Therapy of candidal vaginitis: The effect of eliminating intestinal Candida

Abstract

A total of 258 patients with candidal vulvovaginitis, all of whom also exhibited Candida organisms in the rectum, were treated for 1 week with vaginal tablets only (nystatin or clotrimazole) or with both vaginal and oral tablets (nystatin). Mycologic and symptomatic responses were superior for the group receiving combined intravaginal-oral therapy; the vaginas of 88% of those treated by both routes were cleared of Candida, as compared with 75% of those receiving only intravaginal medication (p < 0.05). Nystatin and clotrimazole were equally effective. When the 258 patients, regardless of treatment regimen, were grouped into those whose intestinal tracts after therapy contained Candida or those free of Candida, the response rates of the vaginal infection at all follow-up examinations favored the latter group (p < 0.05 to < 0.001). Vaginal infection recurred in 19.7% of patients treated only intravaginally and 14.7% of those receiving combined therapy. These results suggest the value of eliminating any intestinal reservoir of Candida when treating patients with candidal vulvovaginitis.