Diagnosis Of Vulvovaginal Candidiasis Research Articles

Bridging Diagnostic Gaps: Utilising HiCrome Agar and Tetrazolium Reduction Medium for the Rapid and Presumptive Identification and Speciation of Candida Species in Vulvovaginal Candidiasis in Low-Resource Environments.

Background Vulvovaginal candidiasis (VVC) is a common fungal infection caused by an overgrowth of Candida species, primarily Candida albicans (C. albicans). Using HiCrome agar and tetrazolium reduction medium offers cost-effectiveness in Candida detection by eliminating the need for additional tests, reducing equipment costs compared to automated systems, and simplifying workflow with direct species identification while maintaining high specificity. They expedite detection by directly identifying Candida species based on colony colour, bypassing the multiple steps of phenotypic methods. This efficiency saves time in the laboratory, providing rapid results without the extended processing times associated with automated systems and facilitating prompt diagnosis and treatment decisions. These diagnostic tools are especially valuable in low-resource environments where a quick and accurate diagnosis of VVC is crucial for effective treatment and management of antifungal resistance. Aims and objectives This study aims to evaluate the efficacy of HiCrome agar and tetrazolium reduction medium's efficacy in speciating Candida species in VVC cases. Materials and methods A cross-sectional observational study was conducted at Saveetha Medical College and Hospitals, Chennai, India, over six months. High vaginal swabs from 126 patients suspected of VVC were collected and plated on Sabouraud dextrose agar (SDA), HiCrome Candida differential agar (Himedia, Mumbai, India), and tetrazolium reduction medium. The results were compared with those obtained from the VITEK2 compact system (bioMérieux, Marcy-l'Étoile, France). Results Of the 126 samples, 74.6% showed single yeast infections, 7.9% displayed mixed yeast infections, and 17.5% showed no growth. A total of 114 Candida isolates were identified. Both HiCrome agar and tetrazolium reduction medium accurately identified all isolates, with complete concordance with the VITEK2 compact system. The most commonly isolated species were C. albicans (55.2%), Candida tropicalis (32.4%), Candida glabrata (8.8%), and Candida parapsilosis (3.6%). Both media provided rapid and accurate presumptive identification in low-resource settings. Conclusions HiCrome agar and tetrazolium reduction medium demonstrated high sensitivity and specificity in identifying Candida species. These methods are reliable for rapid and accurate diagnosis, particularly in resource-limited settings. However, they may require supplementary tests for definitive species identification. The adoption of these diagnostic tools represents a significant advancement in clinical microbiology, improving VVC management and addressing antifungal resistance.

Clinical Evaluation of Polymerase Chain Reaction Coupled with Quantum Dot Fluorescence Analysis for Diagnosis of Candida Infection in Vulvovaginal Candidiasis Practice.

Time-consuming culture methods and wet-mount microscopy (WMM) with low sensitivity have difficulties in diagnosing Vulvovaginal candidiasis (VVC). Rapid and highly sensitive polymerase chain reaction coupled with quantum dot fluorescence analysis (PCR-QDFA) for the diagnosis of VVC has not been reported to date. This study was the first to evaluate the performance of PCR-QDFA for diagnosis of Candida strains in the leukorrhea samples from patients with suspected VVC. Leukorrhea samples from all visited patients were taken from the vagina using vaginal swabs by clinicians. We evaluated patients admitted with suspected VVC who completed WMM for diagnosis and reported the diagnostic effectiveness of PCR-QDFA and Candida culture (gold standard) when testing leucorrhea samples. A total of 720 leukorrhea samples from 387 VVC-positive patients and 333 VVC-negative patients were included in this study. Of the 387 leukorrhea samples from the VVC-positive patients, 391 Candida strains were identified by culture. 99.23% (388/391) Candida strains were included in the PCR-QDFA list. The 388 Candida strains belonged to four different species of Candida, including C. albicans (n = 273, 70.36%), C. glabrata (n = 85, 21.91%), C. tropicalis (n = 16, 4.12%), and C. krusei (n = 14, 3.61%). PCR-QDFA diagnosed Candida strains in 340/384 (88.54%) of the leucorrhea samples with Candida strains infection. The sensitivity of PCR-QDFA for C. albicans, C. glabrata, C. tropicalis, and C. krusei was 89.01%, 85.88%, 81.25% and 92.86%, respectively. The specificity of PCR-QDFA for C. albicans, C. glabrata, C. tropicalis and C. krusei was 93.69%, 99.37%, 99.71%, and 99.57%, respectively. The highly sensitive and specific PCR-QDFA technique can be exploited as a rapid (approximately 4 h) diagnostic tool for common Candida strains of leucorrhea samples from patients with suspected VVC.

