Chronic Vulvovaginal Candidiasis Research Articles

Informing of estimation of cytokine status at nonspecific infectious-inflammatory diseases of cervix and vagina

The objective: to estimate informing estimation of cytokine status at nonspecific infectious inflammatory diseases of the cervix and vagina. Materials and methods. 9 type groups are selected: I –conditionally healthy (42 women), II –candidacy (45 women), III – bacterial vaginosis (112 women), IV - a nonspecific vulvovaginitis (107women), V – acute vulvovaginal candidiasis (61 women), VI - chronic vulvovaginal candidiasis (76women), VII – bacterial vaginosis + candida infection (71 women), VIII - a nonspecific vulvovaginitis+ candida infection (84 women), IX – bacterial vaginosis + nonspecific vulvovaginitis (63 women). The complex of the conducted research included cytological, bacterioscopic, bacteriological, and immunological. Results. The set connection between clinical and laboratory by the features of the studied states and biological properties of stamps of C. albicans, selected from different patients. Together with the comparative analysis of morphological and cultural descriptions of mycotic cultures, the special interest was presented by the determination of their phospholipase activity, which is examined as basic, correlating with other, factors of pathogenicity of C. аlbicans. It is marked, that in those cases when it is possible it was to foresee the participation of C. аlbicansin an infectious process as a mono exciter or fellow member of parasitocenosis, registered the meaningful increase of the degree of their virulence for certain. The sizes of cages varied, but more frequently were below averages. The coefficient of virulence which correlates with the level of phospholipase activity hesitated within the limits of 0,3–0,9 and, as a rule, exceeded 0,5. Dependence is marked also on a temperature factor: the speed of growth of «virulent» variants at room temperature was considerably slowed, or growth absented in general, that typically for exciters infectious inflammatory diseases. In those cases, when candida was discovered for practically healthy women or as«casual», transient components on a background of nonspecific vaginitis or bacterial vaginosis, the coefficient of virulence of the selected stamps was always below the 0,3, a tendency was traced to thejumboizing of cages, here cultures identically well grew and at a room temperature, and at 37 °С. Obviously, at clarification of diagnosis, for differentiation of the states, C is related to infecting. аlbicans, and estimations of their contribution to the infectious process, together with traditional clinical-and laboratory by tests, expedient study of the transferred properties of microbial cultures which are selected. Conclusions. The results of the conducted research testify to the substantial role of cytokine status in the estimation of the state of local factors of defense for patients from infectious inflammatory diseases of the cervix and vagina. The got results must be taken into account in the development of an algorithm for diagnostic and treatment-and-prophylactic measures.

Developing the Principles of Studying and Treatment of Vaginal Dysbiosis During Pregnancy.

In pregnant women bacterial vaginosis was detected in 44.44%, mixed floral vaginitis in 25%, and chronic vulvovaginal candidiasis in 30.55% of cases.

Quality of life impact and treatment response in vulval disease: Comparison of 3 common conditions using the Vulval Quality of Life Index.

To compare the quality of life in patients with vulval lichen sclerosus (VLS), vulval lichen planus (VLP) and chronic vulvovaginal candidiasis (CVVC), as measured by the Vulval Quality of Life Index (VQLI). A retrospective, single-centre cohort study was conducted at a combined dermatology and gynaecology practice from March 2018 to November 2021. VQLI scores and patient data were systematically collected and recorded in an online patient database. Treatment regimens were individualised and titrated to clinical response. Over 3 years, a total of 200 women were recruited: 59 with CVVC, 79 with VLP and 62 with VLS. The median duration of follow-up for all patients was 45.43 (16.25-80.89) weeks. At baseline, the median (interquartile range [IQR]) VQLI score was 24.00 (19.00-31.00), 21.00 (12.00-26.00) and 14.00 (7.00-26.00) for CVVC, VLP and VLS, respectively. At follow-up, the median (IQR) VQLI score for CVVC, VLP and VLS was 9.00 (3.00-15.00), 9.00 (3.00-16.00) and 5.00 (2.00-10.00), respectively. All three groups showed a significant improvement in VQLI score (p < 0.0001). At baseline, the highest scoring domains were 'Sexual Function' for CVVC and 'Future Health Concerns' for VLP and VLS. At follow-up, the highest scoring domains were 'Sexual Function' for CVVC and VLP, and 'Future Health Concerns' for VLS. Vulval disease has an immense impact on QOL, especially in patients with CVVC. The VQLI is useful to clinicians in identifying the unique impact of each vulval condition on a patient's QOL in order to provide better patient-focussed care.

Comparison of various regimens of itraconazole in treatment of acute vulvovaginal candidiasis

One of the most striking change in the current scenario is the increasing occurrence of non-albicans vulvovaginal candidiasis (VVC), which is considered as the major cause of recurrence, relapse and chronic VVC in India. In the present study we evaluated the effectiveness of three different regimens of itraconazole in the treatment of acute VVC.The present randomised, three arm comparative clinical study involved 123 women aged 18 years or above with symptomatic acute VVC. These patients were randomised (41 patients in each group) to receive either itraconazole 200 mg twice daily for 1 day (group I), 200 mg twice daily for 2 days (group II) or 100 mg twice daily for 3 days (group III). Effectiveness was evaluated on the basis of clinical cure (total symptom score), mycological cure (negative KOH test). All the groups were effective in relieving signs and symptoms (p&amp;#60;0.05), but on comparison between all groups, there was statistical difference between Group II and Group I &amp; III (p&amp;#60;0.05) and Group III &amp; I (p&amp;#60;0.05). Complete cure i.e. disappearance of signs and symptoms and negative KOH test was maximum in group II (44%) as compared to groups I (12%) and III (17% of the patients). Relapse was least in seen in 11 patients (27%) in Group I, 3 patients (7%) in Group II and 7 patients (17%) in Group III. All the 3 regimens were well tolerated.In the present study, 2 day high dose itraconazole therapy was found to have better effectiveness compared to conventional regimens. Longer duration of therapy might be required to attain even better cure rates, especially when the incidence of Non Albicans vulvovaginal candidiasis is rising in all parts of the country.

Dynamics of cellular factors of innate immunity and antioxidant protection in the patients with chronic recurrent vulvovaginal candidosis upon exposure to cavitated physiological solution

Dysfunction of colonization resistance factors at the mucous membranes of genitourinary system during adhesion of Candida fungi is a common pathogenic situation leading to impairment of the mucous membrane regeneration, unsuccessful attempts at in vitro fertilization (IVF), increased risk of complications during gestation. The aim of present study was to substantiate the opportunity of complex therapy for chronic vulvovaginal candidiasis using cavitated saline and usage suppositories with alpha-2b human recombinant interferon a (Viferon LLC, Russia). The study involved 90 women at the age of25.45±7.16 years, with clinically and laboratory confirmed recurrencies of chronic vulvovaginal candidiasis observed, on average, 5.55±0.45 times. Group 1 consisted of 30 women with C. albicans infection of urogenital tract, at the mean age of 27.11±1.52 years, who received therapy with fluconazole (150 mg once every 7 days). Group 2 consisted of 30 women with C. albicans infection of mucous membranes, mean age 27.31±1.99 years, treated with Fluconazole (150 mg 1 time in 7 days, and 5-min. irrigation of vagina with ultrasonicated saline solution, 7 days; Low-intensity ultrasound exposure was performed using the Fotek AK100-25 hardware complex, ultrasonic vibration frequency of 25 kHz (Yekaterinburg, Russia). Group 3 consisted of 30 women whose treatment included Fluconazole (150 mg once every 6 days), irrigation of mucous membranes with ultrasonicated cavitated solution and subsequent administration of suppositories containing Viferon® 500,000 IU (1 suppository daily for 7 days). Biochemical studies included determination of isopropanol- and heptane-soluble primary, secondary end products of lipid peroxidation. Activity of the antioxidant system was studied by determination of superoxide dismutase, glutathione peroxidase, ceruloplasmin, vitamin C. Qualitative and quantitative characteristics of neutrophilic granulocytes from vaginal secretions were evaluated by testing phagocytic activity, reduction of nitroblue tetrazolium compound to diformazan. The studies of IL-8, TNFα, IL-2, and IL-10 cytokines were carried out in cell-free supernates of vaginal secretions by ELISA test systems (LLC “Vector Best”, Novosibirsk). Results: upon therapeutic exposure to low-frequency ultrasonic cavitation combined with antioxidant drug, we have observed a decreased local concentration of pro-inflammatory cytokines, the balance of lipid peroxidationantioxidant defense system was restored, and functional metabolic status of the phagocytes in vaginal secretions was normalized.

