Abstract
Candida vulvovaginitis is a frequent condition, and although several risk factors are known, its behavior is still enigmatic. The seasonal influence of climate conditions and living habits on its prevalence was studied. In a retrospective lab-based cohort over 10 years, we studied the prevalence of Candida in 12,941 vaginal cultures taken from women attending a vulvovaginitis clinic. The prevalence of non-albicans and albicans species were compared per month to detect differences in positivity rates in summer versus winter months. Chi-square and chi-square for trend were used. Of the 2109 (16.3%) Candida spp. positive swabs, 201 (1.0%) revealed non-albicans species, varying between 1.0% and 2.0% per month, but without significant monthly differences. Over the 10 years, compared to other months, vaginal Candida was more frequent in June (19.0%, p = 0.008) and less frequent in December (14.5%, p = 0.04). The Candida prevalence was 15.5% in summer (June/July/August) versus 14.0% in the winter (Dec/Jan/Feb, p = 0.04). Change in temperature, dietary habits, and bodily adaptations due to increased amount of sunlight were discussed as potential pathophysiological mechanisms to explain the excess of Candida in summertime. Further confirmatory research would be beneficial. Women at risk for Candida vulvovaginitis should pay more attention to living habits in summertime to avoid recurrences.
Highlights
Vulvo-vaginal Candida infections are amongst the most frequent reasons to visit a gynecological practice [1,2]
In the 1980s it was suggested that recurrent vaginal Candida infections may be caused by sexual activity [6], in recent studies, different types of sexual behavior did not influence the efficiency of maintenance treatment in patients with recurrent vulvovaginal Candida infections [7]
Due to more frequent recurrences [8] and increased resistance against antifungal therapy [9] in women with colonization at multiple non-genital sites of their body, spread, especially form the rectum, was considered a possible mechanisms involved in the causation of recurrent vulvovaginal candidosis (RVVC, defined as four or more episodes per year of which at least one is proven by culture), leading to the preference of systemic rather than local therapy for such women [10]
Summary
Vulvo-vaginal Candida infections are amongst the most frequent reasons to visit a gynecological practice [1,2]. In the 1980s it was suggested that recurrent vaginal Candida infections may be caused by sexual activity [6], in recent studies, different types of sexual behavior did not influence the efficiency of maintenance treatment in patients with recurrent vulvovaginal Candida infections [7]. Due to more frequent recurrences [8] and increased resistance against antifungal therapy [9] in women with colonization at multiple non-genital sites of their body, spread, especially form the rectum, was considered a possible mechanisms involved in the causation of recurrent vulvovaginal candidosis (RVVC, defined as four or more episodes per year of which at least one is proven by culture), leading to the preference of systemic rather than local therapy for such women [10]. Intensive research is ongoing to unravel the T-helper 1 and 2 responses to Candida infection of the vagina, thereby trying to explain the different responses of women to the same challenge with Candida organisms [17,18,19,20,21]
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