Original Articles
Vaginal colonization by Candida in asymptomatic women with and without a history of recurrent vulvovaginal candidiasis

https://doi.org/10.1016/S0029-7844(99)00577-3Get rights and content

Abstract

Objective: The asymptomatic carriage of Candida in the vagina of women with a history of recurrent vulvovaginal candidiasis was compared with that of women with no such history.

Methods: Vaginal swabs from 50 women with a history of recurrent vulvovaginal candidiasis and 45 women with one or fewer episodes of candidal vaginaitis within the past 12 months were evaluated for Candida by wet mount/Gram stain, culture, and polymerase chain reaction (PCR). All women were asymptomatic for at least 30 days.

Results: Candida was identified in 28 women by PCR, in 14 women by culture, and in 13 women by wet mount/Gram stain. Candida was identified by PCR in a similar proportion of patients with previous recurrent vulvovaginal candidiasis (30%) and in controls (28.8%). However, Candida was identified by culture in more women with previous recurrent vulvovaginal candidiasis (22%) than in controls (6.6%, P = .04); it also was identified by wet mount/Gram stain in more women with recurrent vulvovaginal candidiasis (22%) than in controls (4.4%, P = .01). For the recurrent vulvovaginal candidiasis patients, culture and wet mount/Gram stain had a sensitivity of 66.6% compared with PCR. For the controls, the sensitivity of the two former assays relative to PCR was only 15.3%.

Conclusion: Women with a history of recurrent vulvovaginal candidiasis have more easily detectable Candida in their vagina, even when asymptomatic, than do other women. A relative inefficiency in regulating the proliferation of Candida in the vagina may increase susceptibility to periodic symptomatic recurrences.

Section snippets

Materials and methods

This study was approved by the committee of ethics from the University of Campinas, and informed oral consent was obtained from all subjects. Ninety-five sexually active reproductive age women took part in this study. Fifty women with a history of three or more episodes of recurrent vulvovaginal candidiasis per year and no vulvovaginal complaints for at least 30 days were recruited. The remaining 45 women, attending the clinic for routine gynecologic check-ups, were invited to take part in the

Results

Candida albicans was detected by PCR in 28 (29.4%) women (Table 1). Only 14 (14.7%) of the women tested (all PCR-positive) were positive for Candida by culture, and 13 (13.6%) were positive by wet mount/Gram stain (P < .02 compared with PCR).

The percentage of women positive for Candida by PCR was similar for recurrent vulvovaginal candidiasis patients (30%) and controls (28.8%). In contrast, detection of Candida by wet mount/Gram stain and culture was more frequent in recurrent vulvovaginal

Discussion

With the use of PCR gene amplification technology, Candida was detected in vaginal samples from 29.4% of the asymptomatic women tested. Similar frequencies of Candida colonization were observed, regardless of history of recurrent vulvovaginal candidiasis. These results reinforce previous studies11 that women may harbor Candida in their vagina in the absence of symptoms. Furthermore, the data demonstrate that in many women with no history of recurrent vulvovaginal candidiasis, Candida

References (15)

There are more references available in the full text version of this article.

Cited by (0)

Supported in part by Fundação de Amparo a Pesquisa do Estado de São Paulo and Universidade Estadual de Campinas.

View full text