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Vulvovaginitis Caused by Candida Species Following Antibiotic Exposure

  • Female Genital Tract Infections (J Sobel, Section Editor)
  • Published:
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Abstract

Purpose of Review

Goal was to review epidemiology, pathophysiology, and prevention of post-antibiotic Candida vulvovaginitis (VVC).

Recent Findings

Antibacterial therapy, whether systemic or locally applied to the vagina, represents the single most frequent and predictable cause or triggering mechanism of symptomatic vulvovaginal candidiasis (VVC). Such initiating mechanisms may precipitate sporadic or recurrent episodes of VVC. In spite of this widely recognized association, the exact mechanism whereby antibiotics of all classes cause acute exacerbation of symptomatic vaginal disease remains largely unstudied and therefore largely unknown. Pathophysiology is hypothesized to be reduction or alteration of vaginal microbiome restraints of yeast colonization, proliferation, and expression of virulence characteristics.

Summary

The predictable link between antibiotic use and post-antibiotic VVC affords practitioners an opportunity for timely intervention using selective, convenient antimycotics usually drugs but possibly probiotic measures. Indications and limitation of these steps are discussed.

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References

  1. Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 2016;214:15–21.

    Article  Google Scholar 

  2. Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis. A. Systematic review. Lancet Infect Dis. 2018;18:339–47.

    Article  Google Scholar 

  3. Marchaim D, Lemanek L, Bheemreddy S, Kaye KS, Sobel JD. Fluconazole-resistant, Candida albicans vulvovaginitis. Obstet Gynecol. 2012;120(6):1407–14.

    Article  CAS  Google Scholar 

  4. lj C. Vaginal moniliasis after tetracycline therapy: the effects of amphotericin B. Am J Obstet Gynecol. 1964;90:374–8.

    Google Scholar 

  5. Oriel JD, Waterworth PM. Effects of minocycline and tetracycline on the vaginal yeast flora. J Clin Pathol. 1975;28:403–6.

    Article  CAS  Google Scholar 

  6. Iravani A, Richard GA. Amoxicillin-clavulanic acid versus Cefaclor in the treatment of urinary tract infections and their effects on the urogenital and rectal flora. Antimicrob Ag Chemo. 1986;29:107–9.

    Article  CAS  Google Scholar 

  7. Bluestein D, Rutledge C, Lumsden L. Predicting the occurrence of antibiotic-induced candidal vaginitis (AICV). Fam Pract Res J. 1991;11:319–26.

    CAS  PubMed  Google Scholar 

  8. MacDonald TM, Beardon PH, McGilchrist MM, Duncan ID, McKendrick AD, McDevitt DG. The risks of symptomatic vaginal candidiasis after oral antibiotic therapy. Q J Med. 1993;86:419–24.

    CAS  PubMed  Google Scholar 

  9. Geiger AM, Foxman B. Risk factors for vulvovaginal candidiasis: a case-control study among university students. Epidemiology. 1996;7:182–7.

    Article  CAS  Google Scholar 

  10. Glover DD, Larsen B. Relationship of fungal vaginitis therapy to prior antibiotic exposure. Infect Dis Obstet Gyn. 2003;11:157–60.

    Article  Google Scholar 

  11. Spinillo A, Capuzzo E, Acciano A, Santolo AD, Zara F. Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis. Am J Obstet Gynecol. 1999;180:14–7.

    Article  CAS  Google Scholar 

  12. Menday AP. Symptomatic vaginal candidiasis after pivmecillinam and norfloxacin treatment of acute uncomplicated lower urinary tract infection. Interna J Antimicrob Ag. 2002;20:297–300.

    Article  CAS  Google Scholar 

  13. Pirotta MV, Gunn JM, Chondros P. “Not thrush again!” Women’s experience of post-antibiotic vulvovaginitis. General Practice In Action. 2003;179:43–6.

    Google Scholar 

  14. Pirotta M, Gunn J, Chondros P, Grover S, O’Malley P, Hurley S, et al. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomized controlled trial. BMJ. 2004;27:1–5.

    Article  Google Scholar 

  15. Pirotta MV, Garland SM. Genital Candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics. J Clin Micro. 2006;44:3213–7.

    Article  Google Scholar 

  16. Tabrizi SN, Pirotta MV, Rudland E, Garland SM. Detection of Candida species by PCR in self-collected vaginal swabs of women after taking antibiotics. Mycoses. 2006;49:523–4.

    Article  Google Scholar 

  17. Xu J, Schwartz K, Bartoces M, Monsur J, Severson RK, Sobel JD. Effect of antibiotics on vulvovaginal candidiasis: a MetroNet study. J Am Board Fam Med. 2008;21:261–8.

    Article  Google Scholar 

  18. Woods JW, Manning IH Jr, Patterson CN. Monilial infections complicating the therapeutic use of antibiotics. J Am Med Assoc. 1951;145(4):207–11.

    Article  CAS  Google Scholar 

  19. Miller CP. New problems in the treatment of infectious diseases. Ann Intern Med. 1951;35(4):763–70.

    Article  CAS  Google Scholar 

  20. Waterworth PM. The effect of minocycline on Candida albicans. J Clin Pathol. 1974;27:269–72.

    Article  CAS  Google Scholar 

  21. Glover DD, Larsen B. Longitudinal investigation of Candida vaginitis in pregnancy: role of superimposed antibiotic use. Obstet Gynecol. 1998;91:115–8.

    Article  CAS  Google Scholar 

  22. McVay LV Jr, Srunt DH. A study of moniliasis in aureomycin therapy. Proc Soc Exp Biol Med. 1951;78(3):759–61.

    Article  CAS  Google Scholar 

  23. Moore M. In vivo and in vitro effect of aureomycin hydrochloride on Syringospora (Monilia, Candida) albicans. J Lab Clin Med. 1951;37(5):703–12.

    CAS  PubMed  Google Scholar 

  24. Huppert M, MacPherson DA, Cazin J. Pathogenesis of Candida Albicans infection following antibiotic therapy. Department of Bacteriology and Immunology, University of North Carolina School of Medicine. 1952;65:171–6.

    Google Scholar 

  25. Drell T, Lillsaar T, Tummeleht L, Simm J, Aaspõllu A, Väin E, et al. Characterization of the vaginal micro- and mycobiome in asymptomatic reproductive-age Estonian women. PLoS One. 2013;8(1):e54379. https://doi.org/10.1371/journal.pone.0054379.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Greenbaum S, Greenbaum G, Moran-Gilad J, Weintraub A. Ecological dynamics of the vaginal microbiome in relation to health and disease. Am J Obstet Gyn. 2019;220:324–36.

    Article  Google Scholar 

  27. Agnew KJ, Hillier SL. The effect of treatment regimens for vaginitis and cervicitis on vaginal colonization by lactobacilli. Sex Transm Dis. 1995 Sep-Oct;22(5):269–73.

    Article  CAS  Google Scholar 

  28. Sobel JD, Chaim W. Vaginal microbiology of women with acute recurrent vulvovaginal candidiasis. J Clin Microbiol. 1996;34(10):2497–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. St H, Hillier SL, Benedetti J, et al. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infection. J Infect Dis. 1996;174:1058–63.

    Article  Google Scholar 

  30. Chetwin E, Manhanzva MT, Abrahams AG, Froissart R, Gamieldien H, Jaspan H, et al. Antimicrobial and inflammatory properties of South African clinical Lactobacillus isolates and vaginal probiotics. Sci Rep. 2019;9:1917.

    Article  Google Scholar 

  31. Nichols RG, Peters JM, Patterson AD. Interplay between the host, the human microbiome, and drug metabolism. Hum Genomics. 2019;13(1):27.

    Article  Google Scholar 

  32. Swidsinski A, Guschin A, Tang Q, Dörffel Y, Verstraelen H, Tertychnyy A, et al. Vulvovaginal candidiasis: histologic lesions are primarily polymicrobial and invasive and do not contain biofilms. Am J Obstet Gynecol. 2019 Jan;220(1):91.e1–8.

    Article  Google Scholar 

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Correspondence to J. D. Sobel.

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This article is part of the Topical Collection on Female Genital Tract Infections

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Shukla, A., Sobel, J.D. Vulvovaginitis Caused by Candida Species Following Antibiotic Exposure. Curr Infect Dis Rep 21, 44 (2019). https://doi.org/10.1007/s11908-019-0700-y

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