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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 -
PloS One 2022Vulvovaginal candidiasis (VVC) is a common infection, and high-quality studies report that misdiagnosis is frequent, with diagnostic testing needed to distinguish it...
Vulvovaginal candidiasis (VVC) is a common infection, and high-quality studies report that misdiagnosis is frequent, with diagnostic testing needed to distinguish it from other causes of vaginitis and avoid inappropriate empiric treatment. However, few recent studies have evaluated U.S. healthcare providers' testing practices for VVC in detail. We evaluated healthcare providers' self-reported testing practices for VVC and treatment outcomes as part of a nationwide online survey in order to identify potential opportunities for improving VVC testing and treatment in the United States. Among 1,503 providers surveyed, 21.3% reported "always" (7.4%) or "usually" (13.9%) ordering diagnostic testing for patients with suspected VVC; this proportion was higher among gynecologists (36.0%) compared with family practitioners (17.8%) and internists (15.8%). Most providers (91.2%) reported that patients' VVC "always" (6.4%) or "usually" (84.9%) responds to initial treatment. Whether the symptom resolution reported in this survey was truly related to VVC is unclear given high rates of misdiagnosis and known widespread empiric prescribing. With only about one-in-five providers reporting usually or always performing diagnostic testing for VVC despite guidelines recommending universal use, research is needed to address barriers to proper testing.
Topics: Female; Humans; United States; Candidiasis, Vulvovaginal; Surveys and Questionnaires; Treatment Outcome; Self-Testing; Health Personnel
PubMed: 36584109
DOI: 10.1371/journal.pone.0278630 -
BMC Public Health Jan 2024Vulvovaginal Candidiasis (VVC) is a public health problem, with approximately 30-50% of women affected at least once during their lifetime. Recurrent Vulvovaginal...
INTRODUCTION
Vulvovaginal Candidiasis (VVC) is a public health problem, with approximately 30-50% of women affected at least once during their lifetime. Recurrent Vulvovaginal Candidiasis (RVVC) is diagnosed following three or four repeated episodes of VVC in a calendar year. This condition poses health concerns with significant impacts on the quality of life of women. This cross-sectional study estimated the prevalence of RVVC and assessed the relationship between feminine/vaginal washes and other factors on RVVC among Ghanaian women in the Sekondi/Takoradi Metropolis.
METHODOLOGY
A cross-sectional study was employed to gather data from 304 women. Data were collected using a pretested questionnaire. Bivariate and multivariate analyses, including chi-square/Fisher's exact test and logistic regression, were performed using Jamovi (R Core Team 2021) software. Proportions were calculated, and odds ratios and their corresponding 95% confidence intervals were computed with the level of significance set at 0.05.
RESULTS
The prevalence of RVVC was estimated as 48.4% (95% CI 42.6%, 54.1%). Feminine Vaginal wash use (aOR = 3.86; 95% CI = 2.18, 6.84); age 36-45 years (aOR = 0.36; 95% CI = 0.17, 0.76) marital status (aOR = 2.37; 95% CI = 1.17, 4.79) and Sexual activity (aOR:0.43: 95%CI = 0.21, 0.88) were significantly associated with RVVC with p < 0.005.
CONCLUSION
RVVC is prevalent among women in the Sekondi/Takoradi Metropolis of Ghana. Feminine/Vaginal washes could be cautiously linked to the development of RVVC.
Topics: Humans; Female; Adult; Middle Aged; Candidiasis, Vulvovaginal; Ghana; Cross-Sectional Studies; Quality of Life; Vagina
PubMed: 38183091
DOI: 10.1186/s12889-024-17668-x -
Revista Brasileira de Ginecologia E... Feb 2022To evaluate genital hygiene among women with and without bacterial vaginosis (BV) and/or vulvovaginal candidiasis (VVC).
OBJECTIVE
To evaluate genital hygiene among women with and without bacterial vaginosis (BV) and/or vulvovaginal candidiasis (VVC).
METHODS
A cross-sectional study of reproductive-aged women who underwent gynecological and laboratory tests and fulfilled a genital hygiene questionnaire.