Vaginal Yeast Infection

This review includes a detailed overview of the vaginal yeast infection based on current literature available, addressing etiology, epidemiology, risk factors, and pathophysiology, as well as clinical presentation, burden, diagnostic, and treatment strategies. There are multiple meta-analyses, systematic reviews, randomized control trials, and critical reviews recently published that have advanced the understanding of pathophysiology and answered questions regarding global burden, prevention, and treatment in a systematic way. In the recent years, important work has been made to better understand the pathophysiology and global burden behind the vaginal yeast infection. Diagnostic criteria were proposed for chronic vulvovaginal candidiasis. While fluconazole resistance has been making maintenance suppressive therapy of recurrent vulvovaginal candidiasis difficult and probiotics do not seem to be very effective, significant improvements and advances in the area of antifungal therapeutic innovation research have been made and further results of vaccine trials are pending. There is a need for well-designed RCTs in evidence-based treatment development and research.

Forming diagnostic criteria for vulvar lichen planus

Vulvar lichen planus is a debilitating skin condition usually complicated by delayed diagnosis due to its highly variable clinical appearance and inconsistent histopathological characteristics. This study aims to devise a clinical diagnostic tool for the disease and to correlate this with histopathology findings. The retrospective single-centre chart review was conducted for patients presenting between January 2010 and December 2019. Clinical features were compared between 243 women with clinically suspected vulvar lichen planus with available histopathology, 50 patients with biopsy-proven vulvar lichen sclerosus and 50 patients with culture-proven chronic vulvovaginal candidiasis. Features which significantly differentiated between conditions were further studied using multivariate nonlinear regression analyses to formulate a score-based diagnostic criteria. Criteria was then applied to the remaining patients with inconclusive biopsies (classified as 'normal', 'non-specific' or 'suggestive or lichenoid') to determine sensitivity and specificity. The clinical features that significantly differentiated the conditions were the presence of erosions (P<0.001), glazed erythema (P<0.001), oral involvement (P<0.001), pain/burning sensation (P<0.001) and hyperkeratotic border (P<0.001). A score ≥2 correlated with a histopathological diagnosis of vulvar lichen planus with a sensitivity of 100%. The specificity was 92% and 88% when compared against vulvar lichen sclerosus and chronic vulvovaginal candidiasis, respectively. Sensitivity was 97%, 97% and 93% in suggestive, nonspecific and normal histopathological subgroups, respectively. The proposed criteria may aid clinicians in diagnosing patients if histopathology is inconclusive. Nonspecific and suggestive findings on biopsy for patients with ≥2 features on diagnostic criteria are comparable to a conclusive biopsy.

A therapeutic effect of Nigella sativa extract on female Wistar rats vulvovaginal candidiasis model.

Aim Vulvovaginal candidiasis (VVC) is a disease mostly caused by Candida albicans and affects the quality of life of women especially in the form of chronic recurrent vulvovaginal candidiasis(RVVC). Nigella sativa is known to have several effects such as antimicrobial, anti-inflammatory, immune stimulation and anticancer properties. The aim of this study was to evaluate the effect of Nigella sativa on vulvovaginal candidiasis. Methods This study is a true experimental design, we used 28 Wistar strain rats divided into 4 groups, all groups were conditioned in a pseudoestrus state. Candida albicans was inoculated into the rats' vagina for 3 consecutive days. All groups were observed every 24 hours, 48 hours and 72 hours to evaluate the number of Candida albicans colonies, IgG and IgM anti Candida. Results After administration of intervention, there was a significant difference in the amount of fungal colonization after the treatment in each group (p<0.001). There was no significant difference in the effectiveness of Nigella sativa and fluconazole in supressing Candida albicans colonies after 72 hours (p=0.101). The administration of Nigella sativa showed a significant difference in the increase in IgM levels compared to the others group (p<0.001), while the IgG level did not show a significant difference (p=0.423). Conclusion Nigella sativa provides a therapeutic effect by decreasing the number of fungal colonies and increasing IgM levels.

