<i>In Vitro</i>Effects of Photodynamic Therapy with Three Photosensitizers on <i>Candida</i>spp from Complicated Vulvovaginitis and Asymptomatic Women

Aim: To evaluate photodynamic therapy (PDT) in vitro to reduce the growth of Candida spp, and its synergy with the antifungals fluconazole and ketoconazole for inhibition of resistant, DDS and susceptible isolates from asymptomatic carriers and with complicated vulvovaginitis. Methods: Between 2017 and 2020, we evaluated 230 women with vulvovaginal candidiasis and 400 asymptomatic. We obtained 130 positive cultures for Candida spp from vulvovaginitis and 94 asymptomatic. Yeasts were characterized by classical and molecular tests. Sensitivity to fluconazole and ketoconazole was evaluated by E-test. We used photodynamic light through blue LED, wavelengths between 450 to 470 nm, power of 260 mW, energy fluence of 270 J/cm2, for 15 minutes over all colonies of Candida spp. Methylene blue (MB) at 450 mg/mL, 2% gentian violet (VG) and 50 μM curcumin (CR) were used in association or not with LED irradiation. Suspensions of Candida spp of 106 CFU/mL, subjected to the different assays, were introduced in 96-well microplates, incubated for 48 hours at 35˚C and the readings at 530 nm. The samples were finally cultivated in Petri plates containing Sabouraud dextrose agar to assess the growth inhibition. All procedures were in triplicate. Results: C. albicans was prevalent in vulvovaginal candidiasis, however, we also isolated non-albicans species such as C. glabrata, C. tropicalis and C. parapsilosis. There was a substantial reduction (66.6% to 83.8%) of the CFU/mL of the isolates treated with FDT. Gentian violet at 2% alone reduced the growth of CFU/ml of Candida spp from 69% to 75%. Among isolates of vaginitis and asymptomatic carriers, after using FDT, we found a reduction in resistant phenotypes and DDS for fluconazole in percentages from 20% to 100% for C. albicans, from 50% to 100% C. glabrata, 33.3% to 100% C. parapsilosis and 100% C. tropicalis. For ketoconazole in the same isolates, there was a reduction in phenotypes with MIC > 16 μg/mL of up to 50% in C. albicans, 50% to 100% C. glabrata, 50% to 100% C. tropicalis. Conclusions: PDT with MB, GV and CR revealed efficacy in vitro in reducing the growth of C. albicans and non-albicans, especially due to chronic recurrent vulvovaginitis.

Clinical and microbiological features of vulvovaginitis in Mexican girls

Study Objective: To determine the prevalence of vulvovaginitis, predisposing factors, microbial etiology and therapy in patients treated at the Hospital del Nino DIF, Pachuca, Hidalgo, Mexico. Design. This was an observational and descriptive study from 2006 to 2009. Setting: Hospital del Nino DIF, Pachuca, Hidalgo, Mexico. Participants. Patients from 0 to 16 years, with vulvovaginitis and/or vaginal discharge were included. Interventions: None. Main Outcome Measures: Demographic data, etiology, clinical features, risk factors and therapy were analyzed. Results: Four hundred twenty seven patients with diagnosis of vulvovaginitis were included. The average prevalence to 4 years in the study period was 0.19%. The age group most affected was schoolchildren (225 cases: 52.69%). The main signs and symptoms presented were leucorrhea (99.3%), vaginal hyperemia (32.6%), vulvar itching (32.1%) and erythema (28.8%). Identified risk factors were poor hygiene (15.7%), urinary tract infection (14.7%), intestinal parasites (5.6%) and obesity or overweight (3.3%). The main microorganisms found in vaginal cultures were enterobacteriaceae (Escherichia coli, Klebsiella and Enterococcus faecalis), Staphylococcus spp, and Gardnerella vaginalis. Several inconsistent were found in the drug prescription of the patients. Conclusion: Vulvovaginitis prevalence in Mexican girls is low and this was caused mainly by opportunist microorganisms. The initial treatment of vulvovaginitis must include hygienic measure and an antimicrobial according to the clinical features and microorganism found.