An Integrated and Multi-Target Nucleic Acid Isothermal Analysis System for Rapid Diagnosis of Vulvovaginal Candidiasis.

Rapid identification of Candida species is significant for the diagnosis of vulvovaginal candidiasis (VVC). An integrated and multi-target system for the rapid, high-specificity, and high-sensitivity detection of four Candida species was developed. The system consists of a rapid sample processing cassette and a rapid nucleic acid analysis device. The cassette could process the Candida species to release nucleic acids in 15 min. The released nucleic acids were analyzed by the device as fast as within 30 min, using the loop-mediated isothermal amplification method. The four Candida species could be simultaneously identified, with each reaction using only 1.41 µL of reaction mixture, which was low cost. The RPT (rapid sample processing and testing) system could detect the four Candida species with high sensitivity (<2 CFU/reaction) and high specificity. The system also processed and analyzed 32 clinical samples, giving the results with high clinical sensitivity and specificity. Hence, the system was a significant and effective platform for the diagnosis of VVC. Furthermore, the period of validity of the reagents and chips used in the system was >90 days, and the system could also be used for the detection of bacteria.

Vulvovaginal Candidiasis: A Review of the Evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines.

Vulvovaginal candidiasis (VVC) is a common cause of vulvovaginal itching and discharge. This article discusses the latest CDC STI Treatment Guidelines for VVC. A literature search of relevant topics was performed, and a team of experts was convened to discuss (1) diagnosis/testing modalities; treatment of (2) uncomplicated VVC , (3) complicated VVC, and (4) VVC caused by non-albicans yeast; (5) alternative treatment regimens; (6) susceptibility testing of yeast; Special Populations: (7) pregnancy and (8) HIV and VVC. Yeast culture remains the gold standard for diagnoses. Newer molecular assays have been developed for the diagnosis of VVC and perform well. Azole antifungals remain the treatment of choice for uncomplicated VVC. Two new drugs, TOL-463 and recently FDA-approved ibrexafungerp, appeared promising in clinical trials. For recurrent VVC, oteseconazole, not yet commercially available, may represent a new option. For non-albicans yeast infections in symptomatic patients, boric acid appears useful. No evidence supports the use of alternative treatments, including probiotics. Fluconazole during pregnancy may be associated with spontaneous abortion and craniofacial and heart defects. In women with HIV infection, lower CD4+ T-cell counts are associated with increased rates of VVC, and VVC is associated with increased viral shedding. Treatment measures in women with HIV infection are identical to those women without HIV infection. There has been significant new knowledge generated about VVC since the 2015 CDC Guidelines which have led to changing recommendations.

THE PREVALENCE OF VULVOVAGINAL CANDIDIASIS (VVC) AMONG WOMEN SUFFERING VAGINITIS ATTENDED A PRIVATE GYNECOLOGICAL CLINIC, ADEN-YEMEN

The study was carried out to determine the prevalence of vulvovaginal candidiasis among women suffering vaginitis. This prospective cross-sectional study was conducted among 120 women between the age of 15 to 45 years (mean age 39 years), attended a private gynecological clinic in Aden with symptoms of vaginitis between January and June 2019. A questionnaire was used to obtain information on the participants’ sociodemographic data and medical history. Direct microscopic examination (10% KOH), culture on SDA, germ tube test and gram staining were used to determine the prevalence of vulvovaginal candidiasis and to differentiate between C.albicans and non-albicans species. Out of 120 women, 25 (20.8%) were diagnosed with vulvovaginal candidiasis (VVC) and 95 (79.2%) with non-candidal vaginitis. C.albicans was the most prevalent with a prevalence rate of 17.5%. Although not statistically significant, vulvovaginal candidiasis tended to be more prevalent among women with 25-34 years. No statistically significant association between the prevalence of vulvovaginal candidiasis and educational level and marital status. Vulvovaginal candidiasis (VVC) was slightly high in Aden and Candida albicans was the most common causative agent of VVC. In the clinical diagnosis of VVC, both clinical criteria and microbiological tests must be used. Further study is needed to find out the prevalence of RVVC among women in the Aden governorate.

Evaluating the accuracy and diagnostic value of CFW and a new fluorescent reagents, fluorescent brightener 85, for the diagnosis of vulvovaginal candidiasis.

BackgroundVulvovaginal candidiasis (VVC) is a common vaginitis in females. The commonly used diagnostic method, 10% potassium hydroxide (KOH) smear microscopy, makes it not very easy to recognize fungi.MethodsVaginal secretions were collected from clinically suspected VVC patients and divided into four groups and examined using KOH, CFW (Calcofluor White), FB 85(fluorescent brightener 85), and culture. The data were statistically analyzed.ResultsIn total, 110 patients with suspected VVC were recruited. The positive rates of KOH, CFW, FB 85, and the culture method were 68.2%, 64.5%, 61.8%, and 77%, respectively. According to the McNemar test, there was no statistically significant difference between the KOH, CFW, and the FB 85 methods (p > 0.05). However, CFW had a shorter diagnosis time than the KOH method and had a statistically significant difference (p < 0.001). Moreover, CFW has the highest sensitivity, specificity, and accuracy. In morphological recognition, it was easier to recognize fungal structures with CFW and FB 85 than with the KOH.ConclusionsThe fluorescent method is a good method for the diagnosis of VVC. And the fungi can be found more quickly. Similar to CFW, FB 85 is also a potential good fluorescent reagent for the diagnosis of VVC and has potential value for application in clinical fungal infection diseases.

Nucleic Acid Amplification Testing Compared With Cultures, Gram Stain, and Microscopy in the Diagnosis of Vaginitis

The aim of the study was to evaluate the performance of nucleic acid amplification testing (NAAT) for the diagnosis of vulvovaginal candidiasis (VVC), bacterial vaginosis, and Trichomonas vaginalis. A cross-sectional analysis of women with (n = 200) and without (n = 100) vulvovaginal symptoms was enrolled from outpatient gynecology offices and a vulvovaginal referral clinic. Vaginal swabs were analyzed by wet mount microscopy, yeast culture, Gram stain, T. vaginalis culture, and NAAT. Sensitivity and specificity analyses were performed. Among symptomatic women, the sensitivity of microscopy was 48.5% for VVC and 75% for T. vaginalis. Sensitivities of NAAT and culture for diagnosing VVC were 92.4% and 83.3%, respectively, whereas these methods were 100% and 93.8% for T. vaginalis. The sensitivity for bacterial vaginosis diagnosis by clinical criteria ("Amsel criteria"), Gram stain, and NAAT were 98.7%, 82.7%, and 78.7%, respectively. Test concordance rates were high between culture and NAAT for Candida species (91%) and between Gram stain and NAAT for the detection of bacterial vaginosis (88%). Among asymptomatic women, 20%-21% tested positive for bacterial vaginosis by Gram stain or NAAT, and 8%-13% were colonized with Candida species based on culture or NAAT. Given the limitations of wet mount sensitivity for VVC and T. vaginalis, culture or NAAT testing should be considered when evaluating women with symptoms of vaginitis who test negative by microscopy. Although Amsel criteria accurately diagnosed bacterial vaginosis, NAAT is preferred for detection of T. vaginalis and performed similarly to culture for the diagnosis of VVC.

