Skip to main content
PMC home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2001 Jun;77(3):179–183. doi: 10.1136/sti.77.3.179

An investigation into the pathogenesis of vulvo-vaginal candidosis

S El-Din 1, M Reynolds 1, H Ashbee 1, R Barton 1, E Evans 1
PMCID: PMC1744307  PMID: 11402224

Abstract

Objective: To monitor yeasts isolated from women during and between episodes of recurrent vulvo-vaginal candidosis (VVC) to determine whether vaginal relapse or re-infection occurred.

Methods: Women presenting at the genitourinary medicine clinic with signs and symptoms of VVC were recruited to the study (n = 121). A vaginal washing, high vaginal swab (HVS) and rectal swab were taken and the women treated with a single 500 mg clotrimazole pessary. Women were asked to re-attend after 1, 4, and 12 weeks, or when the VVC recurred, when vaginal washings and HVS were repeated. Candida isolates recovered were strain typed using the Ca3 probe and their similarity assessed. Antifungal susceptibility to fluconazole and clotrimazole were determined.

Results: Of the women recruited, 47 completed the study, either returning for four visits or suffering a recurrence during the study period. Of the 22 women who experienced recurrence, the same strain was responsible for the initial and recurrent episode in 17 women. For the remaining five women, four had strain replacement and one had a change of species. None of the isolates recovered from the women demonstrated resistance to either clotrimazole or fluconazole.

Conclusions: Our findings support the theory of vaginal relapse and thus may support the use of more prolonged courses of antifungal therapy initially to increase the chances of eradication of the yeast.

