| Vulvovaginal candidiasis(VVC),caused by Candida sp. or yeasts, is one of the common infectious disease of department of gynaecology. Recurrenct vulvovaginal candidiasis(RVVC) was defined as the presence of at least four documented episodes of candida vaginitis in the 12~month period preceding entry into the study. The situation, once had VVC, again confirmed attack, attack frequency of 1 year of less than 4 times, is called relapse of VVC. An estimated 75% of women will have at least one episode of VVC in their life time, and 40%~45% will have two or more episodes, About 5% ~10% of the VVC patients develop into RVVC. A growing number of older women remain at risk of VVC and RVVC as the result of hormone replacement therapy, especially vaginal topical use. Most women reported duration of RVVC to be 1~2 years although a substantial number had symptoms for 4 or 5 years and some very much longer, with risk and symptoms lasting decades. RVVC, by virtue of the frequent, numerous acute recurrences or chronicity has a profound effect on the quality of life of affected women with additional systemic symptoms including depression and anxiety. We face the great challenge of RVVC treatment. Objective:The objective of this study was to identify the risk factors associated with recurrence of vulvovaginal candidiasis(VVC),for instance, life habbits and the quantity of Lactobacillus. So as to recommend preventive measures of recurrenct vulvovaginal candidiasis( RVVC). Methods:In the first part of this study, a prospective case-control study was implemented from March 2010 to December 2015. A total of 282 women with the relapse of VVC and RVVC were enrolled as study participants. Controls were 652 women with sporadic VVC. All participants were asked to complete a standardized questionnaire, which covered sociodemographic factors,past history, personal history,childbearing history, fungus strains,etc. Univariate and multivariate logistic regression analysis were used for statistical evaluation. The strength of associations of these factors was analyzed using the odds ratio(OR) with 95% confidence interval(CI). A P-value less than 0.05 was considered statistically significant.The second part of this study was implemented from March 2010 to December 2015. Participants included 337 women with VVC for the first time and 23 women with RVVC. We take the method of directly observing vaginal gram staining smear by optical microscope to count lactobacillus. Lactobacillus count between the two groups were compared with Chi-squared test or Fisher's exact probability test. Results:In the first part of this study, according to univariate analysis, age of more than 30 years old(OR:1.435,95%CI:1.084~1.900,P=0.012), married status(OR:2.038,95%CI:1.403~2.962,P=0.000), having a history of genital tract inflammation(OR:14,377,95%CI:9.570~21.598,P=0.000), having a history of sexually transmitted disease(OR:1.966,95%CI:1.188~3.254,P=0.009), vaginal douching(OR:2.348,95%CI:1.697~3.248,P=0.000), anal sex(OR:1.206,95%CI:1.050~4.635,P=0.037)and having history of pregnancy(OR:1.360,95%CI:1.013~1.827,P=0.041)were risk factors for the recurrence of VVC. On the contrary, occasionally using pads besides menstrual period(OR:0.595,95%CI:0.405~0.875,P=0.008) and having history of intrauterine operation(OR:0.593,95%CI:0.434~0.812,P=0.001) were protective factors for the recurrence of VVC. In the multivariate analysis, married status(OR:2.378,95%CI:1.358~4.165,P=0.002), having a history of genital tract inflammation(OR:13.418,95%CI:8.027~22.428,P=0.000), vaginal douching(OR:2.058,95%CI:1.324~3.198,P=0.001), and anal sex(OR:3.476,95%CI:1.193~10.132,P=0.022)were independent risk factors for the recurrence of VVC. Having history of pregnancy(OR:0.546,95%CI:0.332~0.896,P=0.017)was the independent protective factor for the recurrence of VVC.In the second part of this study, lactobacillus count had no statistical difference between the VVC for the first time and RVVC groups in the age group from 20 to 30 years old(?2=2.021,P=0.155).In the same way, lactobacillus count had no statistical difference between the VVC for the first time and RVVC groups in the age group from 30 to 40 years old(?2=0.012,P=0.900), the age group from 40 to 50 years old(?2=1.709,P=0.243)and the age group of more than 50 years old(P=0.333).In the age group of less than 20 years old, we did not conduct statistical analysis because of too little study participants.Totally,lactobacillus count had no statistical difference between the VVC for the first time and RVVC groups in all age group(?2=2.144,P=0.143). Conclusions:(1) Married status, having a history of genital tract inflammation, vaginal douching, and anal sex were independent risk factors for the recurrence of VVC. Having history of pregnancy was the independent protective factor for the recurrence of VVC.Advocating healthy habits assists to reduce the recurrence of VVC.(2)Lactobacillus count was not a risk factor associated with the recurrence of VVC. We hope through the application of lactobacillus preparation, interfere with the fungal growth and breeding of the ecological environment, inhibits fungal proliferation, re-established vaginal microecological balance of the dominance of acid producing bacteria, effectively reduce the recurrence of VVC. |
PDF Full Text Request