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American Family Physician Jun 2000Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur... (Review)
Review
Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. Although greater than 50 percent of women more than 25 years of age develop vulvovaginal candidiasis at some time, fewer than 5 percent of these women experience recurrences. Clinical evaluation of recurrent episodes is essential. Patients who self-diagnose may miss other causes or concurrent infections. Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. If microscopic examination of vaginal secretions in a potassium hydroxide preparation is negative but clinical suspicion is high, fungal cultures should be obtained. After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. Because many patients experience recurrences once prophylaxis is discontinued, long-term therapy may be warranted. Patients are more likely to comply when antifungal therapy is administered orally, but oral treatment carries a greater potential for systemic toxicity and drug interactions.
Topics: Antifungal Agents; Boric Acids; Candidiasis, Vulvovaginal; Clotrimazole; Drug Interactions; Female; Fluconazole; Humans; Ketoconazole; Patient Education as Topic; Recurrence; Risk Factors; Teaching Materials; Time Factors; Triazoles
PubMed: 10865926
DOI: No ID Found -
MBio May 2018Trained immunity was originally proposed as a program of innate immunity memory by innate immunity cells of hematopoietic origin such as the monocytes/macrophages and... (Review)
Review
Trained immunity was originally proposed as a program of innate immunity memory by innate immunity cells of hematopoietic origin such as the monocytes/macrophages and the NK cells. Here I discuss some old and new data justifying this program and some specific, still unanswered, questions it raises regarding the model fungus and the chronic, inflammatory vulvovaginal disease it causes. Building upon this well-established program, the recent reports that epithelial cells of mammals can also acquire memory from previous stimulations, and the apparent intrinsic ability of many living cells from bacteria to mammals to learn from experience, I suggest an expansion of the concept of trained immunity to include all cells of different lineages with the potential of memorizing previous microbial encounters. This expansion would better fit the complexity of innate immunity and the role it plays in infectious and inflammatory diseases.
Topics: Adaptive Immunity; Animals; Candida albicans; Candidiasis, Vulvovaginal; Cytokines; Female; Humans; Immunity, Innate; Killer Cells, Natural
PubMed: 29789368
DOI: 10.1128/mBio.00570-18 -
Brazilian Journal of Microbiology :... Dec 2020Vulvovaginal candidiasis is a serious health problem affecting numerous women around the world. Its treatment is based on antifungals which may not provide an effective...
Vulvovaginal candidiasis is a serious health problem affecting numerous women around the world. Its treatment is based on antifungals which may not provide an effective cure because of the resistance presented by its etiological pathogens Candida spp. Candida albicans is the most prevalent species related to vulvovaginal candidiasis. Here, we evaluated the in vivo antifungal potential of thiosemicarbazide and thiosemicarbazide encapsulated within chitosan nanoparticles in a murine model of vulvovaginal candidiasis. The results demonstrated the antifungal capacity of free or nanoencapsulated thiosemicarbazide within chitosan to reduce the fungal load in the vaginal tissue of infected mice. In addition, histological analyses indicated the absence or a mild to moderate infection in thiosemicarbazide-treated groups. Statistical tests confirmed the existence of significant differences between the treated and the control groups. Therefore, our results suggest a potential application of thiosemicarbazide and encapsulated thiosemicarbazide as an alternative vulvovaginal candidiasis therapy.
Topics: Animals; Antifungal Agents; Candida albicans; Candidiasis, Vulvovaginal; Chitosan; Drug Evaluation, Preclinical; Female; Mice; Mice, Inbred BALB C; Nanoparticles; Semicarbazides; Vagina
PubMed: 32638273
DOI: 10.1007/s42770-020-00326-w -
Cancer Prevention Research... Feb 2023Genital tract infections, including vulvovaginal candidiasis and bacterial vaginosis, have emerged as potential modulators of persistent human papillomavirus (HPV)...
UNLABELLED
Genital tract infections, including vulvovaginal candidiasis and bacterial vaginosis, have emerged as potential modulators of persistent human papillomavirus (HPV) infections causing cervical cytologic abnormalities and cervical cancer. This study aimed to investigate whether vulvovaginal candidiasis or bacterial vaginosis had an additional effect on HPV infection and thus caused such abnormalities. ThinPrep cytologic tests were used to detect cytologic abnormalities, vulvovaginal candidiasis, and bacterial vaginosis in 14,679 women. Cytologic abnormalities included atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, atypical squamous cells-cannot exclude HSIL, and squamous cell carcinoma. Logistic regression Model 1 (univariate regression) and Model 2 (multivariate logistic regression analysis adjusted for age combined with HPV infection) were used to analyze the association between bacterial vaginosis and cytologic abnormalities, or vulvovaginal candidiasis and cytologic abnormalities, alone or in the presence of HPV infection. Bacterial vaginosis infection rates were found to be significantly higher in the cytology-negative group among all participants and those with HPV infection (P = 0.003, P < 0.001, respectively). Analyses using Model 1 and Model 2 both pointed to bacterial vaginosis as a protective factor against cytologic abnormalities for all participants (OR = 0.36, 0.17, respectively, P < 0.05) and for HPV-infected participants (OR = 0.17, 0.16, respectively, P < 0.05). Neither vulvovaginal candidiasis nor vulvovaginal candidiasis + HPV was significantly associated with the incidence of cytologic abnormalities based on Model 1 (OR = 0.94, 0.71, respectively, P > 0.05) and Model 2 (OR = 0.91, 0.74, respectively, P > 0.05). Furthermore, neither vulvovaginal candidiasis nor bacterial vaginosis increased the incidence of cytologic abnormalities regardless of HPV infection status, while bacterial vaginosis might possibly prevent cytologic abnormalities in women coinfected by HPV.
