Chronic vulvovaginal candidiasis: characteristics of women with Candida albicans, C glabrata and no candida.
PDF (965K)
Journal: 1996/January - Genitourinary medicine
ISSN: 0266-4348
PUBMED: 7490047
Abstract:
BACKGROUND
Although as many as 5% of all women complain of chronic vulvovaginitis, little is known about these women. They may often be misdiagnosed and the role of vaginal yeast culture in diagnosing vulvovaginal candidiasis (VVC) among them has not been clearly defined.
METHODS
To address these deficiencies, we tabulated initial diagnoses among new patients and conducted a medical record-based, unmatched case-control study among women reporting a history of chronic vulvovaginitis (four or more episodes in the past year) at a vulvovaginitis specialty clinic. Clinical presentation and medical history were compared for women who had a positive vaginal yeast culture for either Candida albicans or C glabrata, or who had a negative culture.
RESULTS
One-third of the women had no apparent vulvovaginal disease at their initial visit. All women reported similar symptoms, except for an increased prevalence of painful sexual intercourse in women with C albicans (chi 2 p = 0.014 versus women with C glabrata and p < 0.001 versus women with no candida). Women with C glabrata were more likely to be non-white (chi 2 p = 0.071 compared with women with C albicans) and to report an underlying medical condition (chi 2 p < or = 0.001 versus both women with C albicans and women with no candida). Physical examination was normal only in women with no candida. C albicans cases were more likely to have positive potassium hydroxide microscopy (chi 2 p = 0.016) and a pH < or = 4.5 (chi 2 p = 0.011) than were C glabrata cases.
CONCLUSIONS
These results suggest that reliance on symptoms and signs alone will result in significant misdiagnosis of chronic vulvovaginitis. Among women with VVC, subtle differences in clinical presentation do not reliably distinguish women with C albicans from those with C glabrata. Our study also indicates that vaginal yeast cultures, while not necessary for every patient, are valuable in confirming negative diagnoses, detecting microscopy false-negatives, and identifying non-C albicans isolates.
Open in
PUBMED | PMC | Google Scholar | Wikipedia
Relations:
Content
Citations
(16)
References
(21)
Diseases
(2)
Conditions
(1)
Organisms
(3)
Affiliates
(2)
Similar articles
Articles by the same authors
Discussion board
Genitourin Med 71(5): 304-307
PMID: 7490047

Chronic vulvovaginal candidiasis: characteristics of women with Candida albicans, C glabrata and no candida.

Abstract

INTRODUCTION--Although as many as 5% of all women complain of chronic vulvovaginitis, little is known about these women. They may often be misdiagnosed and the role of vaginal yeast culture in diagnosing vulvovaginal candidiasis (VVC) among them has not been clearly defined. METHODS--To address these deficiencies, we tabulated initial diagnoses among new patients and conducted a medical record-based, unmatched case-control study among women reporting a history of chronic vulvovaginitis (four or more episodes in the past year) at a vulvovaginitis specialty clinic. Clinical presentation and medical history were compared for women who had a positive vaginal yeast culture for either Candida albicans or C glabrata, or who had a negative culture. RESULTS--One-third of the women had no apparent vulvovaginal disease at their initial visit. All women reported similar symptoms, except for an increased prevalence of painful sexual intercourse in women with C albicans (chi 2 p = 0.014 versus women with C glabrata and p < 0.001 versus women with no candida). Women with C glabrata were more likely to be non-white (chi 2 p = 0.071 compared with women with C albicans) and to report an underlying medical condition (chi 2 p < or = 0.001 versus both women with C albicans and women with no candida). Physical examination was normal only in women with no candida. C albicans cases were more likely to have positive potassium hydroxide microscopy (chi 2 p = 0.016) and a pH < or = 4.5 (chi 2 p = 0.011) than were C glabrata cases. CONCLUSIONS--These results suggest that reliance on symptoms and signs alone will result in significant misdiagnosis of chronic vulvovaginitis. Among women with VVC, subtle differences in clinical presentation do not reliably distinguish women with C albicans from those with C glabrata. Our study also indicates that vaginal yeast cultures, while not necessary for every patient, are valuable in confirming negative diagnoses, detecting microscopy false-negatives, and identifying non-C albicans isolates.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (965K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.
icon of scanned page 304
304
icon of scanned page 305
305
icon of scanned page 306
306
icon of scanned page 307
307

