An investigation into the pathogenesis of vulvo-vaginal candidosis

Objective: To monitor yeasts isolated from women during and between episode s of recurrent vulvo-vaginal candidosis (WC) to determine whether vaginal r elapse or re-infection occurred. Methods: Women presenting at the genitourinary medicine clinic with signs a nd symptoms of VVC were recruited to the study (n = 121). A vaginal washing , high vaginal swab (HVS) and rectal swab were taken and the women treated with a single 500 mg clotrimazole pessary. Women were asked to re-attend af ter 1, 4, and 12 weeks, or when the WC recurred, when vaginal washings and HVS were repeated. Candida isolates recovered were strain typed using the C a3 probe and their similarity assessed. Antifungal susceptibility to flucon azole and clotrimazole were determined. Results: Of the women recruited, 47 completed the study, either returning f or four visits or suffering a recurrence during the study period. Of the 22 women who experienced recurrence, the same strain was responsible for the initial and recurrent episode in 17 women. For the remaining five women, fo ur had strain replacement and one had a change of species. None of the isol ates recovered from the women demonstrated resistance to either clotrimazol e or fluconazole. Conclusions: Our findings support the theory of vaginal relapse and thus ma y support thr use of more prolonged courses of antifungal therapy initially to increase the chances of eradication of the yeast.