Determination of minumum inhibitory concentrations of Candida species isolated from vaginal swab specimens by using broth macrodilution and E-test

Distribution of Candida species in women with vulvovaginal symptoms and their association with different ages and contraceptive methods

The aim of this study was to determine the frequency and distribution of Candida spp. within different age groups and different contraceptive methods users in women with vulvovaginal symptoms. The study included 569 female outpatients who had visited the Education and Research Hospital of Mustafa Kemal University, Turkey, between Jaunary 2004 and June 2005. Among 569 women with symptoms of vulvovaginitis, 240 (42.2%) were positive for Candida spp., of which 106 (44.2%) were C. albicans and 134 (55.8%) were non-albicans spp. The age group 26-30 y had the highest frequency of Candida spp. (23.7%). Candida spp. were isolated from 44.2% of contraceptive method users, and 37.9% of non-contraceptive users (p>0.05). The isolation rate of C. albicans was higher among oral-contraceptive users (57.5%) than IUCD users (38.5%), coitus interruptus (48.5%) and condom users (42.8%). These results indicate that factors associated with age and contraceptive method used may influence the occurrence and distribution of Candida spp. in women with vulvovaginal symptoms.

Zafirlukast for severe recurrent vulvovaginal candidiasis: an open label pilot study

BACKGROUND

Recurrent vulvovaginal candidiasis (VVC) has been linked to allergic disease, particularly allergic rhinitis.

OBJECTIVE

A pilot study to assess the possible use of the leukotriene receptor antagonist zafirlukast as a treatment for recurrent VVC.

METHODS

20 women with six or more symptomatic attacks of VVC in the past year (at least four proved microbiologically). Clinical atopy determined by the International Study for Asthma and Allergies in Childhood (ISAAC) questionnaire assessed blindly. Monitoring by daily symptom diary and self taken vaginal swabs. Treatment with zafirlukast 20 mg twice daily for 24 weeks or until three microbiologically confirmed episodes of VVC. Response assessed by daily symptom diary and self taken vaginal swabs. Subjective response scales for improvement, side effects, and change in other allergic disease completed when stopping treatment. Semistructured telephone interview 1 year after stopping medication.

RESULTS

14 patients (70%) reported a subjective response on the improvement response scale. Six (30%) showed a complete response with no further symptomatic attacks of VVC or negative swabs when symptomatic. Seven (37%) remained symptom free 18 months after entering the study-that is, 12 months after stopping therapy. 11 (58%) remained symptom free for at least 3 months after stopping therapy. This does not include one patient who remained symptom free but continued on zafirlukast because of an improvement in her asthma. There was no clear relation between response and atopic status. Six of nine atopic subjective responders reported improvements in other allergic symptoms. Side effects were minimal; one seemed clearly attributable to the drug.

CONCLUSION

Zafirlukast offers a potential new treatment for recurrent VVC that requires confirmation in controlled studies.