PREVENTION RELEVANCE
Neither vulvovaginal candidiasis nor bacterial vaginosis was found to increase the incidence of cervical cytologic abnormalities with or without the presence of HPV. On the contrary, bacterial vaginosis may play a role in preventing cytologic abnormalities in women with HPV coinfection.
Topics: Female; Humans; Uterine Cervical Dysplasia; Papillomavirus Infections; Vaginosis, Bacterial; Vaginal Smears; Candidiasis, Vulvovaginal; Uterine Cervical Neoplasms; Papillomaviridae
PubMed: 36280380
DOI: 10.1158/1940-6207.CAPR-22-0288 -
Sexually Transmitted Infections Dec 2006
Topics: Candidiasis, Vulvovaginal; Data Interpretation, Statistical; Diagnosis, Differential; Female; Humans; Mass Screening; Secondary Prevention; Specimen Handling; Vaginal Discharge; Vaginal Smears
PubMed: 17151050
DOI: 10.1136/sti.2006.023168 -
Revista Espanola de Quimioterapia :... Jun 2020Vulvovaginal candidiasis (VVC) is a common vaginal infection. Risk factors include diabetes, antibiotic use and pregnancy. Candida albicans is the most common species...
OBJECTIVE
Vulvovaginal candidiasis (VVC) is a common vaginal infection. Risk factors include diabetes, antibiotic use and pregnancy. Candida albicans is the most common species identified but non-C. albicans species appear to be more commonly associated with VVC in some Asian and African countries. We had studied the distribution of Candida species in Spanish and immigrants' women residents in Spain.
METHODS
Retrospective study of vaginal yeast cultures between 2015 and 2018.
RESULTS
A total of 2,283 vaginal yeast cultures were collected. Candida spp. was detected in 25.7% from Spanish women and in 28.5% from immigrants (no significant differences). Immigrants have higher rates of vaginal candidiasis compared other studies in Spain. C. albicans was the most common species isolated (82.4%).
CONCLUSIONS
There were no differences in vaginal candidiasis rate between Spanish and immigrants' women. Immigrants consulted proportionally more compared with the Spanish women.
Topics: Adolescent; Adult; Africa; Aged; Aged, 80 and over; Asia; Candida albicans; Candidiasis, Vulvovaginal; Child; Child, Preschool; Emigrants and Immigrants; Female; Humans; Infant; Middle Aged; Retrospective Studies; Risk Factors; Spain; Young Adult
PubMed: 32304363
DOI: 10.37201/req/099.2019 -
Advanced Science (Weinheim,... Dec 2023Candida albicans (C. albicans), a ubiquitous polymorphic fungus in humans, causes different types of candidiasis, including oral candidiasis (OC) and vulvovaginal...
Candida albicans (C. albicans), a ubiquitous polymorphic fungus in humans, causes different types of candidiasis, including oral candidiasis (OC) and vulvovaginal candidiasis (VVC), which are physically and mentally concerning and financially costly. Thus, developing alternative antifungals that prevent drug resistance and induce immunity to eliminate Candida biofilms is crucial. Herein, a novel membrane-targeted aggregation-induced emission (AIE) photosensitizer (PS), TBTCP-QY, is developed for highly efficient photodynamic therapy (PDT) of candidiasis. TBTCP-QY has a high molar absorption coefficient and an excellent ability to generate O and •OH, entering the interior of biofilms due to its high permeability. Furthermore, TBTCP-QY can efficiently inhibit biofilm formation by suppressing the expression of genes related to the adhesion (ALS3, EAP1, and HWP1), invasion (SAP1 and SAP2), and drug resistance (MDR1) of C. albicans, which is also advantageous for eliminating potential fungal resistance to treat clinical infectious diseases. TBTCP-QY-mediated PDT efficiently targets OC and VVC in vivo in a mouse model, induces immune response, relieves inflammation, and accelerates the healing of mucosal defects to combat infections caused by clinically isolated fluconazole-resistant strains. Moreover, TBTCP-QY demonstrates excellent biocompatibility, suggesting its potential applications in the clinical treatment of OC and VVC.
Topics: Mice; Humans; Female; Animals; Photosensitizing Agents; Antifungal Agents; Candidiasis; Candidiasis, Vulvovaginal; Candida albicans; Drug Resistance; Immunity
PubMed: 37875397
DOI: 10.1002/advs.202207736 -
PloS One 2022Vulvovaginal candidiasis (VVC) is a common cause of vaginitis, but the national burden is unknown, and clinical diagnosis without diagnostic testing is often inaccurate....
