Prospective study of vaginal bacterial flora and other risk factors for vulvovaginal candidiasis.
BACKGROUND
It has been suggested that vaginal colonization with lactobacilli may reduce the risk of vulvovaginal candidiasis (VVC), but supporting data are limited. Our objective was to determine the relationship between vaginal bacterial flora and VVC.


METHODS
We conducted a prospective cohort analysis that involved 151 Kenyan sex workers. At monthly follow-up visits, VVC was defined as the presence of yeast buds, pseudohyphae, or both on a wet preparation (including potassium hydroxide preparation) of vaginal secretions. Generalized estimating equations were used to identify correlates of VVC.


RESULTS
Participants returned for a median of 12 visits (interquartile range, 11-12 visits). VVC was identified at 162 visits, including 26 involving symptomatic VVC. Bacterial vaginosis was associated with fewer episodes of VVC (adjusted odds ratio [aOR], 0.29 [95% confidence interval {CI}, 0.16-0.50]). After excluding women with concurrent bacterial vaginosis, another possible cause of vaginal symptoms, the likelihood of symptomatic VVC was higher among those who had had yeast identified on wet preparation of vaginal secretions during the past 60 days (aOR, 4.06 [95% CI, 1.12-14.74]) and those with concurrent vaginal Lactobacillus colonization (aOR, 3.75 [95% CI, 1.30-10.83]).


CONCLUSIONS
Contrary to the commonly posited hypothesis that vaginal Lactobacillus colonization has a protective effect, we found that such colonization was associated with a nearly 4-fold increase in the likelihood of symptomatic VVC.
McClelland
R Scott
RS
Department of Medicine, University of Washington, Seattle, WA 98104, USA. mcclell@u.washington.edu
Richardson
Barbra A
BA
Hassan
Wisal M
WM
Graham
Susan M
SM
Kiarie
James
J
Baeten
Jared M
JM
Mandaliya
Kishorchandra
K
Jaoko
Walter
W
Ndinya-Achola
Jeckoniah O
JO
Holmes
King K
KK
D000328:Adult; D001419:Bacteria / Q000145:classification* / Q000302:isolation & purification*; D002181:Candidiasis, Vulvovaginal / Q000150:complications* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D011477:Sex Work; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult