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Background: Vulvovaginal candidiasis (VVC) is a vaginal mucosal infection that usually affects women in their reproductive age. When the signs of VVC persist on a daily basis or last for a long time and repeat at least three times per year, the disease is considered chronic and recurrent., Objective: The purpose of this study was to evaluate the frequency of HLA-DRB1 alleles in patients with recurrent vulvovaginal candidiasis (RVVC)., Study Design: 120 patients with RVVC and 136 age-matched healthy controls underwent low-resolution HLA-DRB typing performed using the polymerase chain reaction-sequence-specific primers (PCR-SSP) technique., Results: In the present work, we studied different genes that encode HLA-DRB (HLA-DRB1 / HLA-DRB3 / HLA-DRB4 / HLA-DRB5) and showed that HLA-DRB1×14, found in 25% of the patients. In the present study, the significant frequency of HLA-DRB1×10 in the control group suggests a resistant role of this allele to RVVC infections CONCLUSIONS: In the HLA-DRB region, the DRB1×14 allele showed a higher frequency in the patients with RVVC than in the controls. Moreover, the higher frequency of DRB1×10 observed in the controls than in the patients with RVVC. These results demonstrate the HLA-DRB1 alleles are in relation with both susceptibility and immunity factors in RVVC infection and possible susceptible role of HLA-DRB1×14., Competing Interests: Disclosure and conflict of interest All authors declare to have no conflicts of interest., (Copyright © 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved.)

Background: Vulvovaginal candidiasis (VVC) is a vaginal mucosal infection that usually infects women in their reproductive age. When the signs of VVC persist on a daily basis or last for a long time and repeat at least three times per year, the disease is considered chronic and recurrent., Objectives: The purpose of this study was to determine the expression rate of 2 genes responsible for adhesion and virulence of candida in RVVC patients using Real-time PCR, and comparing them together and assess the presence or absence of ALS9-2 allele in these patients., Patients/methods: The vaginal discharge was collected from 120 women aged (22-55) attending lolagar hospital which were all diagnosed with RVVC and 120 age-matched healthy controls. The expression rate of ALS2 and ALS 9 genes was quantified using real-time PCR. PCR method was used for Identification of ALS9 gene alleles., Results: Results showed an increase in ALS2 gene expression and a decrease in ALS9 gene expression, comparing to basic level and standard sample. 42.5% (51 of total 120 samples) contained the small allele., Conclusions: The significant difference in expression rates of ALS2 and ALS9 genes indicates their different roles in making morphogenesis changes during the virulence of Candida albicans. Emergence of heterogeneous form and detection of ALS's short allele in invasive form of fungi proves the significant pathogenic role of this allele, specially when attached to mucosal tissue. Invasive and recurrent form of the disease can be accompanied by genetic-morphologic changes in fungi. Considering the form of this disease and the reduction in ALS9 gene expression, it can be concluded that this gene plays a significant role in attachment and initiation of the pathogenic phase., (Copyright © 2020. Published by Elsevier B.V.)

The antifungal effects of 2-phenylethanol are clearly visible through its intervention in Candida morphogenesis. Chronic and recurrent vulvovaginitis, however, does not respond to this standard experimental therapy; therefore, the study presented in this article investigated the effect of common antifungal drugs (amphotericin B [AMB], fluconazole [FLU], and itraconazole [ITC]), in combination with 2-phenylethanol, on the Candida species isolated from cases of chronic and recurrent vulvovaginitis, thereby allowing the recommendation of a more appropriate treatment option. Forty isolates from patients with chronic and recurrent vaginal candidiasis were investigated in this experimental study. The specimens were examined by direct microscopy, culturing, and PCR to identify the species. The antifungal effects of 2-phenylethanol and conventional drugs, both alone and in combination, were determined in duplicate. Finally, the findings were analyzed. In this study, 40 strains of Candida species were identified, whose agents were Candida albicans (95%) and Candida africana (5%). After 48 h, the minimum inhibitory concentration (MIC) range of the 2-phenylethanol was 800-3,200 μg/mL. Also, in the final study on the MIC levels of common antifungal drugs, AMB (0.42 μg/mL) had the lowest MIC, FLU (40.51 μg/mL) had the highest MIC, and the combination of ITC and 2-phenylethanol had the lowest fractional inhibitory concentration index (FICI) of any of the combinations (FICI range, 0.26-1.03). Combining FLU and ITC with 2-phenylethanol can effectively increase their antifungal effect.