Detection of Candida species by PCR in self‐collected vaginal swabs of women after taking antibiotics

Abstract

Women undergoing antibiotic treatment can develop vulvovaginal candidiasis. This study evaluated polymerase chain reaction (PCR) for the detection of Candida species in comparison with the conventional laboratory culture methods in samples from women with and without symptoms of postantibiotic candidiasis. The self-collected vaginal swabs from 90 women, with no recent symptoms of vulvovaginal candidiasis (VVC), who were prescribed antibiotics for non-genital infection were evaluated 8 days after completion of antibiotics and/or at the time of developing symptoms of VVC. Broad-spectrum fungal PCR was performed on extracted DNA from each sample. Overall PCR detected four additional Canidida albicans, three Candida parapsilosis and one Candida tropicalis when compared with culture. All but one case additionally detected by PCR were found in patients with no VVC symptoms. PCR, although more sensitive than conventional culture methods, in this small number of cases, has not been able to detect Candida species in significantly more patients with symptoms suggestive of candidiasis. The results of this study may indicate that other agents including other yeast species may be responsible for symptoms of postantibiotic vulvovaginitis.

Effect of Antibiotics on Vulvovaginal Candidiasis: A MetroNet Study

“…4 Furthermore, several studies reported a positive association in both nonpregnant and pregnant women. 22,25 In this pilot study, we found that receptive oral sex was the only factor that was significantly associated with baseline Candida colonization after adjusting for potential confounders. This finding is consistent with previous reports of an association between vaginal candidiasis and orogenital sex.…”

“…The explanation might reflect a lack of sensitivity of vaginal fungal culture in detecting low level Candida colonization in asymptomatic women. 25 Future large, longitudinal investigations may enhance our understanding of the relationship between yeast colonization and antibiotic-associated symptomatic VVC. Approximately 22% (6 of 27) of women developed symptomatic VVC during the 4 to 6 weeks after taking short-course oral antibiotics, a rate similar to the 23% and 28% reported by Pirotta et al 34 and Bluestein et al, 31 respectively.…”

“…Previous studies have reported prevalence estimates of Candida colonization between 10% and 20%, 1,28,29 with a range of 10% to 50% of healthy adult women in cross-sectional studies. 14,25,30,31 A recent longitudinal cohort study 32 demonstrated that vaginal yeast colonization may be transient in most women, although 70% of young, sexually active women were vaginally colonized by Candida at some time during a period of 1 year, with an average point prevalence of 30%. Although our study sample was small, we also noticed yeast colonization status changed during the 4 to 6 weeks of follow-up among women not taking antibiotics (data not shown).…”

“…Because of the small sample size, we retained the 2 variables that changed the outcome estimates the most (ie, oral sex and smoking for Candida colonization; oral sex and race for symptomatic VVC). Baseline culture may be an important factor associated with the outcome 22,25 and so we adjusted for this variable in all models. We used exact logistic regression to accommodate the small sample size.…”

Comparison of Nucleic Acid Amplification Assays with BD Affirm VPIII for Diagnosis of Vaginitis in Symptomatic Women

“…Although the Affirm VPIII is widely used clinically, only a comparatively small number of studies have been published reporting on the performance characteristics of this test (5)(6)(7)(8)(9), and almost all of these only compared the performance of this system against either clinical criteria or clinical criteria supplemented by microscopic examination. Limited data have thus far been presented directly comparing the Affirm VPIII with nucleic acid amplification (NAA)-based assays for identifying the primary etiologic agents of vaginitis, despite a growing body of literature documenting the utility of NAA-based tests for diagnosis of this condition (10)(11)(12)(13). A recent evaluation of the relative sensitivity of Affirm VPIII and a transcription-mediated amplification (TMA)-based test (GenProbe APTIMA Trichomonas vaginalis assay; ATV) for diagnosis of TV demonstrated a 35% increase in sensitivity of T. vaginalis using the amplified methodology (5).…”