RESULTS
This study evaluated 166 healthy controls and 141 women diagnosed with either BV (n = 72), VVC (n = 61), or both (n = 8). The use of intimate soap and moist wipes after urination was more frequent among healthy women ( = 0.042 and 0.032, respectively). Compared to controls, bactericidal soap was more used by women with BV ( = 0.05).
CONCLUSION
Some hygiene habits were associated to BV and/or VVC. Clinical trials should address this important issue in women's health.
Topics: Adult; Candidiasis, Vulvovaginal; Cross-Sectional Studies; Female; Habits; Humans; Hygiene; Sexual Behavior; Vagina; Vaginosis, Bacterial
PubMed: 35213915
DOI: 10.1055/s-0041-1741536 -
Journal of Clinical Laboratory Analysis Aug 2021Vulvovaginal candidiasis (VVC) is a common vaginitis in females. The commonly used diagnostic method, 10% potassium hydroxide (KOH) smear microscopy, makes it not very...
BACKGROUND
Vulvovaginal candidiasis (VVC) is a common vaginitis in females. The commonly used diagnostic method, 10% potassium hydroxide (KOH) smear microscopy, makes it not very easy to recognize fungi.
METHODS
Vaginal secretions were collected from clinically suspected VVC patients and divided into four groups and examined using KOH, CFW (Calcofluor White), FB 85(fluorescent brightener 85), and culture. The data were statistically analyzed.
RESULTS
In total, 110 patients with suspected VVC were recruited. The positive rates of KOH, CFW, FB 85, and the culture method were 68.2%, 64.5%, 61.8%, and 77%, respectively. According to the McNemar test, there was no statistically significant difference between the KOH, CFW, and the FB 85 methods (p > 0.05). However, CFW had a shorter diagnosis time than the KOH method and had a statistically significant difference (p < 0.001). Moreover, CFW has the highest sensitivity, specificity, and accuracy. In morphological recognition, it was easier to recognize fungal structures with CFW and FB 85 than with the KOH.
CONCLUSIONS
The fluorescent method is a good method for the diagnosis of VVC. And the fungi can be found more quickly. Similar to CFW, FB 85 is also a potential good fluorescent reagent for the diagnosis of VVC and has potential value for application in clinical fungal infection diseases.
Topics: Adult; Benzenesulfonates; Candida albicans; Candida glabrata; Candida tropicalis; Candidiasis, Vulvovaginal; Female; Fluorescent Dyes; Humans; Hydroxides; Image Processing, Computer-Assisted; Microscopy, Fluorescence; Potassium Compounds; Sensitivity and Specificity; Time Factors
PubMed: 34251053
DOI: 10.1002/jcla.23891 -
Molecules (Basel, Switzerland) Oct 2023In the present work, a series of -terpenyl organoselenium compounds (CHB1-6) were evaluated for antimycotic activity by determining the minimum inhibitory concentration...
In the present work, a series of -terpenyl organoselenium compounds (CHB1-6) were evaluated for antimycotic activity by determining the minimum inhibitory concentration (MIC) for each compound in fluconazole (FLU)-sensitive (S1) and FLU-resistant (S2) strains of (). The most active compounds in the MIC screen were CHB4 and CHB6, which were then evaluated for cytotoxicity in human cervical cancer cells (KB-3-1) and found to be selective for fungi. Next, CHB4 and CHB6 were investigated for skin irritation using a reconstructed 3D human epidermis and both compounds were considered safe to the epidermis. Using a mouse model of vulvovaginal candidiasis (VVC), CHB4 and CHB6 both exhibited antimycotic efficacy by reducing yeast colonization of the vaginal tract, alleviating injury to the vaginal mucosa, and decreasing the abundance of myeloperoxidase (MPO) expression in the tissue, indicating a reduced inflammatory response. In conclusion, CHB4 and CHB6 demonstrate antifungal activity in vitro and in the mouse model of VVC and represent two new promising antifungal agents.
