Prevalence of Non-Albicans Candida Infections in Women with Recurrent Vulvovaginal Symptomatology

Jason D. Mintz, Mark G. Martens

Department of Obstetrics and Gynecology, Jersey Shore Uni- versity Medical Center, Neptune, USA.
Rutgers-Robert Wood Johnson Medical School, Piscataway, USA.

DOI: 10.4236/aid.2013.34035                

Abstract

Background: Candida vulvovaginitis is one of the most frequently diagnosed conditions in women’s care practices. Historically, 90% of cultured yeast species were C. albicans. However, due to a variety of interventions, the proportion of non-albicans Candida (NAC) infections appears to be increasing. We sought to estimate the current prevalence of Candida vulvovaginitis and the species-specific distribution of such infections in recurrent cases. Methods: Women with recurrent vulvovaginal symptomatology referred to an Obstetrics and Gynecology practice were tested by genital fungus culture, Candida-specific polymerase chain reaction (PCR), or both between July 2010 and February 2013. Results: A total of 103 women were tested. Mean age was 45.6 years. Including only their most recent positive test result, 29.1% (30/103) of women tested positive for Candida by any of the above testing measures. Of those, 50% (15/30) tested positive for C. albicans and 50% (15/30) tested positive for a NAC species. Across all visits, 60% (18/30) tested positive for C. albicans, 56.7% (17/30) tested positive for NAC, and 16.7% (5/30) tested positive for both a C. albicans and a NAC species. Among all isolated NAC species, 28.6% (6/21) were determined to be C. glabrata, 23.8% (5/21) C. krusei, 23.8% (5/21) C. parapsilosis, and 23.8% (5/21) other Candida species. Conclusion: Approximately 30% of women with recurrent vulvovaginal symptomatology have detectable Candida strains and it appears that NAC species may cause half of all these infections. This is imperative because NAC infections are usually more difficult to diagnose and are resistant to most treatments.

 

Keywords

Recurrent Vulvovaginal Candidiasis; Non--Albicans Candida; Fluconazole; Yeast Infections; Candida Vaginitis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	B. Foxman, R. Barlow, H. D’Arcy, B. Gillespie and J. Sobel, “Candida Vaginitis: Self-Reported Incidence and Associated Costs,” Sexually Transmitted Diseases, Vol. 27, No. 4, 2000, pp. 230-235. http://dx.doi.org/10.1097/00007435-200004000-00009
[2]	J. D. Sobel, “Vulvovaginal Candidosis,” Lancet, Vol. 369, No. 9577, 2007, pp. 1961-1971. http://dx.doi.org/10.1016/S0140-6736(07)60917-9
[3]	B. Foxman, J. V. Marsh, B. Gillespie and J. Sobel, “Frequency and Response to Vaginal Symptoms among White and African American Women: Results of a Random Digit Dialing Survey,” Journal of Women’s Health, Vol. 7, No. 9, 1998, pp. 1167-1174. http://dx.doi.org/10.1089/jwh.1998.7.1167
[4]	T. G. Bauters, M. A. Dhont, M. I. Temmerman and H. J. Nelis, “Prevalence of Vulvovaginal Candidiasis and Susceptibility to Fluconazole in Women,” American Journal of Obstetic Gynecology, Vol. 187, No. 3, 2002, pp. 569574. http://dx.doi.org/10.1067/mob.[phone]
[5]	A. Paulitsch, W. Weger, G. Ginter-Hanselmayer, E. Marth and W. Buzina, “A 5 Year (2000-2004) Epidemiological Survey of Candida and Non-Candida Yeast Species Causing Vulvovaginal Candidiasis in Graz, Austria,” Mycoses, Vol. 49, No. 6, 2006, pp. 471-475. http://dx.doi.org/10.1111/j.1439-0507.2006.01284.x
[6]	F. C. Odds, “Candida and Candidosis: A Review and Bibliography,” Bailliere Tindall, London, 1988, p. 124.
[7]	J. D. Sobel, “Epidemiology and Pathogenesis of Recurrent Vulvovaginal Candidiasis,” American Journal of Obstetic Gynecology, Vol. 152, No. 7, 1985, pp. 924-935.
[8]	J. D. Sobel, “Recurrent Vulvovaginal Candidiasis: A Prospective Study of the Efficacy of Maintenance Ketoconazole Therapy,” The New England Journal of Medicine, Vol. 315, No. 23, 1986, pp. 1455-1458. http://dx.doi.org/10.1056/NEJM198612043152305
[9]	A. Spinillo, E. Capuzzo, R. Gulminetti, R. Marone, L. Colonna and G. Piazzi, “Prevalence and Risk Factors for Fungal Vaginitis Caused by Non-Albicans Species,” American Journal of Obstetic Gynecology, Vol. 176, No. 1, 1977, pp. 138-141. http://dx.doi.org/10.1016/S0002-9378(97)80026-9
[10]	O. Grigoriou, S. Baka, E. Makrakis, D. Hassiakos, G. Kapparos and E. Kouskouni, “Prevalence of Clinical Vaginal Candidiasis in a University Hospital and Possible Risk Factors,” The European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 126, No. 1, 2006, pp. 121-125. http://dx.doi.org/10.1016/j.ejogrb.2005.09.015
[11]	A. B. Guzel, M. Ilkit, T. Akar, R. Burgut and S. C. Demir, “Evaluation of Risk Factors in Patients with Vulvovaginal Candidiasis and the Value of chromID Candida Agar Versus CHROMagar Candida for Recovery and Presumptive Identification of Vaginal Yeast Species,” Medical Mycology, Vol. 49, No. 1, 2011, pp. 16-25. http://dx.doi.org/10.3109/13693786.2010.497972
[12]	T. Weissenbacher, S. S. Witkin, W. J. Ledger, V. Tolbert, A. Gingelmaier, C. Scholz, et al., “Relationship between Clinical Diagnosis of Recurrent Vulvovaginal Candidiasis and Detection of Candida Species by Culture and Polymerase Chain Reaction,” Archives of Gynecology and Obstetrics, Vol. 279, No. 2, 2009, pp. 125-129. http://dx.doi.org/10.1007/s00404-008-0681-9
[13]	J. Zeng, L. L. Zong, T. Mao, Y. X. Huang and Z. M. Xu, “Distribution of Candida albican Genotype and Candida Species Is Associated with the Severity of Vulvovaginal Candidiasis,” Journal of Southern Medical University, Vol. 31, No. 10, 2011, pp. 1649-1653.
[14]	J. P. Vermitsky, M. J. Self, S. G. Chadwick, J. P. Trama, M. E. Adelson, E. Mordechai, et al., “Survey of VaginalFlora Candida Species Isolates from Women of Different Age Groups by Use of Species-Specific PCR Detection,” Journal of Clinical Microbiology, Vol. 46, No. 4, 2008, pp. 1501-1503. http://dx.doi.org/10.1128/JCM.02485-07
[15]	S. Corsello, A. Spinillo, G. Osnengo, C. Penna, S. Guaschino, A. Beltrame, et al., “An Epidemiological Survey of Vulvovaginal Candidiasis in Italy,” The European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 110, No. 1, 2003, pp. 66-72. http://dx.doi.org/10.1016/S0301-2115(03)00096-4
[16]	J. Holland, M. L. Young, O. Lee and S. C.-A. Chen, “Vulvovaginal Carriage of Yeasts Other than Candida Albicans,” The European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 79, No. 3, 2003, pp. 249-250. http://dx.doi.org/10.1136/sti.79.3.249
[17]	M. A. Kennedy and J. D. Sobel, “Vulvovaginal Candidiasis Caused by Non-Albicans Candida Species: New Insights,” Current Infectious Disease Reports, Vol. 12, No. 6, 2010, pp. 465-470. http://dx.doi.org/10.1007/s11908-010-0137-9
[18]	G. J. Dennerstein, D. E. Ellis, C. S. Reed and C. M. Bennett, “The Pathogenicity of Non-Albicans Yeasts in the Vagina,” Journal of Lower Genital Tract Disease, Vol. 15, No. 1, 2011, pp. 33-36. http://dx.doi.org/10.1097/LGT.0b013e3181d94f39
[19]	R. Kaufman and S. Faro, “Candida Benign Diseases of the Vulva and Vaginia,” 4th Edition, Mosby, St. Louis, 1994, p. 321.
[20]	S. S. Richter, R. P. Galask, S. A. Messer, R. J. Hollis, D. J. Diekema and M. A. Pfaller, “Antifungal Susceptibilities of Candida Species Causing Vulvovaginitis and Epidemiology of Recurrent Cases,” Journal of Clinical Microbiology, Vol. 43, No. 5, 2005, pp. 2155-2162. http://dx.doi.org/10.1128/JCM.43.5.2155-2162.2005
[21]	S. Singh, J. D. Sobel, P. Bhargava, D. Boikov and J. A. Vasquez, “Vaginitis Due to Candida Krusei: Epidemiology, Clinical Aspects, and Therapy,” Current Infectious Disease, Vol. 35, No. 9, 2002, pp. 1066-1070. http://dx.doi.org/10.1086/343826
[22]	K. C. Hazen, “Mycology and Aerobic Actinomycetes,” In: H. D. Isenberg, Ed., Essential Procedures for Clinical Microbiology, ASM, Washington DC, 1998, pp. 280-342.
[23]	G. Luo and T. Mitchell, “Rapid Identification of Pathogenic Fungi Directly from Cultures by Using Multiplex PCR,” Journal of Clinical Microbiology, Vol. 40, No. 8, 2002, pp. 2860-2865. http://dx.doi.org/10.1128/JCM.40.8.2860-2865.2002
[24]	M. G. Martens, P. Hoffman and M. El-Zaatari, “Fungal Species Changes in the Female Genital Tract,” Journal of Lower Genital Tract Disease, Vol. 8, No. 1, 2004, pp. 21-24. http://dx.doi.org/10.1097/00128360-200401000-00006
[25]	P. Nyirjesy, S. M. Seeney, M. H. Grody, C. A. Jordan and H. R. Buckley, “Chronic Fungal Vaginitis: The Value of Cultures,” American Journal of Obstetrics & Gynecology, Vol. 173, No. 3, 1995, pp. 820-823. http://dx.doi.org/10.1016/0002-9378(95)90347-X
[26]	L. McCaig and M. McNeil, “Trends in Prescribing for Vulvovaginal Candidiasis in the United States,” Pharmacoepidem Dr S, Vol. 14, No. 2, 2005, pp. 113-120. http://dx.doi.org/10.1002/pds.960
[27]	M. R. Miles, L. Olsen and A. Rogers, “Recurrent Vaginal Candidiasis: Importance of an Intestinal Reservoir,” JAMA, Vol. 238, No. 17, 1977, pp. 1836-1837. http://dx.doi.org/10.1001/jama.1977.03280180040023
[28]	X. L. Lin, Z. Li and X. L. Zuo, “Study on the Relationship between Intestinal Candida in Patients with Vulvovaginal Candidiasis,” Chinese Journal of Obstetrics and Gynecology, Vol. 46, No. 7, 2011, pp. 496-500.