Prospective Study of Vaginal Bacterial Flora and Other Risk Factors for Vulvovaginal Candidiasis

Abstract

Background: It has been suggested that vaginal lactobacilli may reduce the risk of vulvovaginal candidiasis (VVC), but supporting data are limited. Our objective was to determine the relationship between vaginal bacterial flora and VVC. Methods: We conducted a prospective cohort analysis among 151 Kenyan sex workers. At monthly follow-up, VVC was defined as the presence of yeast buds, pseudohyphae, or both on vaginal wet preparation or KOH preparation. Generalized estimating equations were used to identify correlates of VVC. Results: Participants returned for a median of 12 (interquartile range 11-12) visits. Vulvovaginal candidiasis was present at 162 visits, including 26 with symptomatic VVC. Bacterial vaginosis (BV) was associated with fewer episodes of VVC (adjusted odds ratio [aOR] 0.29, 95% confidence interval [CI] 0.16-0.50). After excluding women with concurrent BV, another possible cause of vaginal symptoms, the likelihood of symptomatic VVC was higher in those with yeast on vaginal wet preparation in the past 60 days (aOR 4.06, 95% CI 1.12-14.74) and those with concurrent vaginal Lactobacillus colonization (aOR 3.75, 95% CI 1.30-10.83). Conclusions: Contrary to a commonly posed hypothesis of a protective effect, we found that vaginal Lactobacillus colonization was associated with a >4-fold increase in the likelihood of symptomatic VVC.

Growth of Candida albicans Cells on the Physiologically Relevant Carbon Source Lactate Affects Their Recognition and Phagocytosis by Immune Cells

“…In particular, colonization of the vagina implies sharing of this mucosal environment with lactic acid-producing Lactobacillus spp., which are the main colonizing flora. Interestingly, while older studies have suggested a protective effect of lactobacilli on vaginal colonization with fungi (57), more recent research has revealed that Lactobacillus colonization of the vagina is a strong risk for vulvovaginal candidiasis (58). Our study provides the first evidence for the mechanisms by which lactate supplied by the Lactobacillus vaginal flora could contribute to this process.…”

Candida albicans Pathogenesis: Fitting within the Host-Microbe Damage Response Framework

“…Similar to the oral cavity, C. albicans is a resident of the normal vaginal microbiota and the leading causative agent of vulvovaginal candidiasis (VVC) (14,(130)(131)(132)(133)(134)(135) (Fig. 2F).…”

The vaginal mycobiome: A contemporary perspective on fungi in women's health and diseases

“…116 Recently, however, one group has posited that their findings are more consistent with Lactobacillus being associated with greater risk for vulvovaginal candidiasis. 117 By elucidating the mechanism by which lactic acid suppresses immune responses to C. albicans, Ene et al 46 have supplied evidence for this claim.…”