Candidíase vulvovaginal na Atenção Primária à Saúde

Objetivo: Identificar na literatura como é realizado o diagnóstico clínico e laboratorial e tratamento da candidíase vulvovaginal de pacientes atendidas nos serviços de Atenção Primária à Saúde. Método: Trata-se de uma revisão integrativa da literatura onde artigos foram selecionados utilizando os seguintes descritores controlados “Candisiasis vulvovaginal”, “Diagnosis”, “Therapeutics” e “Primary Health Care”, para a consulta nas bases de dados SCOPUS – base multidisciplinar; Web of Science; National Library of Medicine National Institutes of Health (PubMed) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Resultados: Foram encontradas 54 publicações, e após a aplicação dos critérios de inclusão e exclusão, restaram 6 artigos que passaram a integrar o corpus de análise da presente revisão integrativa. De acordo com a literatura, o diagnóstico da candidíase vulvovaginal na Atenção Primária à Saúde é baseado na observação dos sinais e sintomas sugestivos da doença juntamente com a confirmação laboratorial, o que permite a confirmação da patologia e identificação do patógeno envolvido, a depender do método utilizado. O tratamento medicamentoso é empregado, associado a medidas não farmacológicas. Conclusão: O diagnóstico da Candidíase Vulvovaginal na Atenção Primária à Saúde é baseado na observação das características clínicas desta infecção e para a confirmação, amostras de secreção vaginal devem ser coletadas e enviadas para laboratórios especializados. Em relação ao tratamento, este deve considerar as diferenças entre CVV não complicada e CVV recorrente, onde o tratamento medicamentoso pode ser aliado a medidas não farmacológicas.

Frequency of Coinfection on the Vaginal Wet Preparation in the Emergency Department.

IntroductionVaginal infections are common in the emergency department (ED) but the frequency of vaginal coinfections identified on wet preparation is unknown.MethodsThe study examined a data set of 75,000 ED patient encounters between April 18, 2014, and March 7, 2017, who had received testing for gonorrhea, chlamydia, or trichomonas or had received a urinalysis and urine culture during the ED encounter. From this data set we reviewed 16,484 patient encounters where a vaginal wet preparation was performed on women age 18 years and older. Findings from the vaginal wet preparation and ED discharge diagnoses were examined to evaluate the frequency of vaginal coinfections with vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis.ResultsAmong the women who had wet preparations, 4,124 patient encounters (25.0%) had a diagnosis of bacterial vaginosis, 625 (3.8%) had a diagnosis of vulvovaginal candidiasis, and 1,802 (10.9%) were infected with Trichomonas vaginalis. Twenty encounters (0.1%) had a diagnosis of vulvovaginal candidiasis and trichomoniasis; 150 (0.9%), bacterial vaginosis and trichomoniasis; 136 (0.8%), vulvovaginal candidiasis and bacterial vaginosis; and 10 (0.1%), trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. On vaginal wet preparation, the mean white blood cell count was 13.0 per high-power field. Clue cells were found in 6,988 wet preparations (42.4%); 1,065 wet preparations (6.5%) had yeast and 1,377 (8.4%) had T. vaginalis. T. vaginalis was identified in 2.5% (266/10,542) of urinalyses and 8.4% (406/4,821) of nucleic acid amplification tests.ConclusionsVaginal coinfections were uncommon among women receiving a vaginal wet preparation in the emergency department. The most common vaginal coinfection was bacterial vaginosis and trichomonas.

