Abstract
To identify clinical, microscopic, and biochemical characteristics that differentiate cytolytic vaginosis (CV) from vulvovaginal candidiasis (VVC). The present cross-sectional study analyzed the vaginal contents of 24 non-pregnant women aged 18 to 42 years who were attended at the Genital Infections Clinic at Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM-UNICAMP). They were diagnosed either with (CV = 8, VVC = 8) or without vulvovaginitis or vaginal dysbiosis (controls). The socio-demographic, clinical, and gynecological data were obtained from a detailed patient interview. Samples of the vaginal contents were collected for analysis of vaginal pH, gram stain, and specific fungal culture. The Kruskal-Wallis and Fisher exact tests were used to compare the differences between the groups. Odds ratios were used to compare the categorical variables. The significance level was considered at p < 0.05. Both women with CV and VVC had a lumpy vaginal discharge (p = 0,002) and vaginal hyperemia (p = 0.001), compared with controls. The inflammatory process was more intense in the VVC group (p = 0.001). In the CV group, there was statistical significance for the lactobacillus amount (p = 0.006), vaginal epithelium lysis (p = 0.001), and vaginal pH (p = 0.0002). Cytolytic vaginosis and VVC diagnoses rarely differ on clinical characteristics but have different laboratorial findings. The present study highlights the importance of conducting an accurate investigation through laboratory tests rather than clinical criteria to avoid misdiagnosis.
Highlights
Vulvovaginal candidiasis (VVC) infection caused by the Candida species affects millions of women every year and is considered the second most common vaginitis among women after bacterial vaginosis.[1]
Vulvovaginal candidiasis gives rise to much discomfort in many patients, poses a threatening problem to clinicians, and generates considerable direct and indirect economic costs associated with medication and healthcare visits,[3] representing a cost estimate of $2.84 billion in the United States alone.[4]
The vulvovaginal candidiasis (VVC) manifests itself as an inflammatory process, which, depending on the degree of local inflammation, has variable symptom intensity and is commonly misidentified as cytolytic vaginosis (CV), leading to inadequate treatment.[9,10]
Summary
Vulvovaginal candidiasis (VVC) infection caused by the Candida species affects millions of women every year and is considered the second most common vaginitis among women after bacterial vaginosis.[1]. About 50% of these will have a second episode, and 5 to 10% will develop the recurrent form.[2] Vulvovaginal candidiasis gives rise to much discomfort in many patients, poses a threatening problem to clinicians, and generates considerable direct and indirect economic costs associated with medication and healthcare visits,[3] representing a cost estimate of $2.84 billion in the United States alone.[4] Most women will experience only one or two episodes of VVC, but there is a large, albeit poorly defined, subset that experiences multiple recurrences.[4,5,6,7] Among all cases of VVC, C. albicans is the most common species identified among women, representing 80 to 90% of the cases, followed by non-C. albicans species, usually Candida glabrata.[8] The VVC manifests itself as an inflammatory process, which, depending on the degree of local inflammation, has variable symptom intensity and is commonly misidentified as cytolytic vaginosis (CV), leading to inadequate treatment.[9,10] Cytolytic vaginosis is characterized by symptoms that are very similar to those of VVC, but the laboratorial findings may be quite different. The aim of the present study was to compare the clinical and laboratorial findings of women with CV and VVC to define more accurate criteria to differentiate these two conditions
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