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Risk factors for recurrent vulvovaginal candidiasis  [PDF]
Jankovi? Slobodan,Bojovi? Dragica,Vukadinovi? Dubravka,Daglar Elmedina
Vojnosanitetski Pregled , 2010, DOI: 10.2298/vsp1010819j
Abstract: Background/Aim. Recurrent vulvovaginal candidiasis is relatively frequent condition, and may have serious health consequences, like chronic vulvovaginal pain syndrome. The aim of our study was to determine possible risk factors for recurrent vulvovaginal candidiasis in non-pregnant females within the reproductive age. Methods. The design of our study was of a case-control type. Case and control patients were selected from the gynecological patients at six primary care facilities in Serbia and in Montenegro. The data on the patients' health condition, concomitant therapy and diseases were taken from their records, and the data on habits were obtained by unstructured interview. For potential risk factors crude odds ratios were calculated, and then adjusted by logistic regression. Results. A total of fifty-one patients had four or more episodes of vulvovaginal candidiasis during the last year (cases), and 132 patients with one to three episodes of vulvovaginal candidiasis were sampled as controls, matched by age. The only two significant associations were found between recurrent vulvovaginal candidiasis and continual wearing of panty liners during the last year (Odds ratio - ORadjusted: 3.97; confidence interval - CI: 1.57-10.02; p = 0.004), and between recurrent vulvovaginal candidiasis and predominant use of vaginal tampons during menstruation in the last year (ORadjusted: 4.25; CI: 1.11-16.27; p = 0.035). The synergistic effect was observed for the concurrent continual wearing of panty liners during the last year and selfmedication with antimycotics. Conclusions. Local factors, like wearing of panty liners or use of tampons during menstruation, may promote recurrence of vulvovaginal candidiasis, especially in patients who practice selfmedication with antimycotics.
Zinc Level of Serum in Recurrent Vulvovaginal Candidiasis
M. Zangeneh,S.D. Siadat,M. Jamshidi,M. Alijani,B. Farhoudi,M. Valizadeh
Research Journal of Biological Sciences , 2012,
Abstract: Zinc status has been shown to influence various cell-mediated immunologic mechanisms. These cell-mediated mechanisms are important in preventing mucocutaneous infections caused by Candida albicans. This study evaluated the relationship between zinc status and recurrent vulvovaginal candidiasis by comparing plasma zinc in 51 patients with recurrent vulvovaginal candidiasis and 50 control healthy age-matched women. The results indicated that zinc concentration in plasma in patients with recurrent vulvovaginal candidiasis and control group showed no significant difference between case and control group (p = 0.605), 4(8%) women of control group and 5(11/1%) women of patients group had zinc concentration lower than normal. Also, no significant difference between the mean plasma zinc concentration (case group 48-189 g dL 1 and control group 57-120 g dL 1) in the patient and control group (87 g dL 1, std 23.5, 74.9 g dL 1, std 13 g dL 1) (p = 0.031) .
Zinc Level of Serum in Recurrent Vulvovaginal Candidiasis
M. Zangeneh,S.D. Siadat,M. Jamshidi,M. Alijani
Research Journal of Biological Sciences , 2008,
Abstract: Zinc status has been shown to influence various cell-mediated immunologic mechanisms. These cell-mediated mechanisms are important in preventing mucocutaneous infections caused by Candida albicans. This study evaluated the relationship between zinc status and recurrent vulvovaginal candidiasis by comparing plasma zinc in 51 patients with recurrent vulvovaginal candidiasis and 50 control healthy age-matched women. The results indicated that zinc concentration in plasma in patients with recurrent vulvovaginal candidiasis and control group showed no significant difference between case and control group (p = 0.605), 4(8%) women of control group and 5(11/1%) women of patients group had zinc concentration lower than normal. Also, no significant difference between the mean plasma zinc concentration (case group 48-189 μg dL-1 and control group 57-120 μg dL -1) in the patient and control group (87 μg dL-1, std 23.5, 74.9 μg dL-1, std 13 μg dL-1) (p = 0.031) .
