Vaginal yeasts in the era of "over the counter" antifungals

OBJECTIVE: To establish whether there has been any rise in the prevalence of non-albicans Candida species isolated from vaginal swabs since the introduction of “over the counter” antifungal treatments. METHOD: A retrospective review looking at all positive vaginal yeast isolates collected from women attending one genitourinary medicine clinic during the 6 year period from 1993 to 1998 inclusive. All positive vaginal yeast isolates were included, regardless of whether or not the patients were symptomatic. Isolates from HIV positive women were excluded from the analysis. RESULT: No increase in non-albicans vaginal yeast isolates was shown during the period studied. The proportion of non-albicans yeasts remained constant at approximately 5% of the total yeasts isolated. The most common non-albicans yeast isolated was C glabrata. CONCLUSION: There is no evidence from this study to suggest that the increasing use of “over the counter” antifungal treatment has selected for atypical, possibly inherently azole resistant, strains of vaginal yeasts in HIV seronegative women

An investigation into the pathogenesis of vulvo-vaginal candidosis

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

The X-ray flaring properties of Sgr A* during six years of monitoring with Swift

Starting in 2006, Swift has been targeting a region of ~21'X21' around Sagittarius A* (Sgr A*) with the onboard X-ray telescope. The short, quasi-daily observations offer an unique view of the long-term X-ray behavior of the supermassive black hole. We report on the data obtained between 2006 February and 2011 October, which encompasses 715 observations with a total accumulated exposure time of ~0.8 Ms. A total of six X-ray flares were detected with Swift, which all had an average 2-10 keV luminosity of Lx (1-4)E35 erg/s (assuming a distance of 8 kpc). This more than doubles the number of such bright X-ray flares observed from Sgr A*. One of the Swift-detected flares may have been softer than the other five, which would indicate that flares of similar intensity can have different spectral properties. The Swift campaign allows us to constrain the occurrence rate of bright (Lx > 1E35 erg/s) X-ray flares to be ~0.1-0.2 per day, which is in line with previous estimates. This analysis of the occurrence rate and properties of the X-ray flares seen with Swift offers an important calibration point to asses whether the flaring behavior of Sgr A* changes as a result of its interaction with the gas cloud that is projected to make a close passage in 2013.Comment: 8 pages, 5 figures, 3 tables. Shortened, accepted to Ap