Images in this article

Image
Image
on p.305
Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Berg AO, Heidrich FE, Fihn SD, Bergman JJ, Wood RW, Stamm WE, Holmes KK. Establishing the cause of genitourinary symptoms in women in a family practice. Comparison of clinical examination and comprehensive microbiology. JAMA. 1984 Feb 3;251(5):620–625. [PubMed] [Google Scholar]
  • Reed BD, Slattery ML, French TK. The association between dietary intake and reported history of Candida vulvovaginitis. J Fam Pract. 1989 Nov;29(5):509–515. [PubMed] [Google Scholar]
  • Hurley R. Inveterate vaginal thrush. Practitioner. 1975 Dec;215(1290):753–756. [PubMed] [Google Scholar]
  • Sobel JD. Candidal vulvovaginitis. Clin Obstet Gynecol. 1993 Mar;36(1):153–165. [PubMed] [Google Scholar]
  • Bergman JJ, Berg AO. How useful are symptoms in the diagnosis of Candida vaginitis? J Fam Pract. 1983 Mar;16(3):509–511. [PubMed] [Google Scholar]
  • Bleker OP, Folkertsma K, Dirks-Go SI. Diagnostic procedures in vaginitis. Eur J Obstet Gynecol Reprod Biol. 1989 May;31(2):179–183. [PubMed] [Google Scholar]
  • Friedrich EG., Jr Vaginitis. Am J Obstet Gynecol. 1985 Jun 1;152(3):247–251. [PubMed] [Google Scholar]
  • Kaufman RH, Hammill HA. Vaginitis. Prim Care. 1990 Mar;17(1):115–125. [PubMed] [Google Scholar]
  • Reed BD, Huck W, Zazove P. Differentiation of Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis infections of the vagina. J Fam Pract. 1989 Jun;28(6):673–680. [PubMed] [Google Scholar]
  • Schaaf VM, Perez-Stable EJ, Borchardt K. The limited value of symptoms and signs in the diagnosis of vaginal infections. Arch Intern Med. 1990 Sep;150(9):1929–1933. [PubMed] [Google Scholar]
  • Arilla MC, Carbonero JL, Schneider J, Regúlez P, Quindós G, Pontón J, Cisterna R. Vulvovaginal candidiasis refractory to treatment with fluconazole. Eur J Obstet Gynecol Reprod Biol. 1992 Mar 23;44(1):77–80. [PubMed] [Google Scholar]
  • Horowitz BJ, Giaquinta D, Ito S. Evolving pathogens in vulvovaginal candidiasis: implications for patient care. J Clin Pharmacol. 1992 Mar;32(3):248–255. [PubMed] [Google Scholar]
  • O'Neill S, Howard J. Recurrent vulvovaginal candidiasis. A gynaecological enigma. Aust Fam Physician. 1989 Feb;18(2):99–102. [PubMed] [Google Scholar]
  • Ott AK, Ashman RB. Modern perspectives on vaginal candidiasis. Aust Fam Physician. 1989 Jun;18(6):695–697. [PubMed] [Google Scholar]
  • Redondo-Lopez V, Lynch M, Schmitt C, Cook R, Sobel JD. Torulopsis glabrata vaginitis: clinical aspects and susceptibility to antifungal agents. Obstet Gynecol. 1990 Oct;76(4):651–655. [PubMed] [Google Scholar]
  • Summers PR, Sharp HT. The management of obscure or difficult cases of vulvovaginitis. Clin Obstet Gynecol. 1993 Mar;36(1):206–214. [PubMed] [Google Scholar]
  • White DJ, Johnson EM, Warnock DW. Management of persistent vulvo vaginal candidosis due to azole-resistant Candida glabrata. Genitourin Med. 1993 Apr;69(2):112–114.[PMC free article] [PubMed] [Google Scholar]
  • Goldacre MJ, Milne LJ, Watt B, Loudon N, Vessey MP. Prevalence of Yeast and fungi other than Candida albicans in the vagina of normal young women. Br J Obstet Gynaecol. 1981 Jun;88(6):596–600. [PubMed] [Google Scholar]
  • Higashide K, Aman R, Yamamuro O. Clinical characteristics correlated with different fungi causing vulvovaginal mycosis. Mycoses. 1988 Apr;31(4):213–225. [PubMed] [Google Scholar]
  • Boquet-Jiménez E, Alvarez San Cristóbal A. Cytologic and microbiologic aspects of vaginal Torulopsis. Acta Cytol. 1978 Sep-Oct;22(5):331–334. [PubMed] [Google Scholar]
  • Siapco BJ, Kaplan BJ, Bernstein GS, Moyer DL. Cytodiagnosis of Candida organisms in cervical smears. Acta Cytol. 1986 Sep-Oct;30(5):477–480. [PubMed] [Google Scholar]
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA.
Copyright notice
Abstract
INTRODUCTION--Although as many as 5% of all women complain of chronic vulvovaginitis, little is known about these women. They may often be misdiagnosed and the role of vaginal yeast culture in diagnosing vulvovaginal candidiasis (VVC) among them has not been clearly defined. METHODS--To address these deficiencies, we tabulated initial diagnoses among new patients and conducted a medical record-based, unmatched case-control study among women reporting a history of chronic vulvovaginitis (four or more episodes in the past year) at a vulvovaginitis specialty clinic. Clinical presentation and medical history were compared for women who had a positive vaginal yeast culture for either Candida albicans or C glabrata, or who had a negative culture. RESULTS--One-third of the women had no apparent vulvovaginal disease at their initial visit. All women reported similar symptoms, except for an increased prevalence of painful sexual intercourse in women with C albicans (chi 2 p = 0.014 versus women with C glabrata and p < 0.001 versus women with no candida). Women with C glabrata were more likely to be non-white (chi 2 p = 0.071 compared with women with C albicans) and to report an underlying medical condition (chi 2 p < or = 0.001 versus both women with C albicans and women with no candida). Physical examination was normal only in women with no candida. C albicans cases were more likely to have positive potassium hydroxide microscopy (chi 2 p = 0.016) and a pH < or = 4.5 (chi 2 p = 0.011) than were C glabrata cases. CONCLUSIONS--These results suggest that reliance on symptoms and signs alone will result in significant misdiagnosis of chronic vulvovaginitis. Among women with VVC, subtle differences in clinical presentation do not reliably distinguish women with C albicans from those with C glabrata. Our study also indicates that vaginal yeast cultures, while not necessary for every patient, are valuable in confirming negative diagnoses, detecting microscopy false-negatives, and identifying non-C albicans isolates.
Collaboration tool especially designed for Life Science professionals.Drag-and-drop any entity to your messages.