Topics: Female; Humans; Candidiasis, Vulvovaginal; Antifungal Agents; Fluconazole; Candida albicans; Vagina; Microbial Sensitivity Tests
PubMed: 37959796
DOI: 10.3390/molecules28217377 -
Mycoses Jul 2021Vulvovaginal candidiasis (VVC) is a common and debilitating long-term illness affecting million women worldwide. This disease is caused mainly by Candida albicans and a...
Molecular identification and antifungal susceptibility profiles of Candida dubliniensis and Candida africana isolated from vulvovaginal candidiasis: A single-centre experience in Iran.
BACKGROUND
Vulvovaginal candidiasis (VVC) is a common and debilitating long-term illness affecting million women worldwide. This disease is caused mainly by Candida albicans and a lesser extent by other species, including the two phylogenetically closely related pathogens Candida africana and Candida dubliniensis.
OBJECTIVES
In this study, we report detailed molecular epidemiological data about the occurrence of these two pathogenic yeasts in Iranian patients affected by VVC, or its chronic recurrent form (RVVC), and provide, for the first time, data on the antifungal activity of two new drugs, efinaconazole (EFN) and luliconazole (LUL).
METHODS
A total of 133 vaginal yeast isolates, presumptively identified as C albicans by phenotypic and restriction analysis of rDNA, were further analysed by using a specific molecular method targeting the HWP1 gene. All C africana and C dubliniensis isolates were also tested for their in vitro susceptibility to a panel of modern and classical antifungal drugs.
RESULTS AND CONCLUSIONS
Based on the molecular results, among 133 germ-tube positive isolates, we identify 119 C albicans (89.47%), 11 C africana (8.27%) and 3 C dubliniensis (2.26%) isolates. C africana and C dubliniensis showed low MIC values for most of the antifungal drugs tested, especially for EFN and LUL, which exhibited a remarkable antifungal activity. High MIC values were observed only for nystatin and terbinafine. Although C albicans remains the most common Candida species recovered from Iranian VVC/RVVC patients, our data show that its prevalence may be slightly overestimated due to the presence of difficult-to-identify closely related yeast, especially C africana.
Topics: Adult; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; DNA, Fungal; Female; Fungal Proteins; Humans; Imidazoles; Iran; Membrane Glycoproteins; Microbial Sensitivity Tests; Middle Aged; Prevalence; Triazoles
PubMed: 33811780
DOI: 10.1111/myc.13280 -
Molecules (Basel, Switzerland) Dec 2022Commonly found colonizing the human microbiota, is a microorganism known for its ability to cause infections, mainly in the vulvovaginal region known as vulvovaginal...
Commonly found colonizing the human microbiota, is a microorganism known for its ability to cause infections, mainly in the vulvovaginal region known as vulvovaginal candidiasis (VVC). This pathology is, in fact, one of the main clinical manifestations, changing from a colonizer to a pathogen. The increase in VVC cases and limited antifungal therapy make an increasingly frequent risk in women's lives, especially in immunocompromised patients, pregnant women and the elderly. Therefore, it is necessary to develop new therapeutic options, especially those involving natural products associated with nanotechnology, such as lycopene and mesoporous silica nanoparticles. From this perspective, this study sought to assess whether lycopene, mesoporous silica nanoparticles and their combination would be an attractive product for the treatment of this serious disease through microbiological in vitro tests and acute toxicity tests in an alternative in vivo model of . Although they did not show desirable antifungal activity for VVC therapy, the present study strongly encourages the use of mesoporous silica nanoparticles impregnated with lycopene for the treatment of other human pathologies, since the products evaluated here did not show toxicity in the in vivo test performed, being therefore, a topic to be further explored.