Accuracy in clinical examinations for the diagnosis of vulvovaginitis by CANDIDA SPP. and IN VITRO susceptibility to the main antifungals

Vulvovaginal candidiasis (VVC) is a common infection. This work aims to determine the positive predictive value (PPV) of the clinical diagnosis of VVC and to characterize Candida species isolated from the vaginal mucosa. This cross-sectional study was conducted from February 2016 to February 2017 at the Gynecology and Obstetrics Outpatient Clinic of the Hospital das Clínicas, in Goiânia, Goiás State, Brazil. The study included samples of vaginal secretion from 55 women who complained of vaginal discharge and itching as their main symptoms. The PPV of the clinical diagnosis of VVC was estimated in comparison to the laboratory culture method. The phenotypic methods and molecular tests were performed to identify Candida spp. In vitro susceptibility of Candida spp. isolates to fluconazole, itraconazole, clotrimazole, nystatin, and amphotericin B was determined using the broth microdilution assay. Yeast growth using the enzymes protease, phospholipase, and hemolysin was carried out in media containing respectively bovine albumin, egg yolk, and sheep erythrocytes. A PPV of 61.8% (34/55) was determined. Among the 55 vulvovaginal samples collected, we identified 36 isolates in whichC. albicans was the most common species. High resistance to fluconazole and low minimal inhibitory concentration (MIC) values for clotrimazole, nystatin and amphotericin B were observed. All isolates were proteinase and hemolysin producers, while seven strains were phospholipase negative. The clinical diagnosis of VVC presented a moderate PPV, which meant that cultures had to be conducted in the laboratory to confirm infection. The high resistance to fluconazole and itraconazole indicated the importance of the in vitro susceptibility test.KEY WORDS: Vulvovaginal candidiasis; antifungal susceptibility; enzymatic activity

Identification of various Candida species isolated from patients with vulvovaginal candidiasis attending a tertiary care hospital in North India

Background: Vulvovaginal Candidiasis (VVC) is a condition diagnosed in a large proportion of women presenting with complaints of abnormal vaginal discharge. The risk of VVC is high in women with diabetes mellitus, pregnancy, using oral contraceptives or broad-spectrum antibiotics and those having Human Immunodeficiency Virus infection.Objective of the present study was to identify the various species of Candida isolated from patients with Vulvovaginal Candidiasis.Methods: A cross-sectional study was done from January to June 2018. A total of 69 clinically suspected VVC cases were included in the study whose high vaginal swabs were collected and subjected to direct microscopy and cultured on Sabouraud Dextrose Agar (SDA). Creamy white pigmented colonies on SDA were confirmed as Candida by doing Gram’s staining. Speciation of positive cultures was confirmed by conventional methods like Corn Meal agar culture, Germ tube test (GTT), Candida CHROM Agar Medium (CAM), sugar assimilation and fermentation test.Results: Out of 69 clinically suspected VVC cases included in the study, only 14 cultures were positive for Candida species. All the 14 isolates were found to be Non-albicans Candida (NAC). Most common species isolated were Candida glabrata 7(50%), followed by Candida tropicalis 3(21.4%), Candida lusitaniae 3(21.4%), and Candida parapsilosis 1 (7.1%).Conclusions: Candida albicans was known to be the most common causative agent of VVC as it was isolated in 90% cases. However, this study showed that all isolates from VVC were Non-albicans Candida. Therefore, species identification should be done in all microbiology laboratories for accurate diagnosis of VVC.

Prevalence and antifungal susceptibility of Candida species among pregnant women attending a school maternity at Natal, Brazil.

Vulvovaginal candidiasis (VVC) is a problem that affects a significant number of pregnant women worldwide. This type of fungal infection generates great discomfort due to the symptomatology and difficulties of diagnosis and treatment. In view of the scarcity of data in the State of Rio Grande do Norte, Brazil, regarding studies carried out on fungal populations of the genus Candida associated with VVC in pregnant women, this study considered relevant, the phenotypic and genotypic identification of the species, to estimate the prevalence, to determine their susceptibility to the antifungal and to correlate with signs and symptoms.