Key Words: vaginal candidosis

Full Text

The Full Text of this article is available as a PDF (146.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bisschop M. P., Merkus J. M., Scheygrond H., van Cutsem J. Co-treatment of the male partner in vaginal candidosis: a double-blind randomized control study. Br J Obstet Gynaecol. 1986 Jan;93(1):79–81. doi: 10.1111/j.1471-0528.1986.tb07818.x. [DOI] [PubMed] [Google Scholar]
  2. Buch A., Skytte Christensen E. Treatment of vaginal candidosis with natamycin and effect of treating the partner at the same time. Acta Obstet Gynecol Scand. 1982;61(5):393–396. doi: 10.3109/00016348209156578. [DOI] [PubMed] [Google Scholar]
  3. Fidel P. L., Jr, Sobel J. D. Immunopathogenesis of recurrent vulvovaginal candidiasis. Clin Microbiol Rev. 1996 Jul;9(3):335–348. doi: 10.1128/cmr.9.3.335. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fong I. W., Bannatyne R. M., Wong P. Lack of in vitro resistance of Candida albicans to ketoconazole, itraconazole and clotrimazole in women treated for recurrent vaginal candidiasis. Genitourin Med. 1993 Feb;69(1):44–46. doi: 10.1136/sti.69.1.44. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hopwood V., Crowley T., Horrocks C. T., Milne J. D., Taylor P. K., Warnock D. W. Vaginal candidosis: relation between yeast counts and symptoms and clinical signs in non-pregnant women. Genitourin Med. 1988 Oct;64(5):331–334. doi: 10.1136/sti.64.5.331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kinghorn G. R. Vulvovaginal candidosis. J Antimicrob Chemother. 1991 Jul;28 (Suppl A):59–66. doi: 10.1093/jac/28.suppl_a.59. [DOI] [PubMed] [Google Scholar]
  7. Lockhart S. R., Reed B. D., Pierson C. L., Soll D. R. Most frequent scenario for recurrent Candida vaginitis is strain maintenance with "substrain shuffling": demonstration by sequential DNA fingerprinting with probes Ca3, C1, and CARE2. J Clin Microbiol. 1996 Apr;34(4):767–777. doi: 10.1128/jcm.34.4.767-777.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Lynch M. E., Sobel J. D., Fidel P. L., Jr Role of antifungal drug resistance in the pathogenesis of recurrent vulvovaginal candidiasis. J Med Vet Mycol. 1996 Sep-Oct;34(5):337–339. doi: 10.1080/02681219680000571. [DOI] [PubMed] [Google Scholar]
  9. Meinhof W. Demonstration of typical features of individual Candida albicans strains as a means of studying sources of infection. Chemotherapy. 1982;28 (Suppl 1):51–55. doi: 10.1159/000238153. [DOI] [PubMed] [Google Scholar]
  10. Mercure S., Poirier S., Lemay G., Auger P., Montplaisir S., de Repentigny L. Application of biotyping and DNA typing of Candida albicans to the epidemiology of recurrent vulvovaginal candidiasis. J Infect Dis. 1993 Aug;168(2):502–507. doi: 10.1093/infdis/168.2.502. [DOI] [PubMed] [Google Scholar]
  11. Milne J. D., Warnock D. W. Effect of simultaneous oral and vaginal treatment on the rate of cure and relapse in vaginal candidosis. Br J Vener Dis. 1979 Oct;55(5):362–365. doi: 10.1136/sti.55.5.362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. O'Connor M. I., Sobel J. D. Epidemiology of recurrent vulvovaginal candidiasis: identification and strain differentiation of Candida albicans. J Infect Dis. 1986 Aug;154(2):358–363. doi: 10.1093/infdis/154.2.358. [DOI] [PubMed] [Google Scholar]
  13. Odds F. C. Genital candidosis. Clin Exp Dermatol. 1982 Jul;7(4):345–354. doi: 10.1111/j.1365-2230.1982.tb02441.x. [DOI] [PubMed] [Google Scholar]
  14. Scherer S., Stevens D. A. Application of DNA typing methods to epidemiology and taxonomy of Candida species. J Clin Microbiol. 1987 Apr;25(4):675–679. doi: 10.1128/jcm.25.4.675-679.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Schmid J., Voss E., Soll D. R. Computer-assisted methods for assessing strain relatedness in Candida albicans by fingerprinting with the moderately repetitive sequence Ca3. J Clin Microbiol. 1990 Jun;28(6):1236–1243. doi: 10.1128/jcm.28.6.1236-1243.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Soll D. R., Galask R., Isley S., Rao T. V., Stone D., Hicks J., Schmid J., Mac K., Hanna C. Switching of Candida albicans during successive episodes of recurrent vaginitis. J Clin Microbiol. 1989 Apr;27(4):681–690. doi: 10.1128/jcm.27.4.681-690.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Southern E. M. Detection of specific sequences among DNA fragments separated by gel electrophoresis. J Mol Biol. 1975 Nov 5;98(3):503–517. doi: 10.1016/s0022-2836(75)80083-0. [DOI] [PubMed] [Google Scholar]
  18. Spinillo A., Carratta L., Pizzoli G., Lombardi G., Cavanna C., Michelone G., Guaschino S. Recurrent vaginal candidiasis. Results of a cohort study of sexual transmission and intestinal reservoir. J Reprod Med. 1992 Apr;37(4):343–347. [PubMed] [Google Scholar]
  19. Stein G. E., Sheridan V. L., Magee B. B., Magee P. T. Use of rDNA restriction fragment length polymorphisms to differentiate strains of Candida albicans in women with vulvovaginal candidiasis. Diagn Microbiol Infect Dis. 1991 Nov-Dec;14(6):459–464. doi: 10.1016/0732-8893(91)90001-v. [DOI] [PubMed] [Google Scholar]
  20. TASCHDJIAN C. L., BURCHALL J. J., KOZINN P. J. Rapid identification of Candida albicans by filamentation on serum and serum substitutes. AMA J Dis Child. 1960 Feb;99:212–215. doi: 10.1001/archpedi.1960.02070030214011. [DOI] [PubMed] [Google Scholar]
  21. Vazquez J. A., Sobel J. D., Demitriou R., Vaishampayan J., Lynch M., Zervos M. J. Karyotyping of Candida albicans isolates obtained longitudinally in women with recurrent vulvovaginal candidiasis. J Infect Dis. 1994 Dec;170(6):1566–1569. doi: 10.1093/infdis/170.6.1566. [DOI] [PubMed] [Google Scholar]
  22. Walker P. P., Reynolds M. T., Ashbee H. R., Brown C., Evans E. G. Vaginal yeasts in the era of "over the counter" antifungals. Sex Transm Infect. 2000 Dec;76(6):437–438. doi: 10.1136/sti.76.6.437. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES