Recurrent vaginal candidiasis is one of the most common reasons for patients visiting their primary care doctors. Majority of the cases are caused by Candida albicans. Controlling of risk factors such as diabetes mellitus, used of broad spectrum antibiotics, contraceptive pills and steroid therapy helps in managing recurrent vaginal candidiasis. Initial 14-day course of oral azoles and followed by 6 months maintenance are effective in treating majority of the cases. Failure to treat recurrent vaginal candidiasis can lead to various bio-psycho-social complications.
*Candidiasis, Vulvovaginal ; Recurrence

Background: Vulvovaginal Candidiasis (VVC) is one of the frequent infections of the female genital tract and is the second most common cause of vaginal infections after bacterial vaginosis. According to the Centers for Disease Control and Prevention, azoles are the first‑line treatment for VVC. Among the azoles available in the Philippines, only miconazole and clotrimazole are recommended for both pregnant and non‑pregnant women. Objective: Compare the effect of miconazole versus clotrimazole in the treatment of vulvovaginal candidiasis among patients seen at the out‑patient department in a tertiary hospital Materials and Methods: This involved review of the records of patients diagnosed with VVC in a tertiary medical center from 2016 to 2020. All records of women, pregnant and non‑pregnant, wherein single‑dose 1200 mg miconazole or 6‑day 100 mg clotrimazole given vaginally were included Results: Eleven out of the 316 records (3.46%) remained symptomatic after treatment, about 18.1% (2/161) from those who used miconazole and 81.8% (9/155) from those treated with clotrimazole (p 0.027). In terms of failure rate, for miconazole it was 1.2% (2/161), whereas for clotrimazole it was 5.8% (9/155). None of the charts were found to have recorded adverse reaction to the given treatment Conclusion Single‑dose miconazole intravaginal regimen has a higher clinical cure rate than the 6‑day clotrimazole intravaginal treatment. Thereby, single‑dose intravaginal miconazole has the potential to improve patient compliance and treatment outcome at a lower cost
Clotrimazole ; Miconazole ; Vaginitis ; Candidiasis, Vulvovaginal

In order to study the susceptibility of murine vaginal mucosa to Candida albicans under different conditions, vaginal lavage fluid and vaginal tissue of mice were observed and compared between murine models with normal immune system (estrogen-treated mice) and immunosuppressed murine model, and between primary infection model of vaginal candidiasis and secondary infection one. The average level of colony forming unit (CFU) from the immuosuppressed group was higher than that from estrogen-treated group at each time point and the peak time was delayed. The differences between the two groups were statistically significant (P < 0.05) from the fourth day after inoculation. A significant difference existed in the average level of CFU between the control group and the estrogen-treated group (P < 0.05), and between the control group and the immuosuppressed group (P < 0.01). It was concluded that the vaginal mucosa from the immunosuppressed mice is more susceptible to Candida albicans and no difference is found in susceptibility between mice with primary infection and secondary infection.
Candida albicans/drug effects ; Candidiasis, Vulvovaginal/*etiology ; Candidiasis, Vulvovaginal/*immunology ; Disease Susceptibility ; Estrogens/*pharmacology ; Immunocompromised Host ; Mice, Inbred ICR ; Random Allocation ; Vagina/microbiology

BACKGROUND: There are limited data regarding the antifungal susceptibility of Candida albicans causing recurrent vulvovaginal candidiasis. OBJECTIVE: The aim of the present study was to evaluate the effect of azoles susceptibilities on treatment failure and recurrence of vulvovaginal candidiasis. METHODS: Species identification was performed on 84 vaginal Candida isolates collected from October 2008 to June 2010 from 404 patients with suspected vulvovaginitis. MICs of C. albicans (26 isolates) to fluconazole, itraconazole, and voriconazole were tested by broth microdilution method of the Clinical and Laboratory Standards Institute (CLSI) M27-A2. RESULTS: C. albicans was the most frequently isolated (88.1%). All isolates were susceptible to fluconazole, itraconazole, and voriconazole. Trailing growth was found in treatment success group (10.0%) and treatment failure group (33.3%). CONCLUSIONS: The results of this study suggest the possibility that trailing growth have influence on treatment failure of vulvovaginal candidiasis.
Azoles ; Candida ; Candida albicans ; Candidiasis, Vulvovaginal ; Danazol ; Fluconazole ; Humans ; Itraconazole ; Pyrimidines ; Recurrence ; Treatment Failure ; Triazoles ; Vulvovaginitis

OBJECTIVE: This randomized, single-blind, two-arm controlled study compared the efficacy, safety, and tolerability of an intravaginal suppository preparation containing metronidazole 750mg + miconazole 200mg (Neopenotran Forte) with another vaginal preparation containing metronidazole 500 mg + nystatin 10000 IU (Flagystatin) in the treatment of bacterial vaginosis (BV), candidal and trichomonial vulvovaginitis (CVV, TV), mixed vaginitis and in the prevention of secondary candidal vulvovaginitis.

MATERIALS AND METHODS: Women ages 18-45 years with chief complaints of abnormal vaginal discharge or vaginal/vulvar itching were examined and microbiologic confirmation of BV, VVC, TV or mixed infection was made. They were then randomly assigned to receive either treatment once daily (nightly) for 7 days. A total of 261 subjects had evaluable clinical and microbiological findings at the end of the study. Test of cure by Amsel criteria and Nugent score were performed twice after treatment.

RESULTS: The overall test revealed that microbiological cure rate is significantly different between the two treatment groups.

CONCLUSION: The odds of being cured microbiologically is 2.35 times more in the metronidazole 750mg + miconazole nitrate 200mg group compared to the metronidazole 500 mg + nystatin 10000 IU group. However, no significant difference in the clinical cure between the two groups was found. Both drugs are safe and convenient to use.

Human ; Female ; Adult ; Young Adult ; Vaginosis, Bacterial ; Candidiasis, Vulvovaginal ; Suppositories ; Vaginitis

OBJECTIVES: Human papillomavirus (HPV) is a kind of spherical DNA virus, which is related to many factors such as immune status and pregnancy. Due to the decrease of immunity, pregnant women are more likely to have HPV infection, which causes serious imbalance of vaginal microecology and is not beneficial to pregnancy outcome. Therefore, this study focuses on the impact of HPV infection on vaginal microecology and maternal and neonatal outcomes. METHODS: A total of 140 pregnant women with HPV infection during pregnancy, who received obstetric examination in the First Affiliated Hospital of Hainan Medical College from November 2017 to July 2019, were selected as a HPV infection group, and 150 normal pregnant women with HPV negative in the same period were selected as a control group. Vaginal secretions were collected from all the pregnant women at 28-34 weeks of gestation to evaluate vaginal pH, cleanliness and microecological status, and to record pregnancy outcomes for all pregnant women. RESULTS: The proportions of vaginal pH>4.5, constituent ratio of flora density and diversity of I-II, positive detection rate of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) in HPV infected pregnant women were significantly higher than those in the control group (all CONCLUSIONS Pregnant women with HPV infection during pregnancy are more likely to have vaginal microecological disorders, and can increase the risk of adverse pregnancy outcomes such as premature delivery and chorioamnionitis.
Candidiasis, Vulvovaginal ; Cesarean Section ; Female ; Humans ; Infant, Newborn ; Papillomavirus Infections/epidemiology* ; Pregnancy ; Vaginosis, Bacterial

Three common vaginal infections are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomonas vaginitis (TV). However their symptoms and signs are similar and atypical and other non-infectious vaginal inflammations will be the causes of identical symptoms. Hence accurate diagnosis is the first step in management of vaginitis and then appropriate therapy should be conducted. Metronidazole is the drug of choice for the treatment of BV and TV. Topical or oral azole antifungal regimens are highly effective in reliving symptoms of VVC. Physicians who treat the woman having vaginitis should consider the fact that the disease may be chronic, frequent and recurrent due to antibiotics abuse and over the counter antimycotic agents. Also predisposing factors must be removed before medical therapy.
Anti-Bacterial Agents ; Candidiasis, Vulvovaginal ; Causality ; Danazol ; Diagnosis ; Female ; Humans ; Inflammation ; Metronidazole ; Trichomonas Vaginitis ; Vaginitis* ; Vaginosis, Bacterial

OBJECTIVETo explore the influence of Candida albicans (Ca) on the motility and ultrastructure of human spermatozoa and its possible mechanism.

METHODSSemen samples obtained from 10 healthy volunteers by masturbation were prepared by the swim-up technique and sperm density to 40 x 10(6)/ml. The samples were then inoculated at 37 degrees C with different concentrations of a uropathogenic strain of Ca isolated from an outpatient, with initial fungi/spermatozoa ratios varying among 1:1 (Group A), 1:10 (Group B), 1:100 (Group C), 1:1000(Group D), and 1:10,000 (Group E). And Group F containing Ham's F-10 only was found as the negative control. Motion parameters were analysed by computer-aided sperm analyzer (CASA) at 0 hour, 1 hour, 2 hours and 4 hours respectively. Modalities of spermatozoa and possible adherence and/or agglutination were observed under the light microscope. Finally, all the samples were studied by transmission electron microscopy.

RESULTSDistinct adhesion of spermatozoa to Ca and agglutination were noticed. In all the motion parameters, progressive motility was affected most and dependent upon incubation time and bacterial concentration. Progressive motility showed a significant difference between Group A and the control (P < 0.01). With the prolongation of incubation time, other parameters were showing more and more differences. Analysis by electron microscopy revealed multiple ultrastructural damages.

CONCLUSIONCa significantly inhibits human sperm motility and decreases sperm viability in vitro. Its mechanism is possibly related to Ca's adhesion to human spermatozoa and the impairment inflicted by Ca to sperm ultrastructure.

Candida albicans ; isolation & purification ; physiology ; Candidiasis, Vulvovaginal ; microbiology ; Female ; Humans ; In Vitro Techniques ; Male ; Sperm Motility ; Spermatozoa ; physiology ; ultrastructure

Vulvo-vaginal candidiasis (VVC) is a common infection among women. 5% of women with acute infection experience recurrent vulvo-vaginal candidiasis (RVVC). There is currently no optimal or recommended regime for RVVC. Although antifungal agents, such as imidazoles, have been successfully used as a first-line treatment for acute VVC, its effectiveness is limited in RVVC. This could be due to patient factors, drug application (such as leakage) or dosing factors. A sustained-release (SR) bioadhesive vaginal cream (2% butoconazole nitrate) has incorporated VagiSite technology, a topical drug delivery system that allows SR of the drug. We describe its efficacy and the successful use of a butoconazole-SR formulation in the treatment of two cases of RVVC.
Adult ; Antifungal Agents ; administration & dosage ; Candidiasis, Vulvovaginal ; drug therapy ; Female ; Humans ; Imidazoles ; administration & dosage ; Middle Aged ; Pessaries ; Recurrence

Candidiasis, Vulvovaginal ; microbiology ; Communicable Diseases ; microbiology ; Female ; Humans ; Microbiota ; physiology ; Vagina ; microbiology ; Vaginitis ; microbiology ; Vaginosis, Bacterial ; microbiology