Colonisation of extragenital sites by Candida in women with recurrent vulvovaginal candidosis

Abstract

Objectives: To study colonisation of extragenital sites by Candida in women with a history of recurrent vulvovaginal candidosis and to determine the association of such colonisation with clothing and sexual practice.

Design: A prospective case-control (current genital colonisation by candida organisms vs non-colonisation) study.

Setting: Outpatient clinic, University hospital, Kiev, Ukraine and Department of Obstetrics and Gynaecology, University Hospital, Lund, Sweden.

Sample: Women with a history of recurrent vulvovaginal candidosis and an assumed new attack of the condition.

Methods: Eighty-six women with a history of recurrent vulvovaginal candidosis and an assumed current attack of this condition underwent culture for Candida from the genital tract, the perianal skin, the rectum, the mouth and from voided urine samples, using Sabouraud and chromogenic agar. The women were interviewed about some factors that have been considered to trigger colonisation with Candida spp.

Main outcome measures: Colonisation of extragenital sites of women with recurrent vulvovaginal candidosis by different species of Candida. Correlation with oral and anal sex, and with clothing.

Results: Candida spp. was isolated from the mouth, the rectum, the perianal skin and from voided urine in 11(13%), 24(28%), 35(41%) and 16(19%) of women, respectively. Candida was recovered from one or more of these sites in 44(51%) of the women. The rate of culture of Candida from the extragenital sites was significantly higher (P < 0.05) in women who had a positive culture from the introitus or the vagina. The recovery rates of Candida in the 46 vaginal culture-positive women were 8 (17%), 24 (52%), 34 (74%) and 16 (35%) from the extragenital sites in the order mentioned. Species of Candida other than Candida albicans occurred more often at the extragenital than the genital sites. Neither oral nor anal sex was associated with colonisation of the mouth and the rectum with Candida spp. Neither tight-fitting trousers nor underwear produced from synthetic material was associated with colonisation of the perianal skin with Candida spp.

Conclusions: Extragenital sites are often colonised by Candida spp. in women with a history of recurrent vulvovaginal candidosis, but significantly more often if the genital tract is also colonised. Extragenital sites are significantly more commonly colonised with species other than C. albicans. Extragenital sites may be reservoirs for recolonisation of the genital tract in women with recurrent vulvovaginal candidosis. This has implications for treatment.