Highly-cited estimates of the cumulative incidence and recurrence of vulvovaginal candidiasis are inadequately documented.

BACKGROUND: Available literature concerning the epidemiologic or clinical features of vulvovaginal candidiasis commonly reports that: 75% of women will experience an episode of vulvovaginal candidiasis in their lifetimes, 50% of whom will experience at least a second episode, and 5-10% of all women will experience recurrent vulvovaginal candidiasis (≥4 episodes/1 year). In this debate we traced the three commonly cited statistics to their presumed origins. DISCUSSION: It is apparent that these figures were inadequately documented and lacked supporting epidemiologic evidence. Population-based studies are needed to make reliable estimates of the lifetime risk of vulvovaginal candidiasis and the proportion of women who experience recurrent candidiasis. SUMMARY: The extent to which vulvovaginal candidiasis is a source of population-level morbidity remains uncertain

Investigations by Cell-Mediated Immunologic Tests and Therapeutic Trials With Thymopentin in Vaginal Mycoses

Objective: According to unsatisfactory therapeutic results in patients with chronically recurrent vaginal candidosis, we investigated if immunologic patient factors could be found and treated

Functional evaluation of the pelvic floor muscles and the sexuality of women with recurrent vulvovaginal candidiasis and vulvodynia

Orientadores: Paulo César Giraldo, Cássia Raquel Teatin JuliatoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: Candidíase vulvovaginal recorrente (CVVR) e vulvodínia (VVD) cursam com dor e desconforto vulvoperineal, o que afeta a vida da mulher nas esferas: sexual, afetiva, social, e psíquica. Objetivo: Avaliar a função da musculatura do assoalho pélvico (MAP) e da sexualidade de mulheres com CVVR ou VVD. Desenho do estudo: Estudo de corte transversal com 61 mulheres entre 18 e 50 anos e sexualmente ativas, sendo 19 mulheres com VVD, 12 mulheres com CVVR e 30 assintomáticas (controles). A função da MAP foi avaliada através de eletromiografia de superfície (sEMG) e de registro da pressão vaginal (PV), utilizando-se o aparelho "Miotool Uro" e o "software Biotrainer" (Miotec LTDA). A função sexual foi avaliada através do questionário "Female Sexual Function Index" (FSFI) que consta de 19 questões, agrupadas em 6 domínios (desejo sexual, excitação, lubrificação vaginal, orgasmo, satisfação sexual e dor). Resultados: As mulheres com CVVR e VVD apresentaram potenciais elétricos da MAP, evidenciados pela sEMG, significativamente menores que os controles, porém não foram encontradas diferenças significativas entre as mulheres portadoras de CVVR, VVD e controles para os valores eletromiograficos do tônus basal e pressão vaginal no repouso ou nas contrações da MAP. Da mesma forma mulheres com CVVR e VVD apresentaram um tempo máximo de contração sustentada significativamente menor que os controles. Mulheres com VVD apresentaram um pior desempenho sexual (excitação, lubrificação, orgasmo, satisfação sexual e dor). Apenas o desejo sexual não foi pior que das mulheres controles. Nas mulheres com CVVR estas diferenças não foram tão evidentes, havendo comprometimento apenas dos domínios orgasmo e satisfação. O escore total de pontuação do grupo CVVR foi 25 (±5), do VVD 21 (±5) e dos controles de 29 (±4) (p<0,05). Conclusão: Mulheres com VVD e CVVR apresentam disfunção da MAP e qualidade de vida sexual inferior aos controlesAbstract: Introduction: Recurrent vulvovaginal candidiasis (RVVC) and vulvodynia (VVD) are characterized by pain and vulvoperineal discomfort, which may affect a woman's life in the sexual, affective, social and psychological spheres. Objective: To evaluate pelvic floor muscle (PFM) function and sexuality in women with RVVC or VVD. Study design: A cross-sectional study conducted with 61 sexually active women (age range: 18 to 50 years). Of the total women, 19 had VVD, 12 had RVVC caused by Candida and 30 were asymptomatic (controls). PFM function was evaluated by surface electromyography (sEMG) and vaginal pressure (PV) recording. A "Miotool Uro" device and Biotrainer" software (Miotec Ltd) were used for this purpose. Sexual function was assessed by the "Female Sexual Function Index" (FSFI) questionnaire including 19 questions, grouped into 6 domains (sexual desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and pain). Results: The electrical potential of the PFM in women with RVVC and VVD as evidenced by sEMG was significantly lower than in the controls. However, no significant differences were found among women with RVVC, those with VVD and controls for electromyography values at basal tone and vaginal pressure at rest or PFM contractions. Similarly, the maximum time of sustained contraction in women with RVVC and VVD was significantly lower than in women in the control group. Women with VVD had a worse sexual performance (arousal, lubrication, orgasm, sexual satisfaction and pain). Only sexual desire was not worse in these women compared to the control group. In women with RVVC, these differences were not sufficiently evident and only the domains of orgasm and satisfaction were compromised. The total score was 25 (±5) for the RVVC group, 21 (±5) for the VVD group and 29 (±4) for the control group (p<0.05). Conclusion: Women with VVD and RVVC had PFM dysfunction and a lower sexual quality of life than women in the control groupMestradoFisiopatologia GinecológicaMestre em Ciências da Saúd

