PREREQUISITES FOR AN EFFECTIVE TREATMENT OF CHRONIC RECURRENT VAGINALCANDIDOSIS

67 women with chronic recurrent or per sistent vaginal candidosis betw een 5-79 years of age were seen in our outdoor department. In 34- case s, yeasts could be isolated in a vaginal swab taken at the first consu ltation. On average the patients reported 5 episodes per year during t he last years. Typical symptoms consisted of pruritus vulvae, local in flammation and a curdy vaginal discharge. Nearly all of the women had received local or systemic antimycotic treatment for several times. In 53% (18 patients), C. albicans had been isolated, in 29% (10 patients ) C. glabrata and in 9% (3 patients) C. krusei. While candidosis due t o C. albicans and C. Krusei was frequently associated with distressing complaints, infections with C. glabrata caused only very few symptoms . Independant of the species, severe and persistent infections were ch aracterized by long term persisting specific IgM-antibody-titers and r emarkable lack of IgG-antibodies. The laboratory parameters of WBC, CR P and immunelectrophoresis were normal. The minimum inhibitory concent rations (MIC) of 60 Candida strains against fluconacole were determine d by microdilution assay. The MIC for C. albicans (n = 35) were betwee n 0.78 and 3.125 mu g/ml, for C. glabrata (n = 20) between 8 and 32 mu g/ml and for C. krusei (n = 5) between 25 and 128 mu g/ml. In 7 cases , local antimycotic treatment was sufficient. Correlating to the sensi tivity, 18 women were treated with 100-800 mg fluconacole/d for 10-20 days. In 13 of them, clearance of symptoms and yeasts was achieved. Th e treatment of fluconacole-resistant. strains with itraconazole (100-2 00 ml/d for 10-20 days) together with local application of nystatin (2 x 1 Mio. IE for 10 days) was without any effect. Three women with C. albicans, C. glabrata and C. krusei infection received a candidin-vacc ination (0.005 BE/ml - 500 BE/ml). In all of these cases, production o f IgM-antibodies was induced. However, the clinical symptoms could not be influenced. Only in two cases it was not: possible to reach a clea rance of symptoms and yeasts. The results show the benefit of a precis e differentiation before therapy. Serologic controls of antibody titer s seem to be useful tools to control the efficacy of treatment.