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Introduction: Vulvovaginal candidiasis (VVC) is frequent in women worldwide and usually responds rapidly to topical or oral antifungal therapy. However, some women develop recurrent vulvovaginal candidiasis (RVVC), which is arbitrarily defined as four or more episodes every year. RVVC is a debilitating, long-term condition that can severely affect the quality of life of women. Most VVC is diagnosed and treated empirically and women frequently self-treat with over-the-counter medications that could contribute to an increase in the antifungal resistance. The effective treatment of RVVC has been a challenge in daily clinical practice. This review aims to assess the efficacy of antifungal agents administered orally or intravaginally for the treatment of RVVC, in order to define clinical practices that will impact on the reduction of the morbidity and antifungal resistance., Methods and Analysis: A comprehensive search of the following databases will be carried out: PubMed, Embase, Scopus, Web of Science, Scientific Electronic Library Online (SciELO), the Cochrane Central Register of Controlled Trials (CENTRAL), Biblioteca Virtual em Saúde (Virtual Health Library)/Biblioteca Regional de Medicina (Regional Library of Medicine) (BVS/BIREME), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and in the clinical trials databases (www.trialscentral.org; www.controlled-trials.com; www.clinicaltrials.gov). The risk of bias will be assessed according to the Cochrane Risk of Bias tool. We will perform data synthesis using the Review Manager (RevMan) software V.5.2.3. To assess heterogeneity, we will compute the I2 statistic., Ethics and Dissemination: This study will be a review of published data and it is not necessary to obtain ethical approval. Findings of this systematic review will be published in a peer-reviewed journal., Trial Registration Number: CRD42018093817., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To quantify the number of defense cells and immunoglobulin E (IgE) levels in peripheral blood sampled from women with recurrent vulvovaginal candidiasis., Methods: A cross-sectional study was conducted on 60 women, 40 with vulvovaginal candidiasis and 20 controls. The defense cells were identified using an impedance system combined with flow cytometry and total and specific IgE was measured by chemiluminescence. The Mann-Whitney test was used for nominal variables and the Spearman test was used to determine the correlation of IgE concentration and eosinophils in peripheral blood., Results: The number of eosinophils in peripheral blood from patients with recurrent vulvovaginal candidiasis, 302.60 (± 253.07), was significantly higher compared to control, 175.75 (± 109.24) (p=0.037). Serum levels of total and specific IgE were similar in the groups of women with and without recurrent vulvovaginal candidiasis (p=0.361). However, there was a moderate positive correlation between eosinophils and total serum IgE in the candidiasis group (r=0.25)., Conclusion: Women with recurrent vulvovaginal candidiasis are more likely to have eosinophils in peripheral blood.

Problem:   The extent of the vaginal immune response is not fully determined. The purpose of this study was to evaluate the vaginal immune cells from women with vulvovaginitis (VV)., Method of Study: A total of 142 volunteers diagnosed with bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and BV associated with VC or normal microflora were sampled to evaluate the immune cells by flow cytometry. The immune cells were obtained by vaginal lavage and labeled with fluorochrome-conjugated monoclonal antibodies to identify neutrophil granulocytes, macrophages, CD4(+) and CD8(+) T lymphocytes, B lymphocytes, and NK lymphocytes., Results: Neutrophil granulocytes were present in 84.6% of samples among the leukocyte populations. Considering samples in which neutrophils were present, the mean percentage of neutrophil granulocytes was significantly higher in women with VC than BV and normal microflora and was significantly lower in women with BV than normal microflora. Macrophages and lymphocytes were present in a lower percentage of samples. The mean percentage of CD4(+) T lymphocytes in vaginal lavages was significantly higher in VC and BV compared with women with normal microflora., Conclusions: Neutrophils were the predominant leukocytes and were associated with VC and inversely with BV. CD4(+) T lymphocytes were associated with both VC and BV., (© 2011 John Wiley & Sons A/S.)

Objective: To evaluate whether the use of "breathable" panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation., Methods: A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n=53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n=54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears., Results: After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P=0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P=0.7974) at the end of the study period., Conclusion: After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

To determine the frequency of abnormal vaginal flora and bacterial vaginosis (BV) in female sex workers (FSW) and the association between douching and vaginal microflora imbalance, a cross-sectional study enrolled 94 users and 61 non-users of vaginal douching. The social-demographic and sexual profile of these women was obtained and their abnormal vaginal flora, BV, vaginal candidiasis, trichomoniasis and cytolitic vaginosis on blinded samples were identified by Gram stain. A stepwise multivariate regression determined the risk of development of vaginal microflora imbalance. Prevalence of abnormal flora, BV, candidiasis, trichomoniasis and cytolytic vaginosis in the entire FSW was 75.5%, 51.0%, 5.1%, 0.64% and 1.9%, respectively. There were no significant differences in these findings between users and non-users of vaginal douching. Regression analysis did not identify any increased risk for altered vaginal flora or BV in vaginal douche users. In conclusion, vaginal douching did not increase the rate of these alterations in FSW.

Objective: To evaluate associations between polymorphisms in the gene coding for mannose-binding lectin (MBL) and the diagnosis of acute or recurrent vulvovaginal candidiasis and bacterial vaginosis, Methods: Women at two outpatient clinics in Brazil filled out a questionnaire and were examined for the presence of vulvovaginal candidiasis or bacterial vaginosis. A buccal swab was blindly tested for codons 54 and 57 MBL2 gene polymorphisms by polymerase chain reaction and endonuclease digestion., Results: A total of 177 women were enrolled. Vulvovaginal candidiasis was identified in 78 (44.1%) women, 33 (18.6%) had bacterial vaginosis, and 66 (37.3%) were normal controls. Recurrent vulvovaginal candidiasis was present in 50 (64.1%) of the women with vulvovaginal candidiasis; 20 (60.6%) of the bacterial vaginosis patients had recurrent disease. Vulvovaginal candidiasis was associated with white race (P=.007), bacterial vaginosis was associated with nonwhite race (P=.05), and both were associated with a history of allergy (P< or =.02) and having sexual intercourse at least three times a week (P<.001). Carriage of the variant MBL2 codon 54 allele B was more frequent in women with recurrent vulvovaginal candidiasis (25.0%) than in the women with acute vulvovaginal candidiasis (17.9%) or controls (10.6%) (P=.004). Allele B was also more prevalent in women with recurrent bacterial vaginosis (22.5%) than in those with acute bacterial vaginosis (0%) (P=.009). The MBL2 codon 57 polymorphism was infrequent and not associated with vulvovaginal candidiasis or bacterial vaginosis., Conclusion: The incidence of vulvovaginal candidiasis and bacterial vaginosis differs by ethnicity in Brazilian women. The MBL2 codon 54 gene polymorphism is associated with both recurrent vulvovaginal candidiasis and recurrent bacterial vaginosis.