Sexually Transmitted Diseases (STDs)

High rates of unprotected sexual behavior in adolescents result in millions of cases of STDs in the world. This chapter reviews factors inducing high STD rates, specific STDs, and their management based on 2010 U.S. Centers for Disease Control and Prevention (CDC) STD guidelines. Clinicians should screen all their sexually active adolescent patients for STDs and provide preventive education as well as treatment measures

Management of Azole-Refractory Candida Species Using Boric Acid Preparations: A Case Study in Dar Es Salaam, Tanzania

The aim of this study was to determine the antifungal agents and boric acid susceptibility to the azole-resistant Candida species, as well as clinical outcomes following treatment with antifungal agents that are commonly prescribed in Dar es Salaam and boric acid which is not available in Tanzania market. Microscopic examination of the vaginal discharge during prolonged therapy with three antifungal agents (clotrimazole, miconazole, and nystatin) and boric acid were carried out. Samples were collected from 150 women of reproductive age group (13 to 45 years) with chronic vaginal candidal infections. The samples were cultured in Sabouraud’s dextrose agar (supplemented with 0.005% chloramphenicol and 0.05% cycloheximide) followed by aerobic incubation for 48 hours at 37ºC in order to obtain pure cultures. Identification was done by Gram stain, while the test for ability to ferment and assimilate different sugars was done on API Candida and API 20C AUX. The stock cultures of Candida albicans (ATCC 32354), Candida glabrata (ATCC2001) and Candida guilliermondii (ATCC6260) were used as controls. Patients were dispensed together with 10 ml syringes for self douching of boric acid solution, and three commonly used antifungal vaginal drugs for Candida vaginitis. The results revealed a total of 167 Candida species dominated by C. albicans 116 (69.46%), followed by C. glabrata 21 (12.57%), C. krusei 8 (4.8%), C. tropicalis 7 (4.2%), C. famata 6 (3.59%), C. lusitaniae 5 (3.0%), C. parapsilosis, Trichosporon 2 (1.2%) and C. guilliermondii 1(0.6%). The results further showed that out of 116 C. albicans isolates, 23 (19.83%) were resistant to clotrimazole while 14 (12.1%) were resistant to miconazole in vitro test. Interestingly, all C. albicans isolates and the nonalbicans candida species were very sensitive to boric acid at a very low MIC values (0.025μg/ml). Generally, the overall success rate for clotrimazole in treating C. albicans infections was 41.7%, miconazole 56.5%, nystatin 77.3% and boric acid 100%. This study shows that, compared to other commonly used drugs in the country, the best performance of boric acid envisage the need to update the national treatment guidelines for the treatment of Candida vaginitis.Key words: Non-albicans Candida species, azole resistance, boric acid

Differentiation Between Women With Vulvovaginal Symptoms Who are Positive or Negative for Candida Species by Culture

Objective: To investigate whether clinical criteria could differentiate between women with vulvovaginitis who were culture positive or negative for vaginal Candida species. Methods: Vulvovaginal specimens were obtained from 501 women with a vaginal discharge and/or pruritis. Clinical information and wet mount microscopy findings were obtained. All specimens were sent to a central laboratory for species identification. Results: A positive culture for Candida species was obtained from 364 (72.7%) of the specimens. C. albicans was identified in 86.4% of the positive cultures, followed by C. glabrata in 4.5%, C. parapsilosis in 3.9%, C. tropicalis in 2.7% and other Candida species in 1.4%.Women with a positive Candida culture had an increased utilization of oral contraceptives (26.1% vs. 16.8%, p = 0.02) and antibiotics (8.2% vs. 0.7%, p = 0.001), and were more likely to be pregnant (9.1% vs. 3.6%, p = 0.04) than the culture-negative women. Dyspareunia was more frequent in women without Candida (38.0% vs. 28.3%, p = 0.03) while vaginal erythema (p = 0.01) was more common in women with a positive Candida culture. Conclusions: Although quantitative differences were observed, the presence of vaginal Candida vulvovaginitis cannot be definitively identified by clinical criteria

Management of Upapluta Yonivyapad (Vulvovaginitis) during Pregnancy - A Case Study

Pregnant women commonly develop increased vaginal discharge, which in many instances is not pathological. Pregnancy is associated with specific anatomical, physiological and immunological changes that can predispose to infection and also alter the response to the disease process. Infections in pregnancy demands prompt adequate and careful management. Vulvovaginitis during pregnancy may be considered under the umbrella of Upapluta Yonivyapad. Pregnant women are more prone to vulvovaginitis which is a great challenge for obstetricians today. In Ayurveda, Upapluta Yonivyapad described by Acharaya Charaka, Sharangadhara and both Vagbhata can be compared to vulvovaginitis during pregnancy. Here Panchawalkala Kwatha Prakshalna followed by Jatyadi Taila Pichu externally and Tab Leukol internally has been used to correct Garbhini Upapluta

Management of recurrent vulvovaginal candidosis : Narrative review of the literature and European expert panel opinion

Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.Peer reviewe