Gene Polymorphisms in Pattern Recognition Receptors and Susceptibility to Idiopathic Recurrent Vulvovaginal Candidiasis  [PDF]
Diana Rosentul,Martin Jaeger,Theo Plantinga,Irene Constantini,Jos W. Van Der Meer,Jack Sobel
Frontiers in Microbiology , 2014, DOI: 10.3389/fmicb.2014.00483
Abstract: Objective. Approximately 5% of women suffer from recurrent vulvovaginal candidiasis (RVVC). It has been hypothesized that genetic factors play an important role in the susceptibility to RVVC. The aim of this study was to assess the effect of genetic variants of genes encoding for Pattern Recognition Receptors (PRRs) on susceptibility to RVVC. Study design. For the study, 119 RVVC patients and 263 healthy controls were recruited. Prevalence of polymorphisms in five PRRs involved in recognition of Candida were investigated in patients and controls. In silico and functional studies were performed to assess their functional effects. Results. Single nucleotide polymorphisms (SNPs) in TLR1, TLR4, CLEC7A and CARD9 did not affect the susceptibility to RVVC. In contrast, a non-synonymous polymorphism in TLR2 (rs5743704, Pro631His) increased the susceptibility to RVVC almost 3-fold. Furthermore, the TLR2 rs5743704 SNP had deleterious effects on protein function as assessed by in-silico analysis, and in-vitro functional assays suggested that it reduces production of IL-17 and IFN? upon stimulation of peripheral blood mononuclear cells with C. albicans. No effects were observed on serum MBL concentrations. Conclusion. Genetic variation in TLR2 may significantly enhance susceptibility to RVVC by modulating host defense mechanisms against Candida. Additional studies are warranted to assess systematically the role of host genetic variation for susceptibility to RVVC.
Long Term Vaginal Azoles Versus Prophylactic Oral Fluconazole in Treatment of Recurrent Vulvovaginal Candidiasis
Zahra Fardy Azar,Shahram Habib Zadeh
Research Journal of Biological Sciences , 2012,
Abstract: Recurrent Vulvovaginal Candidiasis (RVVC) is a fungal infection of the vagina and vulva that occur usually = 4 episodes in a year. Our object was to compare the efficacy and safety of a single oral dose of fluconazole (150 mg) weekly with clotrimazole vaginal cream 150 mg twice weekly for 6 months as treatment of recurrent VVC. We conducted a clinical trial study among 124 women with Recurrent Vulvovaginal Candidiasis (RVVC) among patients presenting to the Obstetrics and Gynecology Clinics of Tabriz University of Medical Sciences from 2002-2004. There was no significant difference in the therapeutic response as the recurrence rate during 12 months between the two groups. The drug side effects in the fluconazole group were significantly more than clotrimazole group. The satisfactory from the drug in the fluconazole group was significantly less than clotrimazole group. Due to the fewer side effects and more satisfactory of local treatment, we recommend profilactic use of Azole vaginal creams for treatment of RVVC especially in women who are pregnant or have systemic problems.
How Vaginal Infections Impact Women’s Everyday Life
—Women’s Lived Experiences of Bacterial Vaginosis and Recurrent Vulvovaginal Candidiasis
 [PDF]

Annsofie Adolfsson, Anna Hagander, Farzane Mahjoubipour, Per-G?ran Larsson
Advances in Sexual Medicine (ASM) , 2017, DOI: 10.4236/asm.2017.71001
Abstract: Reoccurring symptoms and persistent problems that continue post treatment can be characteristic of the vaginal infections Bacterial Vaginosis (BV) and recurrent vulvovaginal candidiasis (RVVC). The purpose of this study was to describe women’s life experiences in managing the symptoms of bacterial vaginosis and Candida. Sixteen women were recruited and participated in an interview study when they contacted a Swedish gynecology clinic with vaginal complaints that ranged from and included abnormal discharge, irritation itching along with serious malodor. An interpretive phenomenological approach was used with an individual interview to get a more intimate understanding of the women experiencing these problems. The finding of this study shows that managing the recurrent symptoms of the infections remains to be a challenge for women as it has a clearly negative impact on the quality of their lives. Four themes developed: frustration and mood disorders, intimacy changes in the relationship, exposure, hope and relief. The women had high hopes of eliminating the symptoms within the six-month study period. The treatment program, with its well-developed guidelines and continuity of care within the context of the study greatly improved the quality of life of these women. Women had feelings of frustration and anxiety when nothing could cure their problem while they had also a great hope to get rid of the symptoms with a long striking treatment. Well-developed guidelines and continuity of care can help these women to have an improved quality of life.
