title: Prospective study of vaginal bacterial flora and other risk factors for vulvovaginal candidiasis.
abstract: 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.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA 98104, USA. mcclell@u.washington.edu
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Wisal M
authors.initials: WM
authors.lastname: Hassan
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.forename: James
authors.initials: J
authors.lastname: Kiarie
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Jeckoniah O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: King K
authors.initials: KK
authors.lastname: Holmes
mesh_terms: 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