Topics: Female; Humans; Pregnancy; Aged; Fluconazole; Candida; Silicon Dioxide; Lycopene; Candidiasis, Vulvovaginal; Antifungal Agents; Candida albicans; Microbial Sensitivity Tests
PubMed: 36500650
DOI: 10.3390/molecules27238558 -
Clinical Microbiology Reviews Jul 1996Recurrent vulvovaginal candidiasis (RVVC) is a prevalent opportunistic mucosal infection, caused predominantly by Candida albicans, which affects a significant number of... (Review)
Review
Recurrent vulvovaginal candidiasis (RVVC) is a prevalent opportunistic mucosal infection, caused predominantly by Candida albicans, which affects a significant number of otherwise healthy women of childbearing age. Since there are no known exogenous predisposing factors to explain the incidence of symptomatic vaginitis in most women with idiopathic RVVC, it has been postulated that these particular women suffer from an immunological abnormality that prediposes them to RVVC. Because of the increased incidence of mucosal candidiasis in individuals with depressed cell-mediated immunity (CMI), defects in CMI are viewed as a possible explanation for RVVC. In this review, we attempt to place into perspective the accumulated information regarding the immunopathogenesis of RVVC, as well as to provide new immunological perspectives and hypotheses regarding potential immunological deficiencies that may predispose to RVVC and potentially other mucosal infections by the same organism. The results of both clinical studies and studies in an animal model of experimental vaginitis suggest that systemic CMI may not be the predominant host defense mechanism against C. albicans vaginal infections. Rather, locally acquired mucosal immunity, distinct from that in the peripheral circulation, is now under consideration as an important host defense at the vaginal mucosa, as well as the notion that changes in local CMI mechanism(s) may predispose to RVVC.
Topics: Animals; Candida; Candida albicans; Candidiasis, Vulvovaginal; Cytokines; Disease Models, Animal; Disease Susceptibility; Female; Host-Parasite Interactions; Humans; Immunity, Innate; Immunity, Mucosal; Mice; Models, Immunological; Th1 Cells; Th2 Cells; Vagina; Vaginitis
PubMed: 8809464
DOI: 10.1128/CMR.9.3.335 -
BMC Women's Health Jan 2019Probiotics are live microorganisms that, when administered in adequate amounts, should confer a health benefit to the host. Media sources tend to present probiotics as...
BACKGROUND
Probiotics are live microorganisms that, when administered in adequate amounts, should confer a health benefit to the host. Media sources tend to present probiotics as an appealing health promotion method able to prevent or treat a wide variety of clinical conditions. In obstetrics and gynaecology, Lactobacilli species are mainly used to restore the physiologic vaginal microbiota in order to treat bacterial vaginosis and vulvovaginal candidiasis (VVC) and prevent preterm birth.
DISCUSSION
Several RCTs investigated the potential benefits of probiotics in gynaecological and obstetrics conditions. For all potential indications, recent specific meta-analyses have been published. Considering vulvovaginal candidiasis in non-pregnant women, probiotics slightly improved the short-term clinical and mycological cure, and reduced the 1-month relapse. However, no important impact of probiotic use was observed on long-term clinical or mycological cure. Similarly, the addition of probiotics to metronidazole for the treatment of bacterial vaginosis was not shown to provide any additional benefit. In obstetrics, using probiotics during pregnancy neither decreased nor increased the risk of preterm birth before 34 weeks or before 37 weeks. Similarly, no benefits emerged for gestational diabetes, preterm premature rupture of membrane, and small and large for gestational age infants.
CONCLUSION
Despite increasing marketing of probiotics for the treatment of vulvovaginal candidiasis and prevention of preterm birth robust evidence demonstrating a beneficial effect is scarce. Moreover, there was considerable heterogeneity among the different studies in terms of route of administration, strain/s of probiotic adopted, and length of probiotic use. Before recommending the systematic use of probiotics to treat bacterial vaginosis and VVC and prevent preterm birth, high-quality research is needed. Professional medical associations should issue recommendations defining if, when, and how probiotics should be used for gynaecological disorders.
Topics: Candidiasis, Vulvovaginal; Delayed-Action Preparations; Female; Humans; Infant; Infant, Newborn; Metronidazole; Pregnancy; Probiotics; Vagina; Vaginosis, Bacterial
PubMed: 30704451
DOI: 10.1186/s12905-019-0723-4