Health-related quality of life as measured with the Short-Form 36 (SF-36) questionnaire in patients with recurrent vulvovaginal candidiasis.

BACKGROUND: Recurrent vulvovaginal candidiasis (RVVC) has a poor therapeutic outcome and a severe impact on women and their partners, both physically and psychologically. Health-related quality of life (HRQOL) is significantly affected in patients with RVVC; however, little is known about HRQOL in patients with this disease. In this study, we aim to identify the clinical and mycological characteristics of women with RVVC and the effects of RVVC on women's HRQOL. METHODS: We designed this study as a comparative cross-sectional study. The Short-Form Health Survey (SF-36) was used to measure HRQOL in 102 patients with RVVC and 101 women seeking general health care (controls). RVVC was defined as four or more episodes of proven VVC in the previous 12-month period. VVC was defined as vulvar itching, burning, erythema, vaginal discharge, pseudohyphae or blastoconidia on a wet 10 % potassium hydroxide (KOH)-treated vaginal slide and a positive Candida culture. Group comparisons were conducted with independent samples t test. Correlation analysis was performed on the variables. RESULTS: The mean age at first diagnosis of the patients with RVVC was 30.96 years (SD 5.38), and the mean age of the controls was 29.75 years (SD 5.83; p > 0.05). The duration of the patients' complaints varied from 6 months to 10 years, with a mean duration of 22.28 (±21.75) months. The most common complaints were increased vaginal discharge (102 cases, 100 %), itching (97 cases, 95.1 %), dyspareunia (65 cases, 63.7 %), burning (79 cases, 77.5 %) and erythema (25 cases, 24.5 %). C. albicans was the predominant Candida species (86 strains, 84.3 %) in the patients, followed by C. glabrata (12 strains, 11.8 %). C. parapsilosis (1 strain, 0.9 %), C. tropicalis (1 strain, 0.9 %), C. krusei (1 strain, 0.9 %) and C. lusitaniae (1 strain, 0.9 %). The mean SF-36 dimension scores for physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health were significantly lower in the patients with RVVC than in the controls (85.20, 61.39, 77.79, 54.95, 53.17, 67.89, 52.48 and 59.17 vs. 90.20, 80.87, 87.08, 67.38, 59.69, 79.86, 68.01 and 65.38). The physical composite and mental composite scores of the patients with RVVC were 63.06 and 64.87, respectively, which were lower than those of the controls (75.01 and 74.87; p < 0.05). CONCLUSIONS: Nearly all of the patients with RVVC had clinical symptoms. In our sample, RVVC was mainly caused by C. albicans. RVVC has negative effects on women's HRQOL, as indicated by lower physical and mental composite scores among the RVVC group compared with controls.

[Study of local immunity of lower genital tract infections].

OBJECTIVE: To investigate the profile of local immunity of vagina and the immune defense mechanisms against lower genital tract infections. METHODS: Vaginal lavage was collected from healthy women and patients of vulvovaginal candidiasis, bacterial vaginosis, Trichomonol vaginitis, human papilloma virus infection (VVC), and chlamydia trachomatis infection. Each group included 60 cases. The level of interleukin (IL)2, 4, 5, 13, 8 and human defensin 5 (HD5) were detected by enzyme linked immunosorbent assay(ELISA). RESULTS: (1) Cytokine of helper T cell 1(Th1): the level of IL-2 between healthy women and VVC/ bacterial vaginosis (BV)/ trichomonol vaginitis (TV)/ chlamydia trachomatis (CT) patients had no significant difference. The IL-2 level(96 +/- 33) x 10(-3) pg/L of human papilloma virus (HPV) infection patients was significantly higher than that of healthy women (P < 0.05). (2) Cytokine of helper T cell 2 (Th2): the level of IL-4 between healthy women and VVC/CT patients had no significant difference. The level of IL-5 between healthy women and BV patients had no significant difference. The IL-13 level (42 +/- 15) x 10(-3) pg/L of TV patients was significantly higher than that of healthy women (30 +/- 29) x 10(-3) pg/L (P < 0.05). The IL-4 level (103 +/- 28) x 10(-3) pg/L of HPV infection patients was significantly higher than that of healthy women (36 +/- 22) x 10(-3) pg/L (P < 0.05). (3) IL-8: the IL-8 level (5.8 +/- 2.7) pg/L of TV infection patients was significantly higher than that of healthy women (2.6 +/- 2.4) pg/L (P < 0.05). The level of IL-8 between healthy women and BV patients had no significant difference. (4) HD5: the HD5 level of TV, BV, VVC, HPV and CT infection patients were significantly higher than that of healthy women (P < 0.05). CONCLUSIONS: (1) HD5 plays an important role in the defence of vaginal epithelial cell. (2) Th2 may be more important than Thl in lower genital tract infections. (3) IL-8 plays an important role in extrinsic source infections.

[Study on vaginal production of human defensins and the correlated pathogenetic factors of vulvovaginal candidiasis].

OBJECTIVE: To investigate the correlated pathogenetic factors and vaginal local immunity in vulvovaginal candidiasis (VVC). METHODS: A case control study was conducted to compare VVC group (60 cases) with normal group (60 cases). All of the women filled up the specific questionnaires. Routine examination, pH test and bacterial culture were done on the vaginal discharge. Cytokines of the vaginal lavage were measured by enzyme linked immunosorbent assay. RESULTS: (1) Outcomes of the questionnaires: there was no significant difference between the two groups in educational background, knowledge of gynecologic infection, history of gynecologic infection, hygienic habit, sex life, or use of medicine (P > 0.05). The incidence of chronic cervicitis in normal group (43%, 26/60) was higher than in VVC group (22%, 13/60; P < 0.05). (2) There was no difference in vaginal pH between the two groups (P > 0.05). (3) Detection rate of candida albicans by vaginal discharge routine examination was 72% (43/60). (4) The concentrations of interleukin (IL) 2, and IL-4 in vaginal lavage did not show significant difference between the two groups (P > 0.05), but the concentrations of human defensin 5, human beta-defensin (HBD) 1, and HBD2 in VVC group [(0.94 +/- 0.44) mg/L, (3.1 +/- 0.4) microg/L, (10 +/- 6) microg/L] were higher than normal group (P < 0.05). CONCLUSIONS: VVC is a common vulvovaginitis. There is no significant correlation between the incidence of VVC and educational background, knowledge of gynecologic infection, history of gynecologic infection, hygienic habit, sex life, or use of medicine in the child-bearing period. Human defensin may be closely correlated with the pathogenesis of VVC.

Clinical characteristics of vulvovaginal candidiasis and antifungal susceptibilities of Candida species isolates among patients in southern China from 2003 to 2006.

AIM: To determine the clinical characteristics of vulvovaginal candidiasis (VVC), the Candida species involved and the antifungal susceptibility of Candida species isolated from patients with VVC. METHODS: Candida organisms were cultured from samples obtained from patients who presented with VVC to the Gynecology Department, Peking University Shenzhen Hospital. Antifungal susceptibility testing was performed using a commercial agar diffusion test. RESULTS: Of the 1,070 cases of VVC reported in this study, 36.5% were uncomplicated VVC, and 63.5% were complicated VVC. Twenty-four patients were identified as having two species of Candida. Candid albicans alone was isolated from 89.5% of cases (n = 958). Candida glabrata was isolated from 85 cases (7.9%), Candida tropicalis from 10 (0.9%), Saccharomyces cerevisiae from eight (0.7%), Candida parapsilosis from six (0.6%), Candida famata from two (0.2%), and Candida krusei from one case (0.1%). All isolates of Candida albicans were susceptible to nystatin. The resistant rate of Candida albicans to azole agents was 0-4.9%. CONCLUSION: Candida albicans was the predominant Candida species isolated from this series of patients with VVC. Resistance of vaginal Candida albicans isolates to antifungal agents was infrequent.

Biased genotype distributions of Candida albicans strains associated with vulvovaginal candidosis and candidal balanoposthitis in China.

BACKGROUND: Vulvovaginal candidosis (VVC), which is most frequently caused by Candida albicans, is one of the most common vaginal infections and is a common problem worldwide. Despite the fact that extensive epidemiological studies have been performed, what triggers VVC, especially recurrence of the infection, is still uncertain. METHODS: Genotypes of C. albicans strains associated with VVC and balanoposthitis and of strains isolated from samples from vaginas of asymptomatic women and from various extragenital sites were determined with use of C. albicans microsatellite locus I polymorphism analysis. Genetic similarity of representative strains with the same and different C. albicans microsatellite locus I genotypes were examined by sequence analysis of housekeeping genes CaADP1, CaSYA1, and CaVPS13. RESULTS: The C. albicans microsatellite locus I genotypes of independent C. albicans strains isolated from samples from extragenital sites were mostly of individual specificity. In contrast, strains associated with VVC were mainly concentrated to a few genotypes, with genotypes 30-45 and 32-46 being the most common. The overall frequencies of the 2 genotypes among C. albicans strains from vaginal samples from patients with VVC and from asymptomatic women were 59.1% and 24.0%, respectively (P = .002); the frequencies among patients with complicated VVC and among patients with uncomplicated VVC were 69.2% and 35.7%, respectively (P = .003). A similar genotype distribution pattern of C. albicans strains associated with balanoposthitis was also revealed. The genetic similarity of strains with the dominant genotypes associated with both VVC and balanoposthitis was confirmed by sequence analysis of the 3 genes. CONCLUSIONS: The results suggest the existence of vaginopathic C. albicans strains with enhanced virulence and tropism for the vagina and the high possibility of sexual transmission of genital C. albicans infection. Identification of specific genotypes that correlate with severity of VVC is also of diagnostic and therapeutic significance.

[Study on classification and treatment of vulvovaginal candidiasis].

OBJECTIVE: To determine the clinical manifestations of vulvovaginal candidiasis (VVC) and to study the mycologic eradication rate of different miconazole treatment courses for VVC. METHODS: Three hundred cases of VVC were recruited. The Candidas were cultured. A prospective and randomized study was performed to compare the treatment effect of 3 day miconazole (400 mg/d), 6 day miconazole (400 mg/d), and 7 day miconazole (200 mg/d) for uncomplicated and complicated VVC. RESULTS: Among 300 cases of VVC, uncomplicated, complicated and recurrent VVC were 56.0%, 44.0% and 9.7% (29/300) respectively. C. albicans was isolated most frequently 90.3% (271/300), followed by C. glabrata (7.3%), C. tropicalis (1.3%), C. krusei (0.7%), and C. parapsilosis (0.3 %). Mycologic eradication rate of 3 day, 6 day and 7 day miconazole courses for uncomplicated VVC at day 14 was 96.0%, 93.5% and 98.0%, respectively (P > 0.05). Eradication rate of 3 day, 6 day and 7 day miconazole courses for complicated VVC at day 14 was 86.7%, 92.5%, and 86.4%, respectively (P > 0.05). Eradication rate of 3 day, 6 day and 7 day miconazole courses for uncomplicated VVC at day 35 was 93.8%, 95.3%, and 89.8%, respectively (P > 0.05). Eradication rate of 3 day, 6 day and 7 day miconazole courses for complicated VVC at day 35 was 89.7%, 97.3% and 86.8%, respectively (P > 0.05). CONCLUSION: Treatment of VVC should be individualized, and women with complicated VVC achieve superior mycologic eradication by a 6 day miconazole course.