacillus-predominated vaginal flora, but with the absence of Gardnerella vaginalis. Further studies may be directed towards the interaction between the various members of the vaginal flora. This study should open molecular methodology for determining the possible interactions of lactobacilli and Candida.

Self-Sampling in the Diagnosis of Recurrent Vulvovaginal Candidosis

“…Vulvovaginal complaints account for a large number of visits to general practitioners and medical specialists. The most common underlying cause of abnormal vaginal discharge is an infection with Candida albicans (25%Y35%) [1,2].…”

C<b><i>andida albicans </i></b>and Bacterial Vaginosis Can Coexist on Pap Smears

“…In our study, they were observed in 62.8% (296/471) and 37.2% (175/471) of the cases, respectively. The low detection of blastospores may be due to masking by epithelial cell flake-off, cell detritus and leukocytes [16], or to a failure to recognize them because they are relatively small [8,17]. The reports show Pap smear is insensitive for the detection of Candida spp., with positive results in only about 25% of patients with culture-positive symptomatic vulvovaginal candidiasis (VVC) [2].…”

“…was of lactobacilli, present in 73.63% of the instances, followed by mixed flora (25.40%) and BV (0.73%). Engberts et al [8] found that BV ‘clue cells’ were not to be seen in all smears of the patients without recurrent VVC. Sobel et al [9] reported a similar association between VVC and Lactobacillus species.…”

“…The relationship between Candida albicans and BV remains controversial [5,6,7,8,9,10,11,12]. It is generally thought that coexisting C. albicans and BV are rare [5]; the reasoning behind this is that the growth requirements of the two are completely opposite to each other [6], but a recent study has indicated that this view is incorrect [10].…”

<b><i>Gardnerella</i></b>,<b><i> Trichomonas </i></b>and <b><i>Candida </i></b>in Cervical Smears of 58,904 Immigrants Participating in the Dutch National Cervical Screening Program

“…KOPAC is an acronym (in Dutch), the KOPAC O-axis stands for inflammatory events including O2 for Trichomonas [3], O4 for Candida species [3,4,5,6], O5 for Gardnerella [7,8] and O6 for normal flora [9]. Koilocytes (associated with HPV infection) are coded as O1 [10].…”