RECURRENT VULVOVAGINAL CANDIDIASIS: PATHOPHYSIOLOGY, DIAGNOSIS ANO TREATMENT
Keywords:
candidiasis vulvovaginal, vulvovaginitis, diagnosis, clinical, vaginal dischargeAbstract
Vaginal candidiasis is one of the most frequent gynecological diseases and 75% of the sexually active female population will suffer from an episode at /east once in their life. Despite its high frequency, there are other diseases that mimic vaginal candidiasis, hindering diagnosis and treatment. Vu!vovaginal candidiasis can be considered recurrent when three or more acute episodes, adequate/y diagnosed through clinica/ and microbiological exams, appear within the period of one year. This paper aims to review topics related to the identification of the fungus, signs and symptoms, vaginal immune response to Candida sp, action of semen on vaginal immunity, influence of genetics and strategies for treatment of recurrent cases. The fact that there is usua!ly no direct relation between vaginal candidiasis and symptomato/ogy was also taken into consideration. Another aspect considered was that the majority of women supposedly infected by candida show no bacterioscopical evidence of the fungus in the vaginal epithelium and also that the disease cannot be distinguished from other diseases by symptomatology atone.
Downloads
References
Gomes FAM. Valor do exame clínico especular e da anamnese para o diagnóstico do corrimento vaginal. Campinas [tese]. Campinas: Universidade Estadual de Campinas; 2003.
Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK. Vulvovaginal candidiasis: clinicai manifestations, risk factors, management algorithm. Obstet Gynecol. 1998; 92(5):757-65.
Linhares LM, Witkin SS, Miranda SD, Fonseca AM, Pinotti JA, Ledger WJ. Differentiation between women with vulvovaginal symptoms who are positive or negative for Candida species by culture. lnfect Ois Obstet Gynecol. 2001; 9(4):221-5.
Nyirjesy P, Seeney SM, Grody MH, Jordan CA, Buckley HR. Chronic fungai vaginitis: the value of cultures. Am J Obstet Gynecol. 1995; 173(3 Pt 1):820-3
Ledger WJ, Polaneczky MM, Yin MC. Difficulties in the diagnosis of Candida vagínitis. lnfec Ois Clin Pract. 1999; 9(2):66-9.
Giraldo P, von Nowaskonski A, Gomes FA, Linhares 1, Neves NA, Witkin SS. Vaginal colonization by Candida in asymptomatic women with and without a history of recurrent vulvovaginal candidiasis. Obstet Gynecol. 2000; 95(3):413-6.
Witkin SS, JeremiasJ, LedgerWJ. Vaginal eosinophils and lgE antibodies to Candida albicans in women with recurrent vaginitis. J Med Vet Mycol. 1989; 27(1):57-8.
Witkin SS, Jeremias J, Ledger WJ. A localized vaginal allergic response in women with recurrent vaginitis. J Allergy Clin lmmunol. 1988; 81(2):412-6.
Witkin SS. Transient local immunosuppression in recurrent vaginitis. lmmunol Today. 1987; 8:360-3.
Witkin SS, Kalo-Klein A, Galland L, Teich M, Ledger WJ. Effect of Candida albicans plus histamine on prostaglandin E2 production by peripheral blood mononuclear cells from healthy women and women with recurrent candidal vaginitis. J lnfect Ois. 1991;164(2):396-9.
Kalo-Klein A, Witkin SS. Prostaglandin E2 enhances and gamma interferon inhibits germ tube formation in Candida albicans. lnfect lmmunol. 1990; 58(1):260-2.
Geiger AM, Foxman B, Sabei JD. Chronic vulvovaginal candidiasis: characteristics of women with Candida a/bicans, C glabrata and no candida. Genitourin Med. 1995; 71(5):304-7.
Jeremias J, Mockel S, Witkin SS. Human semen induces interleukin 1O and 70kDa heat shock protein gene transcription and inhibits interferon gamma messenger RNA production in peripheral blood mononuclear cells. Mol Hum Reprod. 1998; 4(11):1084-8.
Jeremias J, Kalo-Klein A, Witkin SS. Individual differences in tumor necrosis factor and interleukin-1 production induced by viable and heat-killed Candida a/bicans. J Med Vet Mycol. 1991; 29(3):157-63.
