1887

Abstract

Recurrent vulvovaginal candidiasis (RVVC) is a microbial, immune and sexual health disorder impacting up to 10 % of the adult female population. Fluconazole is a well-established antifungal drug commonly utilized for acute and long-term RVVC treatment. This insight review provides an overview of known vaginal and gastrointestinal microbiota characteristics in RVVC, presents the potential impacts of fluconazole therapy on multi-microbiome relationships and discusses implications for future research and clinical practice. Next-generation sequencing (NGS) and molecular methods to accurately define vaginal microbiota trends in RVVC are not comprehensively available, limiting understanding of microbiota roles in RVVC. Inconsistencies and variances in profiles in RVVC women suggest poorly understood disease implications on the bacterial and fungal microbiomes. Investigations of environmental conditions like vaginal pH, drug therapy’s impact, especially fluconazole maintenance therapy, and the elucidation of multi-microbiome relationships in RVVC are required to further investigate disease pathogenesis and responsible antimicrobial prescribing.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
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2023-05-12
2024-05-05
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References

  1. Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 2018; 18:e339–e347 [View Article] [PubMed]
    [Google Scholar]
  2. de Cássia Orlandi Sardi J, Silva DR, Anibal PC, de Campos Baldin JJCM, Ramalho SR et al. Vulvovaginal candidiasis: epidemiology and risk factors, pathogenesis, resistance, and new therapeutic options. Curr Fungal Infect Rep 2021; 15:32–40 [View Article]
    [Google Scholar]
  3. Bernstein JA, Seidu L. Chronic vulvovaginal Candida hypersensitivity: an underrecognized and undertreated disorder by allergists. Allergy Rhinol 2015; 6:44–49 [View Article] [PubMed]
    [Google Scholar]
  4. Rosa MI, Silva BR, Pires PS, Silva FR, Silva NC et al. Weekly fluconazole therapy for recurrent vulvovaginal candidiasis: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 167:132–136 [View Article] [PubMed]
    [Google Scholar]
  5. Collins LM, Moore R, Sobel JD. Prognosis and long-term outcome of women with idiopathic recurrent vulvovaginal candidiasis caused by Candida albicans. J Low Genit Tract Dis 2020; 24:48–52 [View Article]
    [Google Scholar]
  6. Bradfield Strydom M, Walpola RL, McMillan S, Khan S, Ware RS et al. Lived experience of medical management in recurrent vulvovaginal candidiasis: a qualitative study of an uncertain journey. BMC Womens Health 2022; 22:384 [View Article] [PubMed]
    [Google Scholar]
  7. Zimmermann M, Patil KR, Typas A, Maier L. Towards a mechanistic understanding of reciprocal drug-microbiome interactions. Mol Syst Biol 2021; 17:e10116 [View Article] [PubMed]
    [Google Scholar]
  8. Smidt I, Kiiker R, Oopkaup H, Lapp E, Rööp T et al. Comparison of detection methods for vaginal lactobacilli. Benef Microbes 2015; 6:747–751 [View Article] [PubMed]
    [Google Scholar]
  9. Bradfield Strydom M, Walpola RL, Khan S, Ware RS, Tiralongo E. Evidence-based update on Australasian pharmaceutical prescribing approaches for recurrent vulvovaginal candidiasis. Aust N Z J Obstet Gynaecol 2021; 61:496–499 [View Article] [PubMed]
    [Google Scholar]
  10. Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SSK et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci 2011; 108:4680–4687 [View Article]
    [Google Scholar]
  11. Tachedjian G, Aldunate M, Bradshaw CS, Cone RA. The role of lactic acid production by probiotic Lactobacillus species in vaginal health. Res Microbiol 2017; 168:782–792 [View Article] [PubMed]
    [Google Scholar]
  12. Zhou X, Westman R, Hickey R, Hansmann MA, Kennedy C et al. Vaginal microbiota of women with frequent vulvovaginal candidiasis. Infect Immun 2009; 77:4130–4135 [View Article] [PubMed]
    [Google Scholar]
  13. Donders GG, Grinceviciene S, Ruban K, Bellen G. Vaginal pH and microbiota during fluconazole maintenance treatment for recurrent vulvovaginal candidosis (RVVC). Diagn Microbiol Infect Dis 2020; 97:115024 [View Article] [PubMed]