Comparison between Fluconazole with Oral Protexin Combination and Fluconazole in the Treatment of Vulvovaginal Candidiasis  [PDF]
S. Nouraei,S. Amir Ali Akbari,M. Jorjani,H. Alavi Majd,M. Afrakhteh,A. Ghafoorian,H. Tafazzoli Harandi
ISRN Obstetrics and Gynecology , 2012, DOI: 10.5402/2012/375806
Abstract: Background. According to the limited studies reporting new treatments for vulvovaginal candidiasis, this study was designed to compare the combination of fluconazole and oral protexin with fluconazole in the treatment of vulvovaginal candidiasis. Methods. A double-blind clinical trial was conducted, involving 90 women who were referred to the gynecology clinic. Vulvovaginal candidiasis was diagnosed with itching, cheesy vaginal discharge, and any one of the following: dysuria, pH < 4.5, dyspareunia, vulvar erythema, or vulvar edema and if branched hyphae and Candida buds were visible after addition of KOH 10% in the culture and the result of cultivation in Sabouraud’s dextrose agar medium was positive. Patients were randomly classified into two groups Absence of discharge, itching, and negative culture results 5–7 days after completion of treatment indicated treatment success. Data in this study were analyzed using the SPSS version 17.0 software. Results. The combinations, fluconazole-oral protexin and fluconazole-placebo, were equally effective in reduction of complaints and symptoms, but fluconazole-oral protexin combination elicited a better therapeutic response ( , ). In addition, fluconazole-oral protexin combination treatment demonstrated better recovery time ( , ). Conclusion. This study demonstrated that complementary treatment with probiotic Lactobacillus increased the efficacy of fluconazole in treatment of vulvovaginal candidiasis. Further research is recommended. 1. Introduction Vaginitis is the most common gynecological problem, for which women seek treatment [1, 2]. Four types of infectious vaginitis are commonly found in women—candidiasis, trichomoniasis, bacterial vaginosis, and gonococcal infections [3]. Among these, candidiasis is the second most common vaginal infection. Seventy-five percent of women suffer from vulvovaginal candidiasis at least once during their lives, almost 45% of women experience the disease twice or more annually and approximately 5% of women are diagnosed with chronic and recurrent infections [4–6]. The disease is most prevalent among women aged 25–35 years. A variation in the incidence of vulvovaginal candidiasis in various communities has been reported in Iran. The prevalence of vulvovaginal candidiasis in Mashhad was reported to be 43% in 2005 [7]; in 1997, it was reported to be 19.8% in Kerman, 22.3% in Kashan, and 26.7% in Sari [8]. The etiology of vulvovaginal candidiasis also varies. Candida albicans is the most commonly found genera in the genitalia in 80–90% of cases of vulvovaginal candidiasis. C.
Polyhexamethylene Biguanide in Vaginal Solution Is Effective in the Treatment of Vulvovaginal Candidiasis: A Pilot Study  [PDF]
Alberto Biamonti, Angela Saracino
Open Journal of Obstetrics and Gynecology (OJOG) , 2017, DOI: 10.4236/ojog.2017.71002
Abstract: Vaginitis is one of the most recurrent conditions that afflict women and require medical care. Vulvovaginal candidiasis (VVC) is frequently related to vaginal carriage of Candida albicans, an opportunistic polymorphic fungus, which colonizes the human skin, the mucosa and the reproductive tract. Actually, standard treatments to counteract vaginitis include several topical and oral treatments. The aim of this study was to evaluate the efficacy of a new biguanide compound, polyhexamethylene biguanide (PHMB) in avaginal solution, in women affected by vaginal candidiasis. For this reason, 40 women showing the symptoms previously ascribed to vaginal candidiasis were recruited and treated with a single PHMB dose of vaginal solution. After a single dose of treatment, 80% of them had a complete resolution of the fungal infection; furthermore, all of them reported clinical benefits, statistically significant reduction in both clinical signs and symptoms of candidiasis and a score’s reduction of 50%.
Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care
Isabel Del-Cura González, Francisca García-de-Blas González, Teresa Cuesta, Jesús Fernández, Justo M Del-Alamo Rodríguez, Rosa A Escriva Ferrairo, M del Canto De-Hoyos Alonso, Laura Arenas, Ricardo Barrientos, Elisa Wiesmann, Cristina De-Alba Romero, Yolanda Díaz, Ana Rodríguez-Mo?ino, Blanca Teira, Marta del Pozo, Jesús Horcajuelo, María J Rojas Giraldo, Paulino González, Rocío A Vello Cuadrado, Beatriz Uriarte, Jeannet Yepes, Yolanda Sanz, M Iglesias Pi?eiro, Susana Hernández, Fernando Alonso, Ana I González González, Alicia Fernández, Carmen Carballo, Ana López, Fernanda Morales
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-63
Abstract: This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.Vaginitis is the most frequent reason for gynecology consultation in primary health care services. It is estimated that 75% of women experience at least one episode of vulvovaginal candidiasis throughout her life and 40-50% of them have at least one recurrence [1].The most frequent cause of vulvovaginal inflammation is infective, beeing the main organisms: Gardnerella vaginalis (15-50%), Candida (C) (20-25%) and Trichomonas vaginalis (5-50%) species, with a frequency distribution that depends on the populations studied [2]. Candidal vaginitis is a generic term used for vaginal infections caused by Candida species. Candida albicans is responsible for 90% of vulvovaginal candidiasis; the remaining 10% corresponds to C. glabrata and C
Identification of Candida Species Associated with Vulvovaginal Candidiasis by Multiplex PCR  [PDF]
Mahnaz Mahmoudi Rad,Ameneh Sh Zafarghandi,Maryam Amel Zabihi,Mahkam Tavallaee,Yasaman Mirdamadi
Infectious Diseases in Obstetrics and Gynecology , 2012, DOI: 10.1155/2012/872169
Abstract: Background. Vulvovaginal candidiasis is a common infection. The aim of this study was to identify the species of vaginal Candida isolates by using multiplex PCR technique. Methods. 191 isolates from patients admitted to Mahdieh hospital were identified. The vaginal swab specimens were cultured on Sabouraud Dextrose Agar. The ITS1 region between the 18S and 5.8S rRNA genes and a specific DNA fragment within the ITS2 region were amplified. The multiplex PCR products were separated by electrophoresis in 2% agarose gel, visualized by staining with ethidium bromide, and photographed. Descriptive statistics, Chi-square test, and Spearman correlation were used to summarize the findings. Results. C. albicans and C. glabrata were the most common species isolated from the specimens. A mix of C. glabrata and C. albicans was the most common mixed infection isolated from the samples. The analysis revealed a significant positive association between older age and infection with C. glabrata isolates (Spearman’s rho = 0.89, ). Conclusion. Multiplex PCR is a fast, yet reliable method to identify Candida species. C. albicans and then C. glabrata are the two most common causes of vulvovaginal candidiasis. The number of mixed fungal infections is higher among Iranian population compared to international reports. 1. Introduction Candida species are the second most common cause of vulvovaginitis worldwide [1]. The prevalence of vulvovaginal candidiasis (VVC) is increasing due to the extensive utilization of broad-spectrum antibiotics as well as increased cases of immunocompromised patients [2, 3]. Nearly 75% of women over 25 years of age, reported to have at least one episode of physician approved VVC during their lifetime and 5% experienced recurrent type; which is defined by getting infected for at least 4 times in a one-year period [4]. However, 20–50% of women have Candida species in their vaginal flora without showing any clinical symptoms [4, 5]. C. albicans is the most common and clinically relevant species that accounts for 85–90% of VVC [4]. However, there has been a significant trend towards the emergence of other species such as C. glabrata, C. krusei, and C. parapsilosis which ironically show more resistance to the first line antifungal treatments [6]. Hence, the differentiation of diverse species of Candida in the laboratories seems necessary. Traditionally, the identification and classification of Candida species were done by time consuming and unreliable methods such as serotyping [7], colony morphotyping [8], conventional culture techniques, and morphological
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