Vulvovaginal candidiasis: etiology, pathogenesis, diagnosis, treatment

The article represents the main problems of diagnosis and treatment of patients with vulvovaginal candidiasis (VVC). It is noted that C. albicans causes candidiasis in 75-80% of cases. Clinical forms of VVC include acute VVC and chronic (recurrent) vulvovaginal candidiasis (HRVVC). The main diagnostic approaches in the treatment and prevention of disease recurrence are described. The article presents data on the use of Clotrimazole vaginal cream 2% (Esparma) to treat VVC.

Genital lesions in a female child: Approach to the diagnosis

Genital lesions in a female child cause a lot of apprehension in the parents. Hence, thorough knowledge and proper approach to the diagnosis is very important. The aim of this article is to present an overview of the pattern of diseases affecting genitalia in a female child, significance of these diseases, and an approach to the diagnosis of these diseases. Most of these vulval dermatoses present with one of the four clinical scenarios such as pruritus with/without lesions, pain with/without lesions, discharge with/without lesions, and asymptomatic lesions. The approach to the diagnosis has been discussed accordingly. Diseases such as genital warts and genital herpes which are not common in this age group always raise the suspicion of child sexual abuse. There are certain adult vulval dermatoses such as chronic vulvovaginal candidiasis, which are not seen in prepubertal group.

Livarol in the treatment of chronic vulvovaginal candidiasis

The article presents the results of the study of treatment of women with chronic vulvovaginal candidiasis by vaginal suppositories Livarol, which contain 400 mg of ketoconazole.Treatment was carried out according to two schemes. The main group (I) consisted of 22 women with chronic vulvovaginal candidiasis, who were prescribed treatment during the clinical manifestations of the disease in the form of Livarol in vaginal suppositories overnight during 10 days, then for three menstrual cycles in the same dosage during 5 days behind 7–10 days before the onset of menstruation. The comparison group (II) included 10 women with the same pathology, who were prescribed treatment only during the clinical manifestations of the disease in the form of Livarol in vaginal suppositories overnight during 10 days in one course. All patients were comparable in age and reproductive function and were treated on an outpatient basis.The efficacy of treatment was assessed based on the disappearance of clinical symptoms and complaints (itching, burning, pain, caseous vaginal discharge), the lack of positive laboratory tests for the presence of fungal and pathogenic flora after 3, 6, 12 days and 1–10 months from the start of treatment. Therapy in the first group, which in the first stage provided for the elimination of exacerbation of chronic candidiasis by 10-day appointment of vaginal suppositories with ketoconazole, and at the second stage – 3-fold antiretroviral treatment for 5 days through 1 month, was more effective (90.9%). A single course of local treatment of chronic vulvovaginal candidiasis by Livarol within 10 days is less effective (60.0%).The advantages of local use of ketoconazole are the rapid arresting of vulvovaginal candidiasis, a high concentration of antimycotic on the mucosa, the minimum frequency of side effects, the rapid normalization of the vaginal biocenosis, and the elimination of the effects of exo- and endocervicitis due to not only antimycotic but also antimicrobial action.

Chronic vulvovaginal candidiasis in patients using a levonorgestrel-containing intrauterine device.

Chronic vulvovaginal candidiasis is usually responsive to therapy with oral antifungals. We present a case series of 13 patients with this condition who were also using a levonorgestrel intrauterine system (LNG-IUS). All cases responded to ongoing oral fluconazole therapy while the LNG-IUS was in situ. The LNG-IUS was removed in six patients and of these, two experienced clinical improvement with lower fluconazole dosage requirements and three experienced complete resolution of symptoms. One remains on fluconazole 100 mg daily.

Management of chronic vulvovaginal candidiasis: a long term retrospective study.