    [Google Scholar]
  14. Akimoto-Gunther L, Bonfim-Mendonça P de S, Takahachi G, Irie MMT, Miyamoto S et al. Highlights regarding host predisposing factors to recurrent vulvovaginal candidiasis: chronic stress and reduced antioxidant capacity. PLoS One 2016; 11:e0158870 [View Article] [PubMed]
    [Google Scholar]
  15. Liu M-B, Xu S-R, He Y, Deng G-H, Sheng H-F et al. Diverse vaginal microbiomes in reproductive-age women with vulvovaginal candidiasis. PLoS One 2013; 8:e79812 [View Article] [PubMed]
    [Google Scholar]
  16. Jian S, M-j SU. Features of vaginal bacteria community in women with recurrent vulvovaginal candidiasis. J Rep Con 2015; 26:229–238
    [Google Scholar]
  17. McClelland RS, Richardson BA, Hassan WM, Graham SM, Kiarie J et al. Prospective study of vaginal bacterial flora and other risk factors for vulvovaginal candidiasis. J Infect Dis 2009; 199:1883–1890 [View Article] [PubMed]
    [Google Scholar]
  18. Tortelli BA, Lewis WG, Allsworth JE, Member-Meneh N, Foster LR et al. Associations between the vaginal microbiome and Candida colonization in women of reproductive age. Am J Obstet Gynecol 2020; 222:471 [View Article] [PubMed]
    [Google Scholar]
  19. Fine RL, Mubiru DL, Kriegel MA. Friend or foe? Lactobacillus in the context of autoimmune disease. Adv Immunol 2020; 146:29–56 [View Article] [PubMed]
    [Google Scholar]
  20. Petrova MI, Reid G, Vaneechoutte M, Lebeer S. Lactobacillus iners : Friend or Foe?. Trends Microbiol 2017; 25:182–191 [View Article]
    [Google Scholar]
  21. Novak J, Ravel J, Ma B, Ferreira CST, Tristão A da R et al. Characteristics associated with Lactobacillus iners-dominated vaginal microbiota. Sex Transm Infect 2022; 98:353–359 [View Article] [PubMed]
    [Google Scholar]
  22. Witherden EA, Shoaie S, Hall RA, Moyes DL. The human mucosal mycobiome and fungal community interactions. J Fungi 2017; 3:56 [View Article] [PubMed]
    [Google Scholar]
  23. Ameen F, Moslem M, Al Tami M, Al-Ajlan H, Al-Qahtani N. Identification of Candida species in vaginal flora using conventional and molecular methods. J Mycol Med 2017; 27:364–368 [View Article] [PubMed]
    [Google Scholar]
  24. Zheng N-N, Guo X-C, Lv W, Chen X-X, Feng G-F. Characterization of the vaginal fungal flora in pregnant diabetic women by 18S rRNA sequencing. Eur J Clin Microbiol Infect Dis 2013; 32:1031–1040 [View Article]
    [Google Scholar]
  25. Bradford LL, Ravel J. The vaginal mycobiome: a contemporary perspective on fungi in women’s health and diseases. Virulence 2017; 8:342–351 [View Article] [PubMed]
    [Google Scholar]
  26. Drell T, Lillsaar T, Tummeleht L, Simm J, Aaspõllu A et al. Characterization of the vaginal micro- and mycobiome in asymptomatic reproductive-age Estonian women. PLoS One 2013; 8:e54379 [View Article] [PubMed]
    [Google Scholar]
  27. McKloud E, Delaney C, Sherry L, Kean R, Williams S et al. Recurrent vulvovaginal candidiasis: a dynamic interkingdom biofilm disease of Candida and Lactobacillus. mSystems 2021; 6:e00622–00621
    [Google Scholar]
  28. Brown SE, Schwartz JA, Robinson CK, OʼHanlon DE, Bradford LL et al. The vaginal microbiota and behavioral factors associated with genital Candida albicans detection in reproductive-age women. Sex Transm Dis 2019; 46:753–758 [View Article] [PubMed]
    [Google Scholar]
  29. Guo R, Zheng N, Lu H, Yin H, Yao J et al. Increased diversity of fungal flora in the vagina of patients with recurrent vaginal candidiasis and allergic rhinitis. Microb Ecol 2012; 64:918–927 [View Article] [PubMed]
    [Google Scholar]
  30. Lehtoranta L, Hibberd AA, Yeung N, Laitila A, Maukonen J et al. Characterization of vaginal fungal communities in healthy women and women with bacterial vaginosis (BV); a pilot study. Microb Pathog 2021; 161:105055 [View Article] [PubMed]
    [Google Scholar]
  31. Baraniya D, Chen T, Nahar A, Alakwaa F, Hill J et al. Supragingival mycobiome and inter-kingdom interactions in dental caries. J Oral Microbiol 2020; 12:1729305 [View Article] [PubMed]
    [Google Scholar]
  32. Kalia N, Singh J, Kaur M. Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review. Ann Clin Microbiol Antimicrob 2020; 19:5 [View Article] [PubMed]
