Recurrent vaginal candidiasis. Results of a cohort study of sexual transmission and intestinal reservoir.

Yeast cultures from the oral cavity, vagina and rectum were obtained from 125 women experiencing an acute episode of recurrent candidal vaginitis. To investigate the role of sexual transmission, oral, penile and ejaculate cultures were also prepared from all the male sexual partners. The rates of oral and rectal Candida species colonization in the women were 36% (45/125) and 44.8% (56/125), respectively. The male partners' oral cavities were positive in 23.2% (29/125) and the penile coronal sulcus and seminal fluid in 16% (20/125) and 14.4% (18/125), respectively. The susceptibility of the isolated species to the main antimycotic drugs was ascertained with the agar diffusion method. Therapy in the women and the colonized sexual partners was carried out, eliminating the microorganism from every positive site. Control cultures were obtained two weeks after the completion of therapy, and follow-up was continued for one year. The overall clinical and microbiologic cure rate in the study group was 72% (95/125). The rate of relapse was not influenced by the treatment of Candida colonization of the female intestinal tract. The recurrence rate after treatment in the couples in which the man harbored yeast (oral cavity, penile coronal sulcus, seminal fluid) was lower (15.8% vs. 44.8%, P = .0019) than that recorded in the couples without sexual partner involvement. The identification and treatment of the male sexual partner's Candida colonization seems important in the prevention of recurrent vulvovaginitis.