Vulvovaginal candidiasis (VVC) is a common cause of vaginitis, but the national burden is unknown, and clinical diagnosis without diagnostic testing is often inaccurate. We aimed to calculate rates and evaluate diagnosis and treatment practices of VVC and recurrent vulvovaginal candidiasis (RVVC) in the United States. We used the 2018 IBM® MarketScan® Research Databases, which include health insurance claims data on outpatient visits and prescriptions for >28 million people. We used diagnosis and procedure codes to examine underlying conditions, vaginitis-related symptoms and conditions, diagnostic testing, and antibacterial and antifungal treatment among female patients with VVC. Among 12.3 million female patients in MarketScan, 149,934 (1.2%) had a diagnosis code for VVC; of those, 3.4% had RVVC. The VVC rate was highest in the South census region (14.3 per 1,000 female patients) and lowest in the West (9.9 per 1000). Over 60% of patients with VVC did not have codes for any diagnostic testing, and microscopy was the most common test type performed in 29.5%. Higher rates of diagnostic testing occurred among patients who visited an OB/GYN (53.4%) compared with a family practice or internal medicine provider (24.2%) or other healthcare provider types (31.9%); diagnostic testing rates were lowest in the South (34.0%) and highest in the Midwest (41.0%). Treatments on or in the 7 days after diagnosis included systemic fluconazole (70.0%), topical antifungal medications (19.4%), and systemic antibacterial medications (17.2%). The low frequencies of diagnostic testing for VVC and high rates of antifungal and antibacterial use suggest substantial empiric treatment, including likely overprescribing of antifungal medications and potentially unnecessary antibacterial medications. These findings support a need for improved clinical care for VVC to improve both patient outcomes and antimicrobial stewardship, particularly in the South and among non-OB/GYN providers.
Topics: Anti-Bacterial Agents; Antifungal Agents; Candidiasis, Vulvovaginal; Diagnostic Errors; Diagnostic Techniques and Procedures; Female; Humans; Male; Recurrence; United States
PubMed: 35482794
DOI: 10.1371/journal.pone.0267866 -
BMJ (Clinical Research Ed.) Aug 1994
Topics: Adult; Candidiasis, Vulvovaginal; Cystic Fibrosis; Female; Humans
PubMed: 7993497
DOI: 10.1136/bmj.309.6952.475 -
Women's Health (London, England) 2023Recurrent vulvovaginal candidiasis management primarily entails azole therapy used as required or as an extended daily or weekly maintenance therapy for 6 months or... (Randomized Controlled Trial)
Randomized Controlled Trial
Intravaginal Combination Therapy of Acetic and Lactic Acid in premenopausal women with recurrent vulvovaginal candidiasis: A randomized, double-blind placebo-controlled feasibility trial.
BACKGROUND
Recurrent vulvovaginal candidiasis management primarily entails azole therapy used as required or as an extended daily or weekly maintenance therapy for 6 months or more. Unfortunately, relapse within 3-6 months of ceasing maintenance therapy is experienced for more than half the patients, for whom indefinite treatment is required.
OBJECTIVES
To explore the feasibility of trial design examining a prophylaxis treatment to prevent recurrent vulvovaginal candidiasis symptomatic episodes and reduce adverse effects.
STUDY DESIGN
A double-blinded randomized controlled feasibility trial was conducted in Australia. Women with recurrent vulvovaginal candidiasis were enrolled.
METHODS
An intravaginal prophylaxis application of lactic acid and acetic acid (Intravaginal Combination Therapy of Acetic and Lactic Acid) was compared with placebo. Primary outcomes comprised recruitment and retention, compliance to study medications and study assessments. Secondary outcomes included the reduction of symptomatic recurrence over the trial period and the acceptability, satisfaction, safety and tolerability of the intervention. The feasibility of quality-of-life measures was also explored.
RESULTS
Fifteen participants were enrolled and randomized (active = 9, placebo = 6). Consent rate was 23.4%. Eight participants were lost to follow-up (active = 5, placebo = 3). Forty-seven per cent of participants (n = 7) were 100% compliant with the intervention, six of which completed the trial with good assessment compliance. The blinding process was effective. The study demonstrated a reduction in relapse in both active and placebo groups with only four participants across both groups reporting symptomatic episodes while enrolled. The intervention demonstrated good tolerability. Quality-of-life data showed minimal variance with a high quality-of-life measure.
CONCLUSION
This trial assesses the feasibility of conducting a large-scale study exploring the efficacy of the Intravaginal Combination Therapy of Acetic and Lactic Acid intravaginal intervention and hints on the importance of psychological support through appropriate disease-specific communication and clinical attention. Consideration of the reported recruitment challenges, the inclusion of suitable quality-of-life measures and digital data collection is warranted for adaptation to a fully powered trial.
Topics: Female; Humans; Australia; Candidiasis, Vulvovaginal; Feasibility Studies; Recurrence; Double-Blind Method
PubMed: 37635435
DOI: 10.1177/17455057231194138