Effect of Antibiotics on Vulvovaginal Candidiasis: A MetroNet Study
Effect of Antibiotics on Vulvovaginal Candidiasis: A MetroNet Study
Purpose: Vulvovaginal candidiasis (VVC) is believed common after systemic antibiotic therapy, yet few studies demonstrate this association. In this pilot study, we evaluate the effect of short-course oral antibiotic use on VVC.
Methods: Nonpregnant women aged 18 to 64 years who required ≥3 days oral antibiotics for nongynecological diseases were recruited from a family medicine office. Age-matched (±5 years) women seen in the same clinic for noninfectious problems were recruited as controls. The main outcomes are incidence of symptomatic VVC and prevalence of positive vaginal Candida culture 4 to 6 weeks after antibiotics.
Results: Eighty (44 in antibiotic group) women were recruited; 14 of 79 (95% CI, 0.11-0.28) had asymptomatic vaginal Candida cultures positive at baseline. During follow-up, 10 of 27 (95% CI, 0.22-0.56) women in antibiotic group were Candida culture positive. In contrast, 3 of 27 (95% CI, 0.04-0.28) women in the control group were Candida culture positive (relative risk, 3.33; P =.03). Meanwhile, 6 of 27 (95% CI, 0.11-0.41) women in antibiotic group developed symptomatic VVC whereas none (95% CI, 0-0.12) of the women in the control group developed vaginal symptoms (relative risk, ∞; P =.02). Baseline Candida culture did not predict subsequent symptomatic VVC after antibiotics.
Conclusion: In this pilot study, the use of short courses of oral antibiotics seems to increase prevalence of asymptomatic vaginal Candida colonization and incidence of symptomatic VVC. Larger cohort studies are needed to confirm these findings.
Although vulvovaginal candidiasis (VVC) is one of the most common forms of vaginitis in women of childbearing age, its etiology remains poorly understood. Approximately 13 million cases are reported annually in the United States, prompting 10 million gynecologic office visits, and the frequency continues to increase. Although the widespread use of antibiotics has been suggested as one of the major factors contributing to the rising incidence of VVC, the evidence supporting this hypothesis has been limited. Most existing studies have been limited by their retrospective nature,lack of control groups, and lack of mycology culture data.
Accordingly, existing data on the risk of developing antibiotic-associated VVC are conflicting. For example, some case-control studies found no evidence of an association between antibiotic agents and symptomatic VCC, whereas others reached an opposite conclusion. The results from a prospective study of 250 pregnant women concluded that extensive antibiotic use posed little risk for the development of yeast infection.
In addition to antibiotics, other hypothesized risk factors for VVC include pregnancy; a history of VVC; sexual practices (especially receptive oral sex); oral hormones, either contraceptive or replacement therapy; diabetes mellitus and other immunodeficiency states; and African American ethnicity. However, definitive evidence relating each of these factors is limited. Epidemiologic studies have failed to measure the true attack rate and have been unable to specifically identify characteristics of the at-risk subpopulation. In addition, there has been little progress in understanding pathogenesis of antibiotic-associated VVC. There is a critical need for high quality, well-controlled clinical studies investigating the relationship between antibiotic use and the development of VVC.
We designed a prospective cohort study of nonpregnant adult women treated with a short course of oral antibiotics for a range of nongynecological infections to determine the incidence of VVC over the first 4 to 6 weeks after antibiotic therapy and explore the risk factors of antibiotic-associated VVC. The specific aims of this pilot study were to (1) evaluate the feasibility of the methods to be used in a later larger study and (2) estimate the incidence of symptomatic VVC and prevalence of Candida colonization after a short course of antibiotics.
Abstract and Introduction
Abstract
Purpose: Vulvovaginal candidiasis (VVC) is believed common after systemic antibiotic therapy, yet few studies demonstrate this association. In this pilot study, we evaluate the effect of short-course oral antibiotic use on VVC.
Methods: Nonpregnant women aged 18 to 64 years who required ≥3 days oral antibiotics for nongynecological diseases were recruited from a family medicine office. Age-matched (±5 years) women seen in the same clinic for noninfectious problems were recruited as controls. The main outcomes are incidence of symptomatic VVC and prevalence of positive vaginal Candida culture 4 to 6 weeks after antibiotics.
Results: Eighty (44 in antibiotic group) women were recruited; 14 of 79 (95% CI, 0.11-0.28) had asymptomatic vaginal Candida cultures positive at baseline. During follow-up, 10 of 27 (95% CI, 0.22-0.56) women in antibiotic group were Candida culture positive. In contrast, 3 of 27 (95% CI, 0.04-0.28) women in the control group were Candida culture positive (relative risk, 3.33; P =.03). Meanwhile, 6 of 27 (95% CI, 0.11-0.41) women in antibiotic group developed symptomatic VVC whereas none (95% CI, 0-0.12) of the women in the control group developed vaginal symptoms (relative risk, ∞; P =.02). Baseline Candida culture did not predict subsequent symptomatic VVC after antibiotics.
Conclusion: In this pilot study, the use of short courses of oral antibiotics seems to increase prevalence of asymptomatic vaginal Candida colonization and incidence of symptomatic VVC. Larger cohort studies are needed to confirm these findings.
Introduction
Although vulvovaginal candidiasis (VVC) is one of the most common forms of vaginitis in women of childbearing age, its etiology remains poorly understood. Approximately 13 million cases are reported annually in the United States, prompting 10 million gynecologic office visits, and the frequency continues to increase. Although the widespread use of antibiotics has been suggested as one of the major factors contributing to the rising incidence of VVC, the evidence supporting this hypothesis has been limited. Most existing studies have been limited by their retrospective nature,lack of control groups, and lack of mycology culture data.
Accordingly, existing data on the risk of developing antibiotic-associated VVC are conflicting. For example, some case-control studies found no evidence of an association between antibiotic agents and symptomatic VCC, whereas others reached an opposite conclusion. The results from a prospective study of 250 pregnant women concluded that extensive antibiotic use posed little risk for the development of yeast infection.
In addition to antibiotics, other hypothesized risk factors for VVC include pregnancy; a history of VVC; sexual practices (especially receptive oral sex); oral hormones, either contraceptive or replacement therapy; diabetes mellitus and other immunodeficiency states; and African American ethnicity. However, definitive evidence relating each of these factors is limited. Epidemiologic studies have failed to measure the true attack rate and have been unable to specifically identify characteristics of the at-risk subpopulation. In addition, there has been little progress in understanding pathogenesis of antibiotic-associated VVC. There is a critical need for high quality, well-controlled clinical studies investigating the relationship between antibiotic use and the development of VVC.
We designed a prospective cohort study of nonpregnant adult women treated with a short course of oral antibiotics for a range of nongynecological infections to determine the incidence of VVC over the first 4 to 6 weeks after antibiotic therapy and explore the risk factors of antibiotic-associated VVC. The specific aims of this pilot study were to (1) evaluate the feasibility of the methods to be used in a later larger study and (2) estimate the incidence of symptomatic VVC and prevalence of Candida colonization after a short course of antibiotics.
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