Clinical presentation, diagnosis and treatment of vulvovaginitis in girls: a current approach and review of the literature

Background:Vulvovaginitis is the most common cause of gynecological complaints in children and young girls.Some of the factors which cause vulvovaginitis include hypoestrogenism,the anatomical proximity of rectum and delicate vulvar skin and vaginal mucosa.Data sources:We made a literature search with Pubmed,Medline and Cochrane database from January 2002 to May 2015 in English language using the key words vulvovaginitis,children,clinical,diagnosis and treatment.Results:Vulvovaginitis in girls is usually caused by non-specific factors and hygiene measures,bioyoghurt and avoidance of chemical irritants are generally useful.Weight control if necessary and prevention of voiding dysfunction are effective.Vaginal flora is important in girls and results should be interpreted with clinical features to decide whether an isolated microorganism is part of the normal microflora or is the cause of symptomatic vulvovaginitis.Specific treatment is generally considered in case of a detected pathogen microorganism.Isolation of a sexually transmitted organism requires further investigation.Persistent disease may not always indicate a foreign body but it must be taken into account.Girls and parents are encouraged psychologically in all steps of evaluation,diagnosis and treatment.Probiotics,nanotechnology and petroleum jelly are other important treatment options used in vulvovaginitis.Conclusions:In this review,we present current approach to the presentation and management of vulvovaginitis in childhood.This disorder requires a comprehensive evaluation in all steps of diagnosis,differential diagnosis and treatment.

Treatment of Vulvovaginal Candidiasis with A Strategy Based on Phototherapy (M.A.C.® Scar Acceleration Method)

Candidiasis, also known as candidiasis vulvovaginitis, is an infection caused by different types of Candida fungi, the most frequent being Candida albicans. The present study reports an effective strategy, which opens new avenues for the treatment of this public health problem. The MAC® Methodology, conventional laser light-emitting (LLLT)/LED) methods are based on the biphasic response demonstrated many times in LLLT research and as with other forms of drugs, a “drug” (irradiation parameters) and a “dose” (irradiation times) and the “Arndt-Schulz Law” is often cited as a suitable model to describe the dose-dependent effects of LLLT. This method uses photopharmaceuticals, cell markers and the use of correct parameters for each case to induce the acceleration of tissue repair. The present study shows a case of a 32-year-old patient diagnosed with recurrent candidiasis 4 years ago. Eighteen sessions were performed (every other day) using a photoactivated component (Methylene blue 1% + Clotrimazole 1%) and LED phototherapy (red, blue and violet) with emission times of 60 - 260 seconds for each applicator, according to the dose recommendations of the scar acceleration method (MAC®). At the sixth treatment session there was a noticeable decrease in the itching sensation reported by the patient. In session 11 she reported feeling a great improvement, indicating that she no longer felt itching in any area after 18 sessions. The present case demonstrates new methodologies to treat common problems in the population that have a positive impact on the quality of life. This methodology has a promising future because it is non-invasive and requires a great biological transformation for inflammatory, fungal and viral control.

Change in Vaginal Flora as Indicated by Pap Smear (Schr&#246;der’s Classification) in Women Using Levonorgestrel-Releasing Intrauterine System “Mirena”—Prospective Cohort Study

Background: The use of intrauterine device alters the normal balance between vaginal flora. It might change cervicovaginal environment, which was suggested to increase the risk for vulvovaginitis. It was found that up to 85% of levonorgestrel-releasing intrauterine system users become amenorrheic 4 months after insertion, or bleed only sporadically. It was hypothesized that this would have a beneficial effect on vaginal flora maintaining normal balance. Objectives: The aim of this study was to detect the effect of hormonal intrauterine system (“Mirena”: 20 microgram/24 hours intrauterine delivery system Levonorgestrel) on vaginal flora by using pap smear before and 6 months after insertion. Study design: A prospective cohort study was carried out in a university maternity hospital. 210 subjects were included with pap smear taken at time of insertion of IUS “Mirena” and another one taken 6 months later to detect percentage of incidence of infection in IUS users. Vaginal flora was studied, and lactobacilli were graded according to Schr?der’s classification. A comparison was made to allow detection of changes in vaginal flora caused by presence of hormonal IUS “Mirena”. Results: Over half of cases (57.2%) showed worse vaginal flora after hormonal IUS “Mirena” insertion than before. There was a highly statistically significant difference between Schr?der’s Grades before and after insertion (P value < 0.001) as 44.8% of cases presented by Grade I, 44.4% of cases presented by grade IIa, 38% of cases presented by grade IIb before insertion developed Grade III after insertion. Conclusion: Insertion of hormonal IUS “Mirena” results in significant change in microbial flora towards pathological bacteria.

Growing importance of urogenital candidiasis in individuals with diabetes:A narrative review

Both diabetes and fungal infections contribute significantly to the global disease burden,with increasing trends seen in most developed and developing countries during recent decades.This is reflected in urogenital infections caused by Candida species that are becoming ever more pervasive in diabetic patients,particularly those that present with unsatisfactory glycemic control.In addition,a relatively new group of anti-hyperglycemic drugs,known as sodium glucose cotransporter 2 inhibitors,has been linked with an increased risk for colonization of the urogenital region with Candida spp.,which can subsequently lead to an infectious process.In this review paper,we have highlighted notable virulence factors of Candida species(with an emphasis on Candida albicans)and shown how the interplay of many pathophysiological factors can give rise to vulvovaginal candidiasis,potentially complicated with recurrences and dire pregnancy outcomes.We have also addressed an increased risk of candiduria and urinary tract infections caused by species of Candida in females and males with diabetes,further highlighting possible complications such as emphysematous cystitis as well as the risk for the development of balanitis and balanoposthitis in(primarily uncircumcised)males.With a steadily increasing global burden of diabetes,urogenital mycotic infections will undoubtedly become more prevalent in the future;hence,there is a need for an evidence-based approach from both clinical and public health perspectives.

外阴阴道念珠菌病的相关免疫机制研究进展

外阴阴道念珠菌病（vulvovaginal candidiasis,VVC）是一种常见的阴道黏膜真菌感染性疾病。国外研究统计约75%育龄妇女在一生中至少发生一次VVC,其中约5%病例发展为复发性外阴阴道念珠菌病（recurrent vulvovaginal,RVVC）[1]。其主要临床表现为外阴瘙痒和阴道分泌物增多,阴道灼热、疼痛。

中西医结合外治法对外阴阴道假丝酵母菌病的近远期疗效观察

外阴阴道假丝酵母菌病（vulvovaginal candidiasis,VVC）是女性最常见的生殖道炎症之一,复发性外阴阴道念珠菌病（recurrent vulvovaginal candidiasis,RVVC）指1年内有症状并经细菌学证实的VVC发作4次或以上。有资料[1]显示,约75%的妇女一生中至少患1次VVC,45%有过2次以上发作,发病率约为5%,约10%可因治疗不彻底、自身免疫力低下等原因发展为RVVC。

人参五灵脂栓对大鼠假丝酵母菌病转化生长因子-β_1表达的影响

外阴阴道假丝酵母菌病（vulvovaginal candidiasis）又称外阴阴道念珠菌病,是最常见的外阴阴道炎症性疾病之一。本病80%~90%由白色念珠菌感染所致,少数可由光滑念珠菌、近平滑念珠菌或热带念珠菌等引起,属内源性疾病。该病具有高复发性的特点,严重影响妇女身心健康。西医对于复发性外阴阴道假丝酵母菌病的治疗,多采用抗真菌药物进行局部或全身治疗的基础上,延长治疗时间。

Study of Candida Albicans Vaginitis Model in Kunming Mice

The model of vaginal candidiasis in Kunming mice was constructed in order to search for the optima construction conditions and provide an economic animal model of Candida albicans (C. albicans) vaginitis. Estrogen benzoate (E2) was given to mice at different concentrations ranging from 0.0 to 0.05 mg/mouse (4 levels) beginning 72 h prior to vaginal inoculation, then mice were in- oculated intravaginally with various concentrations of stationary-phase C. albicans blastoconidia (ATCC90028) (5 levels) in 20 μL of phosphate-buffered saline (PBS) in each E2 level. General state, scores of genital pathology, the hyphae and vaginal fungal burden (CFU) in vaginal lavage fluid, the hydrops rate of uterus and vaginal tissues for pathological section in mice were observed and ob- tained at day 2, 4, 7, 14 and 21 after inoculation. The results showed the infection rate in mice was related to the dosage of E2 and concentration of C. albicans blastoconidia. Additionally there was better cross-effect between the two treated factors. The infection rate was about 80% on the day 4, and could reach 100% on the day 7 until the end of experiment after inoculated intravaginally in groups of E2I3, E2 0.025 mg/mouse injected hypodermically and inoculated intravaginally with 5×104 C. albicans blastoconidia, and large amount of hyphae and blastoconidia could be observe in superfi- cial layer tissue and canal of vaginal by PAS. From the results in our experiment it was concluded that E2I3 was the optima construction condition in kunming mice.

Treatment of chronic vulvovaginal candidiasis with posaconazole and ciclopiroxolamine

Therapy of chronic recurrent vulvovaginal can- didiasis (VVC) caused by Candida glabrata is still rare in comparison to C. albicans infection, but therapy remains more difficult. Combination therapy with topical antifungals may improve therapy outcome, but still standard agents as fluconazole or itraconazole often fail. Posaconazole is a new systemic triazole with a wide antifungal spectrum including rare Candida species. Up to now, no clinical trials with posa- conazole in chronic recurrent VVC have been undertaken. Here, first results of the application of a new therapy regimen consisting of oral posaconazole in combination with topical ciclopiroxolamine are presented. 15 patients with chronic recurrent VVC caused by C. glabrata have been treated. 14 of these patients experienced successful therapy, clinical and mycological cure 30 days after begin of therapy has been observed. Long-term results are promising, as in 4 patients clinical and mycologic cure persists for more than 1 year up to now.

Prevalence of Non-<i>Albicans Candida</i>Infections in Women with Recurrent Vulvovaginal Symptomatology

Background: Candida vulvovaginitis is one of the most frequently diagnosed conditions in women’s care practices. Historically, 90% of cultured yeast species were C. albicans. However, due to a variety of interventions, the proportion of non-albicans Candida (NAC) infections appears to be increasing. We sought to estimate the current prevalence of Candida vulvovaginitis and the species-specific distribution of such infections in recurrent cases. Methods: Women with recurrent vulvovaginal symptomatology referred to an Obstetrics and Gynecology practice were tested by genital fungus culture, Candida-specific polymerase chain reaction (PCR), or both between July 2010 and February 2013. Results: A total of 103 women were tested. Mean age was 45.6 years. Including only their most recent positive test result, 29.1% (30/103) of women tested positive for Candida by any of the above testing measures. Of those, 50% (15/30) tested positive for C. albicans and 50% (15/30) tested positive for a NAC species. Across all visits, 60% (18/30) tested positive for C. albicans, 56.7% (17/30) tested positive for NAC, and 16.7% (5/30) tested positive for both a C. albicans and a NAC species. Among all isolated NAC species, 28.6% (6/21) were determined to be C. glabrata, 23.8% (5/21) C. krusei, 23.8% (5/21) C. parapsilosis, and 23.8% (5/21) other Candida species. Conclusion: Approximately 30% of women with recurrent vulvovaginal symptomatology have detectable Candida strains and it appears that NAC species may cause half of all these infections. This is imperative because NAC infections are usually more difficult to diagnose and are resistant to most treatments.