Vulvovaginal candidiasis in reproductive age women in Enugu Nigeria, clinical versus laboratory-assisted diagnosis.

Clinical diagnosis of acute vulvovaginal candidiasis (VVC) depends on evidence of clinical symptoms, but symptomatic treatment widely practiced in low-resource area may lead to overdiagnosis and treatment. The objective of the study is to determine the prevalence of VVC among women attending gynecological clinic in University of Nigeria Teaching Hospital (UNTH) Enugu and the accuracy of clinical-based diagnosis versus laboratory test supported diagnosis and patients' characteristics that affect accuracy. This study surveyed patients seen in a gynecologic clinic for VVC using a semi-structured, pretested, and interviewer-administered questionnaire. Vaginal examination was done on each patient and findings documented. A pair of swabs was taken from the vagina and cervical os and cultured for Candida species using Sabouraud Dexttose Agar. Data were analyzed using statistical software, SPSS version 15 (SPSS Inc., Chicago IL, USA). P ≤ 0.05 were considered to be statistically significant. The mean age of 209 women surveyed was 35.9 (standard deviation [SD] ±9.0) years. Their mean parity was 2 (SD ± 3). The prevalence of VVC was 17.7% based on symptoms and laboratory test. Clinically based diagnosis had a sensitivity of 70.3% and specificity of 83.7%. Forty-one (19.6%) of the study population had good knowledge of VVC. More than 44% of the women had self-reported and treated VVC within the year. Young women of 24 years or less (54.5%) and those who had reported other episodes of VVC within the past year (41.1%) were most commonly associated with inaccurate clinical diagnosis. Clinically based diagnosis of VVC has an unacceptably high false-positive rate which may encourage continued presumptive treatment with its attendant risks. Clinical evaluation and laboratory culture of vulvovaginal specimen should be the standard diagnostic method.

Computer-aided diagnosis software for vulvovaginal candidiasis detection from Pap smear images.

Vulvovaginal candidiasis (VVC) is a common gynecologic infection and it occurs when there is overgrowth of the yeast called Candida. VVC diagnosis is usually done by observing a Pap smear sample under a microscope and searching for the conidium and mycelium components of Candida. This manual method is time consuming, subjective and tedious. Any diagnosis tools that detect VVC, semi- or full-automatically, can be very helpful to pathologists. This article presents a computer aided diagnosis (CAD) software to improve human diagnosis of VVC from Pap smear samples. The proposed software is designed based on phenotypic and morphology features of the Candida in Pap smear sample images. This software provide a user-friendly interface which consists of a set of image processing tools and analytical results that helps to detect Candida and determine severity of illness. The software was evaluated on 200 Pap smear sample images and obtained specificity of 91.04% and sensitivity of 92.48% to detect VVC. As a result, the use of the proposed software reduces diagnostic time and can be employed as a second objective opinion for pathologists.

Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database.

BackgroundA recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs.AimTo investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management.Design & settingAn observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database.MethodWomen with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected.ResultsIn total 7066 women with VVC or uncertain VVC were included. Uncertain VVC was found to account for 28% of these patients. Compared to VVC, the group uncertain VVC included significantly more women with female genital symptoms, tiredness, irritable bowel syndrome (all P<0.001), feeling anxious, reduced sexual desire, depressive disorder, relationship problems, and micturition symptoms (all P<0.05). Compared to VVC, the group uncertain VVC included significantly higher mean numbers of telephone consultations (P<0.001), more referrals to gynaecology (P = 0.009), and higher mean numbers of prescriptions per patient (P<0.001).ConclusionThis study's findings indicate that uncertain VVC could be a marker of PVD. GPs might reconsider their diagnostics and management when women present recurrent and persistent vulvovaginal complaints, especially if accompanied by dyspareunia, functional syndromes, micturition symptoms, and psychological conditions.

Automatic diagnosis of vulvovaginal candidiasis from Pap smear images.

Vulvovaginal candidiasis (VVC) is the most common genital infections that are seen every day in clinics. This infection is due to excessive growth of Candida that are normally present in the vagina in small numbers. Diagnosis of VVC is routinely done by direct microscopy of Pap smear samples and searching for the Candida in the Pap smear glass slides. This manual method is subjective, time consuming, labour-intensive and tedious. This study presents a computer-aided diagnostic (CAD) method to improve human diagnosis of VVC. The proposed CAD method reduces the diagnostic time and also can be worked as a second objective opinion for pathologists. Our main objective is detection and extraction of mycelium and conidium of Candida fungus from microscopic images of Pap smear samples. In this regard, the proposed method is composed of three main phases, namely preprocessing, segmentation, feature extraction and classification. At the first phase, bottom-hat filtering is used for elimination of the cervical cells and separating the background. Then decorrelation stretching and colour K-means clustering are used for Candida segmentation. Finally the extracted features used by a decision tree classifier to detect Candida from other parts of smear. The proposed method was evaluated on 200 Pap smear images and showed specificity of 99.83% and 99.62% and sensitivity of 92.18% and 94.53% for detection of mycelium and conidium, respectively.

Self-diagnosis of Vulvovaginal Candidiasis is Poor - A Comparison of Diagnostic Methods Introducing β-Glucan as a Complement

Aim: Self-diagnosis of Vulvovaginal Candidiasis (VVC) may result in misuse of over-the counter (OTC) antifungals. In this study the accuracy of self-diagnosis, clinical diagnosis, and laboratory diagnostic methods, including vaginal smear microscopy and a new method for the diagnosis of VVC (β-glucan), were compared using positive yeast culture as gold standard for diagnosis of VVC. Methods: Women with self-diagnosed VVC (n=88), intending to buy OTC antifungals, were recruited from pharmacies and health care providers. A clinical examination was performed including vaginal samples for quantitative culturing of yeast, for β-glucan determination and vaginal smear microscopy (VSM). Results: In all symptomatic women, 66% were culture-positive for yeast, 20% had bacterial vaginosis (BV) (12% concurrent with VVC), and 25% were not diagnosable. The sensitivity and specificity for diagnosis of VVC were similar for β-glucan (77% and 97%) and VSM (67% and 97%, respectively), while the sensitivity was low for clinical examination (40%). The sensitivity of VVC diagnosed by analysis of β-glucan was equal to gynecological examination combined with VSM. Conclusion: The accuracy of self-diagnosis of VVC is poor. To reduce misdiagnosis women should be offered complementary diagnostic methods. For correct diagnosis analysis of β-glucan or a combination of clinical examination and laboratory VSM is recommended. In cases of therapy resistance vaginal yeast cell culture is recommended. A future rapid bedside test of β-glucan would be useful avoiding misdiagnosis.

Lactobacillus plantarum P17630 for preventing Candida vaginitis recurrence: a retrospective comparative study

BackgroundRecurrence is a frequent complaint of patients with vulvovaginal candidiasis (VVC). Although the pathogenesis of VVC remains a controversial issue, disruption of the balance between the vaginal microbiota may facilitate overgrowth by Candida. Some probiotic bacterial strains can suppress Candida albicans; Lactobacillus plantarum P17630 is able to attach to vaginal epithelial cells and significantly reduce the adhesion of C. albicans. ObjectiveTo evaluate the effect of the application of Lactobacillus plantarum P17630 in restoring the vaginal microbiota and prevention of relapses among women with acute VVC undergoing conventional (azole) local and main therapy. MethodsRetrospective comparative study. We recruited 89 women with a diagnosis of VVC, who were placed into two groups on the basis of reported treatment. The control group was treated with a daily dose of 2% clotrimazole vaginal cream at bedtime for 3 days, followed by vaginal application of a capsule containing lubricant once a day for 6 days and then once a week for another 4 weeks. The probiotic group was treated with the same azole-based protocol but followed by vaginal application of a capsule containing Lactobacillus plantarum P17630 (>108CFU) once a day for 6 days and then once a week for another 4 weeks beginning the day following clotrimazole discontinuation. Clinical and diagnostic patterns were monitored for three months of follow-up. ResultsAt the end of study the probiotic-treated women showed a statistically significant increase in Lactobacillus values “+++” (80% versus 40%, p<0.001) and a better subjective resolution of symptoms such as vaginal discomfort described as burning or itching (90% versus 67.5%, p<0.03). Among controls there was a non-significant increase at 3 months of recurrence of infection, but a significant increase of women with value of pH=5 or >5. ConclusionAlthough the results of different studies are controversial, most have suggested use of probiotics in the prevention or treatment of VVC, and no adverse effects have been reported. Our data with L. plantarum P17630 (Gyno-Canesflor - Bayer) confirm the role of this specific strain as a potential empirical preventive agent for reducing vaginal discomfort after conventional treatment of acute VVC and shifting the vaginal milieu toward a predominance of lactobacilli with an improvement of the vaginal pH value.

Diagnosis of Vulvovaginal Candidiasis and Effectiveness of Combined Topical Treatment with Nystatin: Results of a Non-Interventional Study in 973 Patients

Introduction & Objectives: This non-interventional study was performed in 231 gynaecological surgeries in or- der to assess current routine diagnostic practice well present effectiveness and tolerability of a combined topical treatment with nystatin in patients with uncomplicated vulvovaginal candidiasis (VVC). Methods: Naive or insufficiently treated VVC patients received a combined topical antimycotic treatment § . Diagnostic procedures were documented. Cardinal disease symptoms and dosage regimens were recorded before and after therapy. Investigators and patients rated treatment effectiveness and tolerance. Adverse events and withdrawals were documented. Results: All 1,011case reports were included in the safety analysis; thereof 973 cases in the efficacy analysis. Based on di- agnoses conform to guidelines 74.7% of the patients had a primary infection while 24.9% were experiencing a relapse. After a treatment period of 6 days (median), individual symptoms had ceased in up to 81.9%. Complete healing was achieved in 63.1% (vulva) and 65.4% (vagina). Investigators rated therapy outcome healing/significant improvement in 90.0% (vulva) and 88.2% (vagina), and tolerance as very good/good in 97.4%. Conclusions: Routine diagnosis of VVC predominantly corresponds to relevant guidelines. Combined intra- and perivagi- nal therapy of VVC with nystatin is an effective, safe and cost-conscious treatment option. Nystatin has not lost its effec- tiveness over the years. § Nystatin cream and vaginal tablets (Biofanal ® 100.000 IU combination package), Dr. R. Pfleger GmbH, D-96045 Bam-

A comparison study between the direct agglutination test and conventional methods in the diagnosis of vulvovaginal candidiasis

We compared the current diagnostic methods (clinical examination, microscopy and mycological culture) with a direct agglutination (DA) test in the diagnosis of vulvovaginal candidiasis (VVC). One hundred fifty women with suspected VVC were examined by microscopy and culture methods. The patients' sera were tested for the presence of anti-Candida antibody and iron and zinc concentration. Of the 150 patients studied, 120 (80%) were found to be Candida positive using both microscopy and culture methods whilst 30 cases (20%) were infected with non-Candida agents. Forty nine (32.7%) and 71 (47.3%) were positive in microscopy and culture, respectively. VVC was mostly observed in patients ranging from 20 and 29 years of age (42.5%). Candida albicans (65.3%) was found in significantly higher proportion of patients compared to other isolated yeasts (P < 0.05). The iron and zinc concentrations were similar in the two patient groups. The DA test was positive in 114 (76%) of patients, indicating the incidence of a positive value increasing in direct proportion to the amount of yeast isolated. A titre of 1:16 was the most frequent value in both groups with positive and negative cultures. This study offers the DA test as a useful alternative to conventional methods for the diagnosis of VVC.