    [Google Scholar]
  33. Beigi RH, Meyn LA, Moore DM, Krohn MA, Hillier SL. Vaginal yeast colonization in nonpregnant women: a longitudinal study. Obst Gynecol 2004; 104:926–930 [View Article]
    [Google Scholar]
  34. Ceccarani C, Foschi C, Parolin C, D’Antuono A, Gaspari V et al. Diversity of vaginal microbiome and metabolome during genital infections. Sci Rep 2019; 9:14095 [View Article] [PubMed]
    [Google Scholar]
  35. Lourenço A, Pedro NA, Salazar SB, Mira NP. Effect of acetic acid and lactic acid at low pH in growth and azole resistance of Candida albicans and Candida glabrata. Front Microbiol 2018; 9:3265 [View Article] [PubMed]
    [Google Scholar]
  36. In Y-W, Kim J-J, Kim H-J, Oh S-W. Antimicrobial activities of acetic acid, citric acid and lactic acid against Shigella species. J Food Saf 2013; 33:79–85 [View Article]
    [Google Scholar]
  37. Peleg AY, Hogan DA, Mylonakis E. Medically important bacterial-fungal interactions. Nat Rev Microbiol 2010; 8:340–349 [View Article] [PubMed]
    [Google Scholar]
  38. Donders GGG, Grinceviciene S, Bellen G, Ruban K. Is multiple-site colonization with Candida spp. related to inadequate response to individualized fluconazole maintenance therapy in women with recurrent Candida vulvovaginitis?. Diagn Microbiol Infect Dis 2018; 92:226–229 [View Article] [PubMed]
    [Google Scholar]
  39. 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 [View Article] [PubMed]
    [Google Scholar]
  40. Pendharkar S, Brandsborg E, Hammarström L, Marcotte H, Larsson P-G. Vaginal colonisation by probiotic lactobacilli and clinical outcome in women conventionally treated for bacterial vaginosis and yeast infection. BMC Infect Dis 2015; 15:255 [View Article] [PubMed]
    [Google Scholar]
  41. Oerlemans EFM, Bellen G, Claes I, Henkens T, Allonsius CN et al. Impact of a lactobacilli-containing gel on vulvovaginal candidosis and the vaginal microbiome. Sci Rep 2020; 10:7976 [View Article] [PubMed]
    [Google Scholar]
  42. Donders G, Bellen G, Byttebier G, Verguts L, Hinoul P et al. Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial). Am J Obstet Gynecol 2008; 199:613 [View Article] [PubMed]
    [Google Scholar]
  43. Agnew KJ, Hillier SL. The effect of treatment regimens for vaginitis and cervicitis on vaginal colonization by lactobacilli. Sex Transm Dis 1995; 22:269–273 [View Article] [PubMed]
    [Google Scholar]
  44. Kaur H, Merchant M, Haque MM, Mande SS. Crosstalk between female gonadal hormones and vaginal microbiota across various phases of women’s gynecological lifecycle. Front Microbiol 2020; 11:551 [View Article] [PubMed]
    [Google Scholar]
  45. Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214:15–21 [View Article] [PubMed]
    [Google Scholar]
  46. Wang S, Wang Q, Yang E, Yan L, Li T et al. Antimicrobial compounds produced by vaginal Lactobacillus crispatus are able to strongly inhibit Candida albicans growth, hyphal formation and regulate virulence-related gene expressions. Front Microbiol 2017; 8:564 [View Article] [PubMed]
    [Google Scholar]
  47. Varma K, Kansal M. Cytolytic vaginosis: a brief review. J Skin Sex Transm Dis 2022; 4:206–210 [View Article]
    [Google Scholar]
  48. Yang S, Zhang Y, Liu Y, Wang J, Chen S et al. Clinical significance and characteristic clinical differences of cytolytic vaginosis in recurrent vulvovaginitis. Gynecol Obstet Invest 2017; 82:137–143 [View Article] [PubMed]
    [Google Scholar]
  49. Ventolini G, Gandhi K, Manales NJ, Garza J, Sanchez A et al. Challenging vaginal discharge, lactobacillosis and cytolytic vaginitis. J Family Reprod Health 2022; 16:102–105 [View Article] [PubMed]
    [Google Scholar]
  50. Heng X, Jiang Y, Chu W. Influence of fluconazole administration on gut microbiome, intestinal barrier, and immune response in mice. Antimicrob Agents Chemother 2021; 65:e02552–02520 [View Article]
    [Google Scholar]
  51. Shukla A, Sobel JD. Vulvovaginitis caused by Candida species following antibiotic exposure. Curr Infect Dis Rep 2019; 21:1–6 [View Article] [PubMed]
    [Google Scholar]
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