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Vaginal yeast infection

Vaginal yeast infection, a common fungal infection of the vulva and vagina, seems to be more likely to occur if the balance of the vaginal microbiota is disrupted. Treatment is increasingly directed towards the use of probiotics.

Vaginal yeast infection (or vulvovaginal candidiasis) affects 70 to 75% of women at least once in their life.1 It is characterized by pruritus associated with burning sensation, erythema, and leukorrhea. 

Dysbiosis, a favorable environment for Candida to thrive

In the majority of cases (85 to 90%), vaginal yeast infection is caused by Candida albicans that is naturally present in the vaginal and intestinal microbiota. Following a dysbiosis, the balance of the vaginal flora is disrupted, and C. albicans proliferates abnormally, thus leading to the development of this disease.
This imbalance in the vaginal microbiota may arise from different sources; it can appear with antibiotic treatment or corticosteroids, pregnancy, immunosuppression, and even uncontrolled diabetes,2 although the mechanisms are not totally understood. 

Classic treatment and the potential use of probiotics 

The standard treatment for candidal vulvovagnitis is anti-fungal3,4,5 (azole and polyene derivatives), with a success rate of 80%. However, reoccurrences can happen and new therapeutic options are currently being evaluated including, promisingly, probiotics.6 Taken orally or topically (capsules or vaginal suppositories), probiotics may be able to rebalance the vaginal microbiota and reduce the frequency of recurrent Candida infections.7,8
 

Sources:
1. Sherrard J et al. 2011 European (IUSTI/WHO) guidelines on the management of vaginal discharge. Int J STD AIDS. 2011 Aug;22(8):421 https://www.ncbi.nlm.nih.gov/pubmed/21795415
2 – Mendling W. Guideline: vulvo-vaginal condidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candisosis).  Mycosis 2015; 58:1-15. http://onlinelibrary.wiley.com/doi/10.1111/myc.12292/abstract;jsessionid=069DDE60257C865FFF881D08496D0F19.f04t04 
3 - ACOG Practice Bulletin Number 72: Clinical Management Guidelines For Obstetricians & Gynecologists. Vaginitis. Obst Gyn 2006; 107(5):1195-1206. https://www.ncbi.nlm.nih.gov/pubmed/16648432
4 - Sherrard J et al. 2011 European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge. http://www.iusti.org/regions/europe/pdf/2011/Euro_Guidelines_Vaginal_Discharge_2011.Intl_Jrev.pdf
5 - Van Schalkwyk J et al. Vulvovaginitis: Screening for and Management of Trichomoniasis, Vulvovaginal Candidiasis, and Bacterial Vaginosis. J Obstet Gynaecol Can 2015;37(3):266–274. http://sogc.org/wp-content/uploads/2015/03/gui320CPG1504E.pdf
6 - Reid G et al. Microbiota restoration: natural and supplemented recovery of human microbial communities. Nat Rev Microbiol. 2011 Jan;9(1):27-38. doi: 10.1038/nrmicro2473. Epub 2010 Nov 29. https://www.ncbi.nlm.nih.gov/pubmed/21113182
7. Strus M et al.  Studies on the effects of probiotic Lactobacillus mixture given orally on vaginal and rectal colonization and on parameters of vaginal health in women with intermediate vaginal flora. Eur J Obstet Gynecol Reprod Biol 2012; 163: 210-15. http://www.ejog.org/article/S0301-2115(12)00194-7/abstract
8.  Vujic G et al. Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections:  a double-blind, randomized,  placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2013; 168: 75-9. http://www.ejog.org/article/S0301-2115(13)00013-4/abstract

 

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