Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 May 25;11(6):618.
doi: 10.3390/pathogens11060618.

Role of Vaginal Mucosa, Host Immunity and Microbiota in Vulvovaginal Candidiasis

Subatrra Nair Balakrishnan  1 , Haizat Yamang  1 , Michael C Lorenz  2 , Shu Yih Chew  1 , Leslie Thian Lung Than  1
Affiliations
Review

Role of Vaginal Mucosa, Host Immunity and Microbiota in Vulvovaginal Candidiasis

Subatrra Nair Balakrishnan et al. Pathogens. .

Abstract

Vulvovaginal candidiasis (VVC) is a prevalent gynaecological disease characterised by vaginal wall inflammation that is caused by Candida species. VVC impacts almost three-quarters of all women throughout their reproductive years. As the vaginal mucosa is the first point of contact with microbes, vaginal epithelial cells are the first line of defence against opportunistic Candida infection by providing a physical barrier and mounting immunological responses. The mechanisms of defence against this infection are displayed through the rapid shedding of epithelial cells, the presence of pattern recognition receptors, and the release of inflammatory cytokines. The bacterial microbiota within the mucosal layer presents another form of defence mechanism within the vagina through acidic pH regulation, the release of antifungal peptides and physiological control against dysbiosis. The significant role of the microbiota in maintaining vaginal health promotes its application as one of the potential treatment modalities against VVC with the hope of alleviating the burden of VVC, especially the recurrent disease. This review discusses and summarises current progress in understanding the role of vaginal mucosa and host immunity upon infection, together with the function of vaginal microbiota in VVC.

Keywords: host immune response; pattern recognition receptors (PRRs); vaginal microbiota; vaginal mucosa; vulvovaginal candidiasis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Female genital tract. (B) Illustration of the vaginal wall structure.
Figure 2
Figure 2
Interactions between C. albicans and Lactobacillus spp.
See this image and copyright information in PMC

References

    1. Kalia N., Singh J., Kaur M. Immunopathology of recurrent vulvovaginal infections: New aspects and research directions. Front. Immunol. 2019;10:2034. doi: 10.3389/fimmu.2019.02034. - DOI - PMC - PubMed
    1. Bitew A., Abebaw Y. Vulvovaginal candidiasis: Species distribution of Candida and their antifungal susceptibility pattern. BMC Women’s Health. 2018;18:94. doi: 10.1186/s12905-018-0607-z. - DOI - PMC - PubMed
    1. Sasani E., Rafat Z., Ashrafi K., Salimi Y., Zandi M., Soltani S., Hashemi F., Hashemi S.J. Vulvovaginal candidiasis in Iran: A systematic review and meta-analysis on the epidemiology, clinical manifestations, demographic characteristics, risk factors, etiologic agents and laboratory diagnosis. Microb. Pathog. 2021;154:104802. doi: 10.1016/j.micpath.2021.104802. - DOI - PubMed
    1. Abdullahi Nasir I., Uchenna E., Onyia J., Ifunanya A.L. Prevalence of vulvovaginal candidiasis among nonpregnant women attending a tertiary health care facility in Abuja, Nigeria. Res. Rep. Trop. Med. 2015;6:37. doi: 10.2147/RRTM.S82984. - DOI
    1. O’Hanlon D.E., Come R.A., Moench T.R. Vaginal pH measured in vivo: Lactobacilli determine pH and lactic acid concentration. BMC Microbiol. 2019;19:13. doi: 10.1186/s12866-019-1388-8. - DOI - PMC - PubMed