Post-menopausal recurrent vaginal candidiasis: effect of hysterectomy on response to treatment, type of colonization and recurrence rates post-treatment.
BACKGROUND
Post-menopausal patients are still susceptible to be colonized by fungal organisms despite being estrogen-deprived. Symptomatic vulvovaginal candidiasis, although a rare occurrence in post-menopausal patients, can be diagnosed in about one third of the patients. The purpose of our study was to investigate in post-menopausal patients with recurrent vulvovaginal candidiasis the effect of hysterectomy on response to treatment, the type of colonization and the recurrence rates after treatment.


METHODS
Forty-seven menopausal patients with symptomatic recurrent vulvovaginal colonization were evaluated between January 1995 and August 2002. The study was a retrospective cohort chart review and included complete history and physical examination, basic metabolic blood panel, colposcopy, wet mount, bacterial and fungal cultures. Twenty-three patients had hysterectomy and 24 were not hysterectomized. All the patients received daily fluconazole therapy for 30 days. They were then re-evaluated at 1, 3 and 6 months and retreated if symptomatic and culture positive.


RESULTS
The 2 groups of patients were comparable regarding age, number of years of recurrent colonization, number of previous antifungal treatments and previous, current use of hormone replacement therapy. None used vaginal douching. The 2 groups of patients showed statistical differences regarding: colonization by Candida albicans (P<0.01), colonization by Candida glabrata (P<0.05), colonization by Candida stelloidea (P<0.01), recurrence after 3 months (P<0.05) and 6 months (P<0.05), response to one course of therapy (P<0.02) and need for multiple treatments (P<0.03).


CONCLUSIONS
Hysterectomized post-menopausal patients with recurrent vulvovaginal fungal colonization seems to be more propense to harbor more aggressive and resistant fungi. Post-menopausal recurrent vaginal candidiasis: effect of hysterectomy on response to treatment, type of colonization and recurrence rates post-treatment.
General OB/GYN Division, Department of Obstetrics and Gynecology, CHE 3800 Dayton, OH 45409-2902, USA. gary.ventolin@wright.edu
Gary
G
Ventolini
Michael S
MS
Baggish
D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans / Q000302:isolation & purification; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy* / Q000382:microbiology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D017698:Postmenopause; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina / Q000382:microbiology
D000935:Antifungal Agents; D015725:Fluconazole