IVDP-German Center for Health Services Research in Dermatology, University Medical Center Hamburg, Hamburg, Germany.
Mycoses. 2011 Nov;54(6):e807-10. doi: 10.1111/j.1439-0507.2011.02030.x. Epub 2011 May 25.
Recurrent vulvovaginal candidosis is a frequent disease with a serious impact on women's quality of life. Mostly, recurrences are caused by identical Candida strains suggesting C. albicans persistence in the female anogenital area. Objectives of the presented work were to identify the site of C. albicans persistence, to determine clinical symptoms and signs related to C. albicans positive vulvar cultures and to introduce a new therapeutic approach in women with RVVC. Women with an acute, culture-confirmed episode of RVVC at time of visit were included in this prospective case series. Swabs were obtained from both vagina and inter-labial sulcus. Women received a combined 20-day regimen of 100 mg oral fluconazole and ciclopiroxolamin cream topically. Follow-up visits were at 3, 6, 9 and 12 months. Of 139 women, 105 (76%) had at least one C. albicans positive culture from the external vulva. Vulvar positive cultures correlated with pruritus (OR 5.4; P < 0.001), vulvar edema (OR 3.8; P = 0.03) and fissures (OR 2.4; P = 0.03). Recurrence rates were 27%, 33% and 34% (at 6, 9, 12 months, respectively). The external vulva appears to represent a site of C. albicans persistence and source of endogenous re-infection in patients with RVVC. The combined treatment compared favorably with published fluconazole maintenance regimens.
复发性外阴阴道念珠菌病是一种常见疾病，严重影响女性的生活质量。大多数情况下，复发是由相同的念珠菌菌株引起的，这表明白色念珠菌在女性生殖器官区域持续存在。本研究的目的是确定白色念珠菌持续存在的部位，确定与外阴白色念珠菌阳性培养相关的临床症状和体征，并为复发性外阴阴道念珠菌病患者引入新的治疗方法。本前瞻性病例系列研究纳入了在就诊时患有急性、经培养证实的复发性外阴阴道念珠菌病的女性。从阴道和阴唇间沟获得拭子。女性接受了为期 20 天的联合治疗，即 100mg 口服氟康唑和环吡酮胺乳膏局部用药。随访时间为 3、6、9 和 12 个月。在 139 名女性中，有 105 名（76%）外阴至少有一次白色念珠菌阳性培养。外阴阳性培养与瘙痒（OR 5.4；P<0.001）、外阴水肿（OR 3.8；P=0.03）和皲裂（OR 2.4；P=0.03）相关。复发率分别为 27%、33%和 34%（分别在 6、9 和 12 个月时）。外阴似乎是白色念珠菌持续存在的部位，也是复发性外阴阴道念珠菌病患者内源性再感染的来源。联合治疗与已发表的氟康唑维持治疗方案相比具有优势。
