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Candida
and Yeast Infection
Solutions - Our site has
many articles on this topic.
See below for a review of
one of the studies.
J
Infect Dis.
2009 June 15; 199(12):
1883–1890,
PMCID: PMC2743896
A Prospective Study of
Vaginal Bacterial Flora and
Other Risk Factors for
Vulvovaginal Candidiasis.
R. Scott McClelland, Barbra
A. Richardson3
Wisal M. Hassan, Susan M.
Graham, James Kiarie, Jared
M. Baeten, Kishorchandra
Mandaliya, Walter Jaoko,
Jeckoniah O. Ndinya-Achola,
and King K. Holmes.
The purpose of this study
objective was to determine
the relationship between
vaginal bacterial flora and
vulvovaginal candidiasis
(VVC). It has been suggested
that normal vaginal flora
consisting predominantly of
Lactobacillus
species may protect against
the development of VVC, but
there is limited evidence to
support this hypothesis.
Vulvovaginal candidiasis
affects up to seventy five
percent of reproductive age
women at least once, and
nearly half of those women
will experience at least one
recurrence with five to
eight percent having
multiple episodes each year.
In addition to the
discomfort and costs
associated with medication
and health care visits,
several studies have
suggested that VVC may
increase a woman's risk of
becoming infected with
HIV-1. Because of the high
prevalence of vulvovaginal
candidiasis, it could
contribute substantially to
the population-level risk of
HIV-1.
This study was a prospective
cohort analysis, conducted
jointly by researchers at
the University of Washington
and the Kenyatta National
Hospital in Kenya. Study
participants were one
hundred and fifty one Kenyan
sex workers attending a
municipal clinic in Mombasa.
All participants were
HIV-1-seronegative, were not
pregnant and did not
currently have symptoms of
vulvovaginal pruritis or
abnormal vaginal discharge
at enrollment. At baseline
and at monthly follow-up
visits: a genital/pelvic
examination was performed;
specimens were collected for
laboratory diagnosis of
genital tract infections,
pregnancy and HIV-1
serological status; the
women were interviewed
regarding recent sexual
behavior and genital
symptoms; all medication use
was recorded; and risk
reduction counseling was
provided. During follow-up
the women received treatment
for any sexually transmitted
infection, vulvovaginal
pruritis or abnormal vaginal
discharge that was
identified. Participants in
the trial were asked to
return for a total of twelve
monthly follow-up visits.
Participation was
discontinued if they became
pregnant or HIV-1 positive.
Overall, the women accrued
153 person-years of
follow-up over 1,570 visits,
representing ninety percent
of expected follow-up
visits. Vulvovaginal
candidiasis was identified
at 162 follow-up visits in a
total of 71 women.
Symptomatic VVC was
identified at 26 follow-up
visits, affecting 16 women.
In laboratory analysis
bacterial vaginosis was
associated with fewer
episodes of VVC, however
prior incidence of VVC and
concurrent
Lactobacillus
colonization were both
significantly associated
with symptomatic VVC.
This study provides strong
evidence contradicting the
hypothesis that vaginal
colonization with
Lactobacillus
reduces the risk of
vulvovaginal candidiasis.
Indeed, the opposite may be
true. Although bacterial
vaginosis was associated
with a substantial reduction
in the risk of vulvovaginal
candidiasis,
Lactobacillus
colonization, on the
other hand, was associated
with as much as a 4-fold
increased likelihood of
symptomatic vulvovaginal
candidiasis.
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