氟康唑维持治疗复发性外阴阴道念珠菌病（RVVC）期间的阴道 pH 值和微生物群。

Vaginal pH and microbiota during fluconazole maintenance treatment for recurrent vulvovaginal candidosis (RVVC).

机构信息

Femicare Clinical Research for Women, Tienen, Belgium; Regional Hospital H Hart, Tienen, Belgium; University Hospital Antwerp, Antwerpen, Belgium.

Femicare Clinical Research for Women, Tienen, Belgium; Department of Biothermodynamics and Drug Design, Institute of Biotechnology, Vilnius University, Vilnius, Lithuania.

出版信息

Diagn Microbiol Infect Dis. 2020 Jun;97(2):115024. doi: 10.1016/j.diagmicrobio.2020.115024. Epub 2020 Feb 14.

DOI:10.1016/j.diagmicrobio.2020.115024

PMID:32253071

Abstract

BACKGROUND

It is commonly stated that Candida in the vagina prefers a low pH to develop infection. However, mixed infections of Candida with bacterial vaginosis (BV) and aerobic vaginitis (AV) are rather common and may challenge the rule that Candida should only be looked for in low vaginal pH settings. In this study we tested whether the vaginal pH in acute vaginal candidosis is lower than in women successfully treated to prevent Candida recurrences.

METHODS

Vaginal pH and microscopy findings of vaginal microbiota were recorded during 12 visits over 1.5 years in 117 patients medically monitored during a degressive fluconazole maintenance regimen for proven recurrent vulvovaginal candidosis (ReCiDiF trial). The fluctuation of the mean pH of and microscopic findings of the vaginal smears were studied before, during and after the treatment.

RESULTS

The mean vaginal pH of women with acute infection before or after ending maintenance treatment was (4.7±0.8 and 4.8 ±1.0, respectively, p>0.05). During maintenance treatment with fluconazole, the pH dropped significantly to 4.5±0.8 (p=0.01). Depression of Lactobacilli spp. (increased lactobacillary grades) was more frequent during the acute, pre-treatment period (30.0%) than during the treatment period (23.1%, p=0.03). Aerobic vaginitis type flora was also more prevalent pre-treatment than during treatment (30.0% vs 22.2%, OR=0.7 (95%CI 0.5-0.9), p=0.01).

DISCUSSION

In women with RVVC, acute vaginal Candida infection is associated with an increased pH, and disturbed vaginal bacterial microbiota. During fluconazole maintenance treatment, the pH drops to normal levels and the lactobacillary grade improves.

CONDENSATION

Acute Candida vulvovaginitis can be associated with a disturbance of the vaginal microbiota. In patients with recurrent vulvovaginal candidosis, decrease of pH, and increase of Lactobacilli spp. were observed during fluconazole maintenance treatment. This pH drop was seen in all response groups. This contradicts the common belief that active vaginal Candida infection is related to low pH.

摘要

背景

常说阴道中的念珠菌喜欢低 pH 值来发展感染。然而，念珠菌与细菌性阴道病（BV）和需氧性阴道炎（AV）的混合感染相当常见，这可能挑战了只有在低阴道 pH 值环境中才寻找念珠菌的规则。在这项研究中，我们检测了急性阴道念珠菌病的阴道 pH 值是否低于成功治疗以预防念珠菌复发的女性。

方法

在 117 名患有经证实的复发性外阴阴道念珠菌病（ReCiDiF 试验）的女性中，在 1.5 年的 12 次就诊期间，记录阴道 pH 值和阴道微生物群的显微镜检查结果。研究了治疗前后阴道涂片的平均 pH 值和显微镜检查结果的波动。

结果

急性感染的女性在结束维持治疗前后的阴道 pH 值分别为（4.7±0.8 和 4.8±1.0，p>0.05）。在氟康唑维持治疗期间，pH 值显著下降至 4.5±0.8（p=0.01）。在急性、治疗前阶段，乳杆菌属 spp.（增加乳杆菌属等级）减少更为常见（30.0%），而在治疗期间则较少见（23.1%，p=0.03）。在治疗前，需氧性阴道炎型菌群也比治疗期间更为常见（30.0%比 22.2%，OR=0.7（95%CI 0.5-0.9），p=0.01）。