Susceptibility to Fluconazole and Ketoconazole of Candida spp. Isolated from Primary and Episodic Vulvovaginites by E-Test (São Paulo, SP, Brazil)

Purpose: To evaluate the profile of in vitro susceptibility of yeasts isolated from cases of primary and espisodic vulvovaginitis to two antifungal agents. Methods: 40 Candida isolates from episodes of vulvovaginal candidiasis were identified by classic methodologies. The susceptibility testing of the in vitro fluconazole and ketoconazole activity against the isolates was accessed by E-test. Results: C. albicans was the most common species identified in 70% of the occurrences followed by C. glabrata (20%), C. tropicalis (7.5%), and C. guilliermondii (2.5%). In the susceptibility profile to antifungal agents, 12.5% and 16.7% of the isolates obtained from primary and episodic vulvovaginal candidiasis were resistant to fluconazole, respectively. To ketoconazole, we found that 6.25% and 12.5% of the isolates respectively from primary vulvovaginal candidiasis (PVVC) and episodic vulvovaginal candidiasis (EVVC) had high MIC values. Conclusions: E-test is a reliable method for the susceptibility testing of Candida spp. due to its simplicity, reproducibility, and lack of specialized equipment. Resistant strains and non-albicans species were verified more in cases of EVVC than in PVVC. Clinical and mycological cure of patients with episodic vulvovaginal candidiasis or complicated cases occurred after prolonged treatment and sometimes with multiple antifungals use.

Clinical Experience in the Treatment of Vulvovaginal Candida Disease with Integrated Traditional Chinese and Western Medicine

Summarizing two cases of vaginal candidiasis,cured by integrated traditional Chinese and western medicine in clinical work,it is found that the combination of traditional Chinese and western medicine has a significant effect on the treatment of this disease.The curative effect is outstanding,and the recurrence rate is significantly reduced,which can be used as a reference for gynecological medical workers.

火山蕨矿泉水煎液对外阴阴道假丝酵母菌病疗效观察的报告

目的:探讨火山蕨矿泉水煎液对外阴阴道假丝酵母菌病的疗效。方法:180例患者随机分为两组,对照组90例予制霉菌素(米克定)栓剂治疗,观察组90例给予火山蕨矿泉水煎液治疗。结果:对照组总有效率92.22%,复发率17.78%;观察组总有效率91.11%,复发率5.56%。两组总有效率仅差1.11%,比较无显著性差异,但观察组的治愈率和显效率均比对照组高,尤其是观察组复发率较低(P<0.05)。结论:火山蕨矿泉水煎液治疗外阴阴道假丝酵母菌病费用低、纯天然、无任何副作用,疗效显著。

中药干预复发性念珠菌性外阴阴道炎患者体质的临床研究

目的:观察益生蠲湿汤治疗复发性念珠菌性外阴阴道炎湿热体质患者的临床疗效。方法:将符合诊断标准的82例湿热型复发性念珠菌性外阴阴道炎患者按就诊时间顺序随机分成试验组和对照组A、对照组B。各组按预计的治疗方案治疗10天、1个月、3个月后,进行疗效判定。结果:试验组体质改善明显,与对照组比较P<0.05;治疗后3个月,治疗组有效率明显高于时照组P<0.05。结论:益生蠲湿汤改善了湿热型复发性念珠菌性外阴阴道炎患者体质,提高阴道乳酸杆菌的生成数目,改善阴道微生态环境,对防止念珠菌性外阴阴道炎复发效果好。

Caring for the breast cancer survivor's health and wellbeing

The breast cancer care continuum entails detection, diagnosis, treatment, and survivorship. During this time, focus on the whole woman and medical concerns beyond the breast cancer diagnosis itself is essential. In this comprehensive review, we critically review and evaluate recent evidence regarding several topics pertinent to and specific for the woman living with a prior history of breast cancer. More specifically, we discuss the most recent recommendations for contraceptive options including long-acting reversible contraception and emergency contraception, fertility and pregnancy considerations during and after breast cancer treatment, management of menopausal vasomotors symptomsand vulvovaginal atrophy which often occurs even in young women during treatment for breast cancer. The need to directly query the patient about these concerns is emphasized. Our focus is on non-systemic hormones and non-hormonal options. Our holistic approach to the care of the breast cancer survivor includes such preventive health issues as sexual and bone health,which are important in optimizing quality of life. We also discuss strategies for breast cancer recurrence surveillance in the setting of a prior breast cancer diagnosis. This review is intended for primary care practitioners as well as specialists caring for female breast cancer survivors and includes key points for evidence-based best practice recommendations.

Expression of Candida Albicans Secreted Aspartyl Proteinase in Acute Vaginal Candidiasis

In order to analyze the in vivo expression of Candida albicans secreted aspartyl pro- teinases (SAP) in human vaginal infection, the vaginal secretion from 29 human subjects was col- lected by vaginal swab, and the expression of SAP1–SAP6 was detected by reverse-transcriptase po- lymerase chain reaction using specific primer sets. It was found that Sap2 and Sap5 were the most common genes expressed during infection; Sap3 and Sap4 were detected in all subjects and all 6 SAP genes were simultaneously expressed in some patients with vaginal candidiasis. It was suggested that the SAP family is expressed by Candida albicans during infection in human and that Candida albi- cans infection is associated with the differential expression of individual SAP genes which may be involved in the pathogenesis of vaginal candidiasis.

Polyhexamethylene Biguanide in Vaginal Solution Is Effective in the Treatment of Vulvovaginal Candidiasis: A Pilot Study

Vaginitis is one of the most recurrent conditions that afflict women and require medical care. Vulvovaginal candidiasis (VVC) is frequently related to vaginal carriage of Candida albicans, an opportunistic polymorphic fungus, which colonizes the human skin, the mucosa and the reproductive tract. Actually, standard treatments to counteract vaginitis include several topical and oral treatments. The aim of this study was to evaluate the efficacy of a new biguanide compound, polyhexamethylene biguanide (PHMB) in avaginal solution, in women affected by vaginal candidiasis. For this reason, 40 women showing the symptoms previously ascribed to vaginal candidiasis were recruited and treated with a single PHMB dose of vaginal solution. After a single dose of treatment, 80% of them had a complete resolution of the fungal infection;furthermore, all of them reported clinical benefits, statistically significant reduction in both clinical signs and symptoms of candidiasis and a score’s reduction of 50%.

Patient Preferences in the Treatment of Vaginal Candidiasis

Vulvovaginal candidiasis (VVC) is one of the most frequent problems facing women and their healthcare professionals (HCP). It is difficult for providers to understand the prevalence of VVC because effective over the counter treatments (OTC), are available. It is expected that there are a great many more episodes of VVC in our patient population, as the frequency of self-treatment, success and satisfaction for those that use OTC products prior to seeing a women’s health care provider is unknown. In this study;healthcare providers were given OTC miconazole/tioconazole units for free distribution to patients for whom they diagnosed VVC by exam in their offices. Surveys for both HCP and patients were also distributed to determine the initial or recurrent nature of their symptoms and their satisfaction with their treatments. 1265 OBGYNs and 1821 NP/CNM/PAs reported on over 19,000 patients receiving a single complete treatment. Among HCPs, treatment efficacy was the primary reason for recommending miconazole/tioconazole. However, rapid onset of symptom relief, safety vs. fluconazole, patient preference for the less messy ovule, avoidance with drugs metabolized by the liver, and resistance to, or failure on, fluconazole were additional reasons noted for topical preference. Overall, patient satisfaction (n = 317) was high at 95%, with 97% of patients reporting that they would use miconazole again. Importantly, 100% of first time sufferers (n = 95) would use miconazole again. The few patients dissatisfied with miconazole (2%), reported no symptom relief, burning after use, an “allergic reaction”, pain from the applicator or a messy discharge. Most patients using the external symptom relief products were satisfied with the external cream (93%) and wipes (96%). Almost all patients reported their yeast infection was cured (91%) and that they experienced quick symptom relief (94%), despite the prevalence of recurrent vs first time VVA sufferers that presented to offices in this trial. Most patients were cured and satisfied with their treatment, therefore supporting the use of topical miconazole/tioconazole as first line therapy for vulvovaginal candidiasis patients presenting to a healthcare office.