Recurrent vaginal candidiasis. Importance of an intestinal reservoir.
Miles MR, Olsen L, Rogers A.
To test the hypothesis that all cases of vaginal candidiasis are associated with a "reservoir" of this organism in the bowel, paired specimens of feces and vaginal material were cultured for Candida albicans simultaneously. Ninety-eight young women who complained of recurrent vaginitis were selected in sequence. The results showed that if C albicans was cultured from the vagina, it was always found in the stool. Conversely, if it was not isolated from the stool, it was never found in the vagina. These data are presented as an explanation for the recurrent nature of Candida vaginitis, and thus a cure of vaginitis would not be possible without prior eradication of C albicans from the gut. The gut-reservoir concept may well apply to other forms of candidiasis.
PMID: 333134 [PubMed - indexed for MEDLINE]
Zhonghua Fu Chan Ke Za Zhi. 2011 Jul;46(7):496-500.
[Study on the relationship between vaginal and intestinal candida in patients with vulvovaginal candidiasis].
[Article in Chinese]Lin XL1, Li Z, Zuo XL.
To investigate the relationship between vaginal and intestinal candida in patients with vulvovaginal candidiasis by using microbiological and molecular methods.
The samples of vaginal discharge and anal swabs were collected from 148 cases with vulvovaginal candidiasis, followed by fungal culture, identification, purification and genome DNA extraction. The genome sequences from respective locations were aligned and typed according to their homology analyzed by internal transcribed spacer (ITS) PCR and random amplified polymorphic DNA (RAPD) PCR. Patients with vulvovaginal infection or those with infections in intestine and vulvovagina were pooled respectively, while the recurrent incidences after local anti-fungal treatments were analyzed.
Candida albicans is the dominant pathogen in 148 cases with vulvovaginal candidiasis (91.9%, 136/148); 33.1% (49/148) of patients with vulvovaginal candidiasis were infected in both intestine and vulvovagina. While 92% (22/24) of patients with intestinal and vaginal candida infection showed high homology. The recurrent rate of patients with vulvovaginal candidiasis complicated with concurrent intestinal candida infection (7/14) was significantly higher than that of solo vaginal infected patients [21% (6/29)] after vaginal treatment (P<0.05).
The infection of vulvovaginal candidiasis is highly associated with the concurrent infection of intestinal candida. The recurrent rate is high in patients with vulvovaginal candidiasis with concurrent infection of intestinal candida after vaginal treatment. The general management to those patients infected by both vulvovaginal and intestinal candida is necessary in reducing the recurrence of the disease.
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.