VAGINAL-ASSOCIATED IMMUNITY IN WOMEN WITH RECURRENT VULVO-VAGINAL CANDIDIASIS - EVIDENCE FOR VAGINAL TH1-TYPE RESPONSES FOLLOWING INTRAVAGINAL CHALLENGE WITH CANDIDA ANTIGEN

Studies from women with recurrent vulvovaginal candidiasis (RVVC) and from an animal model of experimental vaginitis suggest that deficienci es in immune function should be examined at the local rather than syst emic level. Evidence of vaginal cell-mediated immunity (CMI) was evalu ated for the first time in cervicovaginal lavage (CVL) fluid from RVVC patients. Results showed that although constitutive Th1- and Th2-type cytokine expression was detectable in CVL fluid from normal women, an d differences in cytokines were observed in RVVC patients, limitations in experimental design of such de novo analyses urged caution in inte rpretation. Alternatively, attempts were made to establish conditions in control subjects whereby vaginal immunity could be detected after i ntravaginal challenge with Candida antigen. Preliminary results showed that Th1-type cytokines (interleukin-2 and -12, interferon-gamma) and histamine were increased 16-18 h after intravaginal introduction of C andida skin test antigen. Intravaginal antigenic challenge represents a novel approach for studying Candida-specific vaginal CMI.