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Non-albicans Candida Vulvovaginitis: Treatment Experience at a Tertiary Care Vaginitis Center

Powell, Anna M. MD1; Gracely, Edward PhD2,3; Nyirjesy, Paul MD1

Journal of Lower Genital Tract Disease: January 2016 - Volume 20 - Issue 1 - p 85–89
doi: 10.1097/LGT.0000000000000126
Original Research Articles: Vulva and Vagina
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Objectives The aims of this study are to analyze a cohort of women with vulvovaginal symptoms and positive cultures for non-albicans Candida (NAC) to determine whether yeast was responsible for their symptoms and to evaluate the mycological effectiveness of various regimens.

Methods This observational study was performed from retrospective chart review of patients with positive NAC cultures between April 1, 2008, and January 31, 2011, at a tertiary care vaginitis center. Patient intake demographics were entered into a database. Follow-up visits were analyzed for data about patient treatments and outcomes. Patients were considered a clinical cure if their symptoms were significantly improved and mycologic cure (MC) if later yeast cultures were negative. If clinical symptoms improved at the same time as MC, the isolate was considered the proximate cause for the symptoms.

Results One hundred eight patients meeting entry criteria were analyzed. Boric acid was effective at obtaining MC in 32 (78%) of 41 patients with C. glabrata, 3 of 3 patients with C. tropicalis, and 3 of 3 patients with C. lusitaniae. Fluconazole was effective as initial treatment for 3 (60%) of 5 patients with C. glabrata and 13 (81%) of 16 patients with C. parapsilosis. In 52.7% of C. glabrata, 66.7% of C. parapsilosis, and 57.1% of C. tropicalis cases, effective antifungal therapy led to symptom improvement.

Conclusions In a tertiary care vaginitis center, NAC, when isolated on culture, caused clinically significant infections in approximately half of symptomatic patients. A majority of infections can be effectively treated with boric acid or fluconazole regardless of the non-albicans Candida species.

In a tertiary care vaginitis center, non-albicans Candida yeasts caused clinically significant infections in approximately half of patients with these isolates.

1Drexel University College of Medicine, Department of Obstetrics and Gynecology; 2Drexel University College of Medicine, Department of Family, Community and Preventive Medicine; and 3Epidemiology and Biostatistics at Drexel School of Public Health, Philadelphia, PA

Reprint requests to: Anna Powell, MD, 245 N 15th St MS 495, Philadelphia, PA 19102. E-mail: powellan@musc.com

Financial disclosures: Dr. Nyirjesy does report the following relationships with industry: Novadigm (consultant, research grant), Viamet Pharmaceuticals (consultant, research grant), and Becton-Dickinson (research grant). Dr. Powell and Dr. Gracely report no conflicts of interest.

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology