Research Article

Previous antibiotic treatment as a risk factor for recurrent vulvovaginal candidiasis

Wen Yang#, You Nie#, Shujuan Wang, Hongwei Wang, Enfeng Zhao and Na Dou*

Published: 03 December, 2019 | Volume 2 - Issue 2 | Pages: 127-132

The incidence of recurrent vulvovaginal candidiasis (RVVC) is extremely high. RVVC is likely to have a greater impact on patients. The aim of the study was to explore the risk factors of recurrent vulvovaginal candidiasis (RVVC) in the tropical coastal area. In this case-control study, a questionnaire survey was conducted in patients with VVC in the Sanya area from July 2014 to December 2016. The data included demographic characteristics, host factors, and behavioural characteristics. According to the maximum number of symptomatic episodes per year, the participants were classified into a non-recurrent VVC (NRVVC; < 4 episodes/year, including the current one) group or a RVVC group (≥ 4 episodes/year, including the current one). Crude odds ratios were calculated for potential risk factors and were adjusted using logistic regression. All vaginal secretions of patients with RVVC were cultured. Of the 728 cases of VVC, 69.0% (502/728) were NRVVC, and 31.0% (226/728) were RVVC. Previous antibiotic treatment (adjusted OR: 4.41, p < 0.01), repeat abortion (p < 0.05), and vaginal lavage (adjusted OR: 1.62, p < 0.05) were significantly associated with RVVC. A total of 230 yeasts isolates were obtained from 226 patients. C. albicans were the predominant Candida species (194 strains) in all patients of VVC. Our results demonstrate that in the tropical coastal area, a significant association was found between previous antibiotic treatment and incident RVVC. Host factors may be the most important factors in the occurrence of RVVC.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001034 Cite this Article Read Full Article PDF


Vulvovaginal candidiasis; Recurrence; Risk factor; Tropic; Antibiotic treatment


  1. Sobel JD. Vulvovaginal candidosis. Lancet. 2007; 369: 1961-1971. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17560449
  2. Aballéa S, Guelfucci F, Wagner J, Khemiri A, Dietz J-P, et al. Subjective health status and health-related quality of life among women with Recurrent Vulvovaginal Candidosis (RVVC) in Europe and the USA. Health Qual Life Outcomes. 2013; 11: 169. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24119427
  3. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016; 62: e1-50. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26679628
  4. Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, et al. Maintenance Fluconazole Therapy for Recurrent Vulvovaginal Candidiasis. N Engl J Med. 2004; 351: 876-883. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15329425
  5. Mendling W, Seebacher C. Working Group for Infections and Infectimmunology of the German Society for Gynecology and Obstetrics; German Speaking Mycological Society; German Dermatological Society. Guideline vulvovaginal candidosis: guideline of the German Dermatological Society, the German Speaking Mycological Society and the Working Group for Infections and Infectimmunology of the German Society for Gynecology And Obstetrics. Mycoses. 2003; 46: 365-369. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14622383
  6. Bolouri F, Moghadami Tabrizi N, Davari Tanha F, Niroomand N, Azmoodeh A, et al. Effectiveness of Fluconazole for Suppressive Maintenance Therapy in Patients with RVVC: a Randomized Placebo-Controlled Study. Iran J Pharm Res. 2009; 8: 307-313.
  7. Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 2016; 214: 15-21. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26164695
  8. Sobel JD. Candida vulvovaginitis. Clin Obstet Gynecol. 1993; 36: 153-165. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8435940
  9. Powell K. Vaginal thrush: quality of life and treatments. Br J Nurs. 2010; 19: 1106-1111. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20871514
  10. Sinkó J, Sulyok M, Denning DW. Burden of serious fungal diseases in Hungary. Mycoses. 2015; 58: 29-33. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26449504
  11. Corzo-León DE, Armstrong-James D, Denning DW. Burden of serious fungal infections in Mexico. Mycoses 2015; 58: 34-44. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26449505
  12. Kennedy MA, Sobel JD. Vulvovaginal Candidiasis Caused by Non-albicans Candida Species: New Insights. Curr Infect Dis Rep. 2010; 12: 465-470. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21308556
  13. Foxman B, Muraglia R, Dietz JP, Sobel JD, Wagner J. Prevalence of recurrent vulvovaginal candidiasis In 5 European countries and the United States: results from an internet panel survey. J Low Genit Tract Dis. 2013; 17: 340-345. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23486072
  14. Gross N, Arias M, Moraga M, Baddasarow YC. Species distribution and susceptibility to azoles of vaginal yeasts isolated prostitutes. Infect Dis Obstet Gynecol. 2007; 2007: 82412. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18273407
  15. Mahmoudi Rad M, Zafarghandi S, Abbasabadi B, Tavallaeec M. The epidemiology of Candida species associated with vulvovaginal candidiasis in an Iranian patient population. Eur J Obstet Gynecol Reprod Biol. 2011; 155: 199-203. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21194828
  16. Liu XP, Fan SR, Peng YT, Zhang HP. Species distribution and susceptibility of Candida isolates from patient with vulvovaginal candidiasis in Southern China from 2003 to 2012. J Mycol Med. 2014; 24: 106-111. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24746725
  17. Xu J, Schwartz K, Bartoces M, Monsur J, Severson RK, et al. Effect of Antibiotics on Vulvovaginal Candidiasis: A MetroNet Study. J Am Board Fam Med. 2008; 21: 261-268. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18612052
  18. Li Y, Xu J, Wang F, Wang B, Lu Z. Overprescribing In China, Driven By Financial Incentives, Results In Very High Use Of Antibiotics, Injections, And Corticosteroids. Health Aff. 2012; 31: 1075-1082. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22566449
  19. Patel DA, Brenda G, Sobel JD, Debbie L, Paul N, et al. Risk factors for recurrent vulvovaginal candidiasis in women receiving maintenance antifungal therapy: results of a prospective cohort study. Am J Obstet Gynecol. 2004; 190: 644-653. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15041994
  20. Janković S, Bojović D, Vukadinović D, Daglar E, Janković M, et al. Risk factors for recurrent vulvovaginal candidiasis. Vojnosanit Pregl. 2010; 67: 819-824. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21061843
  21. Amouri I, Sellami H, Borji N, Abbes S, Sellami A, et al. Epidemiological survey of vulvovaginal candidosis in Sfax, Tunisia. Mycoses. 2011; 54: e499-e505. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21039942
  22. Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, et al. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2016; 42: 905-927. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26690853
  23. Fang X, Zhou Y, Yang Y, Diao Y, Li H. Prevalence and risk factors of trichomoniasis, bacterial vaginosis, and candidiasis for married women of child-bearing age in rural shandong. Jpn J Infect Dis. 2007; 60: 257-261. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17881863
  24. Hellberg D, Zdolsek B, Nilsson S, Mårdh PA. Sexual behavior of women with repeated episodes of vulvovaginal candidiasis. Eur J Epidemiol. 1995; 11: 575-579. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8549733
  25. Segal E, Soroka A, Schechter A. Correlative relationship between adherence of Candida albicans to human vaginal epithelial cells in vitro and candidal vaginitis. Sabouraudia. 1984; 22: 191-200. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/6379915
  26. Aronoff DM, Hao Y, Chung J, Coleman N, Lewis C, et al. Misoprostol impairs female reproductive tract innate immunity against Clostridium sordellii. J Immunol. 2008; 180: 8222-8230. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18523288
  27. Ekpenyong CE, Inyang-etoh EC, Ettebong EO, Akpan UP, Ibu JO, et al. Recurrent vulvovaginal candidosis among young women in south eastern Nigeria: the role of lifestyle and health-care practices. Int J STD AIDS. 2012; 23: 704-709. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23104744
  28. Palacios S, Espadaler J, Fernández-Moya JM, Prieto C, Salas N. Is it possible to prevent recurrent vulvovaginitis? The role of Lactobacillus plantarum I1001 (CECT7504). Eur J Clin Microbiol Infect Dis. 2016; 36: 1701-1708. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27393491
  29. Farage M, Bramante M, Otaka Y, Sobel J. Do panty liners promote vulvovaginal candidiasis or urinary tract infections: A review of the scientific evidence. Eur J Obstet Gynecol Reprod Biol. 2007; 132: 8-19. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17204360

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