Abstract
ObjectivesRecurrent vulvovaginal candidiasis (RVVC) causes significant morbidity. Candida albicans is the main pathogen associated with both sporadic and recurrent candidiasis. Due to unsatisfactory treatment effect, the impact of chlorhexidine digluconate and fluconazole alone or in combination on C. albicans and biofilm was investigated.MethodsVaginal C. albicans isolates from 18 patients with recurrent candidiasis and commensals from 19 asymptomatic women were isolated by culture. Crystal violet, XTT and colony forming unit assay were used to analyze the effect of chlorhexidine digluconate and fluconazole on growth of C. albicans, formation of new and already established, mature, biofilm.ResultsFluconazole reduced the growth of planktonic C. albicans. However, in established biofilm, fluconazole had no effect on the candida cells and was not able to disperse and reduce the biofilm. By contrast, chlorhexidine digluconate had a direct killing effect on C. albicans grown both planktonically and in biofilm. Chlorhexidine digluconate also dispersed mature biofilm and inhibited formation of new biofilm. No major differences were observed between commensal isolates and candida causing recurrent vulvovaginitis with respect to biofilm or growth after chlorhexidine digluconate treatment.ConclusionBiofilm is a problem in patients with recurrent vulvovaginal candidiasis reducing the effect of antifungal treatment. Development of new treatment strategies are urgently needed to decrease the recurrences. In already established biofilm, chlorhexidine digluconate dispersed the biofilm and was more effective in eradicating candida compared to fluconazole. Future treatment strategy may thus be a combination of chlorhexidine digluconate and fluconazole and prophylactic use of chlorhexidine digluconate to prevent biofilm formation and restrict infections.
Highlights
Vulvovaginal candidiasis (VVC) is a common infection and affects 70–75% of all women[1]
Biofilm is a problem in patients with recurrent vulvovaginal candidiasis reducing the effect of antifungal treatment
Impact of chlorhexidine digluconate in vaginal isolates of C. albicans mimic the clinical situation, we analyzed the killing effect on planktonic as well as C. albicans within biofilm, Fig 1A–1D
Summary
Vulvovaginal candidiasis (VVC) is a common infection and affects 70–75% of all women[1]. Many women will experience relapses of the infection and as many as 5–8% suffer from recurrent vulvovaginal candidiasis (RVVC), defined as three or more infections per year [1, 2]. RVVC causes significant morbidity in affected women with a profound effect on the quality of life and increased risk to develop depression, anxiety and provoked vestibulodynia [3, 4]. Candida albicans colonizes skin and mucosal membranes and 85–95% of yeast strains isolated from the vagina belong to C. albicans [1]. Yeast blastospores is the phenotypic form responsible for vaginal transmission and asymptomatic colonization of the vagina [1]. Treatment of RVVC is complex but control of the infection is often achievable with the use of fluconazole (FLZ) suppressive therapy for a period of six months, but cure of RVVC remains elusive [8]
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