CHRONIC VULVO-VAGINAL CANDIDIASIS - CHARACTERISTICS OF WOMEN WITH CANDIDA-ALBICANS, C-GLABRATA AND NO CANDIDA

Introduction-Although as many as 5% of all women complain of chronic v ulvovaginitis, little is known about these women. They may often be mi sdiagnosed and the role of vaginal yeast culture in diagnosing vulvova ginal candidiasis (VVC) among them has not been clearly defined. Metho ds-To address these deficiencies, we tabulated initial diagnoses among new patients and conducted a medical record-based, unmatched case-con trol study among women reporting a history of chronic vulvovaginitis ( four or more episodes in the past year) at a vulvovaginitis specialty clinic. Clinical presentation and medical history were compared for wo men who had a positive vaginal yeast culture for either Candida albica ns or C glabrata, or who had a negative culture. Results-One-third of the women had no apparent vulvovaginal disease at their initial visit. All women reported similar symptoms, except for an increased prevalen ce of painful sexual intercourse in women with C albicans (chi(2) p = 0.014 versus women with C glabrata and p < 0.001 versus women with no candida). Women with C glabrata were more likely to be non-white (chi( 2) P = 0.071 compared with women with C albicans) and to report an und erlying medical condition (chi(2) p less than or equal to 0.001 versus both women with C albicans and women with no candida), Physical exami nation was normal only in women with no candida. C albicans cases were more likely to have positive potassium hydroxide microscopy (chi(2) p = 0.016) and a pH less than or equal to 4.5 (chi(2) p = 0.011) than w ere C glabrata cases. Conclusions-These results suggest that reliance on symptoms and signs alone will result in significant misdiagnosis of chronic vulvovaginitis. Among women with WC, subtle differences in cl inical presentation do not reliably distinguish women with C albicans from those with C glabrata. Om study also indicates that vaginal yeast cultures, while not necessary for every patient, are valuable in conf irming negative diagnoses, detecting microscopy false-negatives, and i dentifying non-C albicans isolates.