Chronic vulvovaginal candidiasis (CVVC) is an unremitting condition causally associated with species of Candida. Limited data are available on its management and long-term outcomes. This retrospective study aimed to explore the long-term outcomes of patients who had experienced symptom remission after a course of oral antifungals. Retrospective study conducted over 1 year from data obtained from a vulval dermatology outpatient clinic in Sydney, Australia. Data from 208 patients satisfying presumptive or definitive criteria for CVVC who had been successfully treated with oral azole antifungal medication were collected from a database, including drugs, induction and maintenance treatment regimes, results and adverse effects. Altogether 208 patients commenced an induction regime of oral fluconazole 50-100 mg daily for up to 12 weeks. All patients demonstrated a clinical improvement within 12 weeks. Of the 208 patients, subsequently 95% remained on oral fluconazole for maintenance treatment, 3% changed to other antifungals due to adverse effects and 2% ceased treatment. The most common maintenance regime was oral fluconazole 50 mg twice weekly (46%). Of the study cohort 99% remained on treatment with antifungal therapy for symptom suppression with the mean duration of follow up 26.2 months (range, 5 months to 8.5 years). Long-term symptom remission was possible in this subset of women with CVVC using fluconazole 50-100 mg or itraconazole 50-100 mg. However, most were unable to cease treatment without experiencing relapse. Adverse effects in this cohort were minimal and there were no cases of drug-induced hepatitis.

Quality of life in patients with chronic vulvovaginal candidiasis: A before and after study on the impact of oral fluconazole therapy.

Chronic vulvovaginal candidiasis (CVVC) is a disorder characterised by the signs and symptoms of vulvovaginal inflammation and causally associated with the presence of Candida spp. in the vagina. This study aimed to establish the impact of treatment with fluconazole in CVVC on patients' quality of life (QoL). This was a before and after study conducted in vulval dermatology clinics in Sydney, Australia. Patients were assessed at baseline by the dermatology life quality index (DLQI) and visual analogue scale (VAS) grading of erythema at baseline and at 12 weeks after an oral fluconazole regime. The primary outcome measures were a change in their DLQI score and VAS grading. The secondary outcome measures were its tolerability and adverse events. A total of 82 of 91 patients (90%) completed the study. The mean drop in their DLQI score was 11.6 [95% CI (10.1, 13.0)] (P < 0.001). The post-treatment VAS scores were significantly lower than the pretreatment scores (P < 0.001). Adverse effects requiring cessation of fluconazole occurred in 4% of patients. Fluconazole treatment at a dose of 50-100 mg daily achieved a significant observable and improvement in the QoL of 96% of patients with CVVC within 12 weeks of treatment. Adverse effects were minimal.

Prophylaxis of recedives of chronic recurrent vulvovaginal candidiasis in women in the early postmenopausal period

Оценена эффективность предложенного лечения хронического рецидивирующего кандидозного вульвовагинита у женщин в период ранней постменопаузы по сравнению со стандартными методами. Основную группу женщин, вошедших в исследование, составили 20 пациенток с хроническим рецидивирующим кандидозным вульвовагинитом, которым проводилась терапия противогрибковым препаратом Ливарол и иммуномодулятором Лавомакс. Во вторую группу были включены 18 пациенток с хроническим рецидивирующим кандидозным вульвовагинитом, которым проводили антимикотическую терапию препаратом Ливарол. В контрольную группу вошли 20 здоровых женщин. Было показано, что использование в составе комплексной противовоспалительной терапии противогрибковых средств и иммуномодуляторов улучшает клиническое проявление заболевания, ускоряет процесс выздоровления, уменьшает осеменение половых путей патологической микрофлорой.

Chronic vulvovaginal candidiasis: new look at old problem

The study on the effectiveness of fenticonazole treatment in 60 patients aged 18 to 45 years old with chronic recurrent vulvovaginal candidiasis was performed. Women were divided into two equal groups of 30 people. The main group received fenticonazole (drug Lomexin®) for 6 days (the sexual partners of women in the same period was recommended cream fenticonazole). The comparison group was administered ketoconazole for 10 days and treatment of sexual partners according to generally accepted recommendations.The results showed a high (96.67%) an anti-recurrence effect of Lomexin® local therapy of chronic vulvovaginal candidiasis compared with ketoconazole (80.0%). These results allow the authors to recommend the scheme of fenticonazole local therapy for chronic vulvovaginal candidiasis

Vulvovaginal Candidiasis as a Chronic Disease

Although recurrent vulvovaginal candidiasis is defined as 4 or more discrete attacks of vulvovaginal candidiasis per year, there is no diagnostic nomenclature or definition for the many women who are chronically symptomatic. This study aims to establish and propose a definition and a set of diagnostic criteria, which would enable clinicians to promptly identify and treat women with chronic vulvovaginal candidiasis (CVVC). Prospective cohort study. Public and private vulvar dermatology outpatient clinics in Sydney, Australia. Data were obtained prospectively from 50 women with presumptive CVVC and 42 controls. Historical and clinical features of CVVC identified by expert consensus were compared between the 2 groups. Diagnostic criteria were then prospectively applied to a further 163 patients to verify their accuracy. Signs and symptoms diagnostic of CVVC. The following characteristics were found to be significantly more common in women with CVVC compared to controls (p ≤ .001): a history of positive vaginal Candida swab, discharge, dyspareunia, soreness, swelling, cyclicity, and exacerbation of symptoms with antibiotics. We propose that CVVC can be confidently diagnosed using the major criteria of a chronic nonspecific and nonerosive vulvovaginitis that includes at least 5 or more properties from the following criteria: soreness, dyspareunia, positive vaginal swab either at presentation or in the past, previous response to antifungal medication, exacerbation with antibiotics, cyclicity, swelling, and discharge. This condition responds reliably to oral antifungal medication.

Физические аспекты использования фотодинамической терапии при хроническом кандидозном вульвовагините

The aim of the presented research was investigation of induced by 5-ALA PPIX accumulation kinetics in mucosa, vagina and vulva chronic in women with vulvovaginal candidiasis after treatment of 5-ALA and the choice of optimal time mode of fluorescence diagnosis and photodynamic therapy (PDT) in chronic vulvovaginal candidiasis. The investigation was held in group of 60 women: 20 with vulvovaginal candidiasis, 25 - bacterial vaginosis, 15 - non - specific vaginitis. Each woman had 4 sessions of PDT. Before and after each of the sessions fluorescence diagnosis (FD) of photosensitizer accumulated in mucosa, vagina and vulva was performed. By means of local fluorescent spectroscopy difference of accumulated PPIX was estimated with statistical methods. It was obtained, that difference between accumulation of PPIX after 1, 2, 3 and 4th session is statistically significant. After the 4th session it was estimated that there is no significant statistical difference between PPIX accumulated in healthy tissue and mucosa of vagina. According to this we concluded, that PDT in this case showed high efficiency.

Chronic vulvovaginal candidiasis: What we know and what we have yet to learn

Vulvovaginal candidiasis (VVC) is defined as vulvovaginitis, causally associated with Candida species in the vagina. It is seen commonly in vulval clinics as a cause of persistent vulvovaginitis and yet this chronic condition is yet to be formally defined and explained. The classic symptom complex of chronic itch, pain and dyspareunia exacerbating premenstrually and remitting during menstruation associated with an erythematous vulval eruption is well described but the exact aetiology remains elusive. Research in recent years has suggested that VVC is not an opportunistic infection or an immunodeficiency but a hypersensitivity response to a commensal organism that may be genetically determined. Further, it is apparent on clinical grounds that oestrogen plays an essential permissive role and that, in healthy non-diabetic patients, VVC does not occur in the absence of oestrogen whether endogenous or exogenous. The nature of this relationship has not been established. In this article I discuss the diagnostic features of VVC, its management and what is currently understood of its aetiology.

Candida glabrata

Chronic recurrent vulvovaginal candidiasis caused by Candida glabrata is still rare in comparison to C. albicans infection, but therapy remains more difficult. Standard agents as fluconazole or itraconazole often fail, as well as the newer systemic triazoles like voriconazole or posaconazole. Micafungin is a new echinocandin drug with a wide antifungal spectrum including rare Candida species. No clinical trials with micafungin in chronic recurrent vulvovaginal candidiasis have been undertaken. We present the initial results employing a new therapy regimen consisting of micafungin in combination with topical ciclopirox olamine. All 14 patients with chronic recurrent vulvovaginal candidiasis caused by C. glabrata were treated successfully.