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The Vaginal Microbiota and Behavioral Factors Associated With Genital Candida albicans Detection in Reproductive-Age Women

Brown, Sarah E. BS*,†; Schwartz, Jennifer A. PhD*; Robinson, Courtney K. MS*; O'Hanlon, D. Elizabeth PhD*; Bradford, L. Latéy MD, PhD*,‡; He, Xin PhD§; Mark, Katrina S. MD; Bruno, Vincent M. PhD*,‡; Ravel, Jacques PhD*,‡; Brotman, Rebecca M. PhD, MPH*,†

doi: 10.1097/OLQ.0000000000001066
Original Study

Background Vulvovaginal candidiasis is commonly diagnosed and has been associated in prospective studies with the acquisition of HIV. Little data is available on how the composition of the vaginal microbiota, and other risk factors, are associated with the molecular detection of Candida albicans—a common cause of vulvovaginal candidiasis.

Methods In a cross-sectional study, self-collected vaginal swabs were obtained from 394 nonpregnant, reproductive-age women. C. albicans was detected using polymerase chain reaction targeting C. albicans ITS1/2 region. Vaginal microbiota was characterized by 16S rRNA gene amplicon sequencing of the V3 to V4 hypervariable regions and clustered into community state types (CSTs). Multiple logistic regression identified factors associated with C. albicans detection.

Results Twenty-one percent had C. albicans detected and 46% reported vaginal symptoms in the prior 60 days. There was a 2-fold increase in the odds of C. albicans if a woman was in a L. crispatus-dominated CST compared to CSTs with low-Lactobacillus levels (adjusted odds ratio, 2.05; 95% confidence interval, 0.97–4.37). History of self-treatment with antifungals, L. crispatus relative abundance, and receptive oral sex were also significantly associated with C. albicans detection.

Conclusions A L. crispatus-dominated vaginal microbiota is thought to protect women from both development of bacterial vaginosis and incidence of sexually transmitted infections; however, our data suggest that L. crispatus is associated with increased C. albicans detection. Receptive oral sex may also be a risk factor for vaginal C. albicans colonization.

High relative abundance of Lactobacillus crispatus, receptive oral sex and over-the-counter antifungal use were associated with genital Candida albicans detection in a cross-sectional study of reproductive-age women.

From the *Institute for Genome Sciences

Department of Epidemiology and Public Health

Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD

§Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park

Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, MD

Conflicts of interest: None declared.

All data can be found at the National Center for Biotechnology Information (NCBI) Database of Genotypes and Phenotypes (dbGaP) under accession number phs001909.v1.p1. This work was supported by the National Institute of Allergy and Infectious Diseases and the National Institutes of Health [U01-AI070921 to JR and R01-AI119012 to RB].

Correspondence: Rebecca Brotman, PhD, MPH, Department of Epidemiology and Public Health, Institute for Genome Sciences, University of Maryland School of Medicine, 670 West Baltimore Street, Room 3175, Baltimore, MD 21201. E-mail:

Received for publication April 29, 2019, and accepted August 25, 2019.

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Online date: September 12, 2019

© Copyright 2019 American Sexually Transmitted Diseases Association