Solutions to manage vulvovaginal candidiasis (VVC) are necessary to improve quality of care, according to a recent review published in Frontiers in Cellular and Infection Microbiology.
Takeaways
- Vulvovaginal candidiasis (VVC) management solutions are essential to improve the quality of care, as indicated in a recent review published in Frontiers in Cellular and Infection Microbiology.
- The human vaginal microbiota is a complex ecosystem with billions of microorganisms, making it an important area of research due to its potential impact on women's health.
- Candida albicans is the primary pathogen causing VVC, but there is evidence of increasing cases of non-Candida albicans infections, prompting research into changes in the vaginal microbiome during VVC.
- Vaginal microbiota is primarily composed of various Lactobacillus species, with Lactobacillus crispatus being the dominant one in healthy individuals. Factors like hygiene, sexual habits, and socio-economic status can affect the vaginal microbiome.
- Lactobacillus plays a crucial role in maintaining vaginal health, and future research may explore how it can be used in the treatment of VVC, which is a common vaginal infection with increasing prevalence and economic burden.
Microbial flora in the human body has been significantly associated with effects in the intestine, but recent research has indicated functions in other organ systems. There are billions of species of microorganisms in the vagina, making vaginal microbiota an important topic of research.
Candida albicans has been found to be the primary pathogen causing VVC, an infectious disease in a woman’s lower reproductive tract. However, data has indicated rises in non-Candida albicans infection. Investigators conducted a review to describe changes in the vaginal microbiome during VVC.
There are 5 types of vaginal bacteria communities, 4 of which are mainly composed of Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, and Lactobacillus jensenii. The fifth community has a high proportion of strictly anaerobic organisms and a low proportion of Lactobacillus.
Lactobacillus are considered the most common organisms isolated from the vagina in healthy individuals and are often used to prevent pathogen invasions. Factors impacting the vaginal microbiome include flushing habits, menstrual hygiene habits, sexual habits, socioeconomic status, geography, community characteristics, psychosocial pressure, and other factors.
When the vaginal ecosystem balance is disrupted, a pathogen overgrowth may occur, leading to conditions such as VVC, bacterial vaginosis, and sexually transmitted infections. In VVC, the Candida is overgrown, causing inflammation. VVC has been reported at least in 75% of women, making it one of the most common infectious vaginitis.
While early studies indicated no significant changes in the vaginal microbiota during VVC infection, many have indicated differences in the vaginal microbiota of VVC patients compared to a normal population. A 1980 study cited in the investigation reported all microbiome, especially Gram-negative bacteria, increased when the prevalence of Candida albicans was reduced.
Data has indicated Lactobacillus crispatus is gradually replaced by Lactobacillus iners during VVC infection. As Lactobacillus is the dominant microflora in healthy vaginas, VVC risk may be reduced through vaginal colonization of Lactobacillus.
By excreting metabolic by-products and acidification of the vaginal microenvironment, Lactobacillus prevents pathogen overgrowth. Additionally, in vitro studies have found reduced adhesion and growth of Candida albicans from Lactobacillus strains. Future analysis will be needed to determine how Lactobacillus may be used to treat VVC.
Current treatments for VVC include prescriptions, oral doses, over-the-counter-topical preparations, and vaginal suppositories. However, VVC has an increased projected global prevalence and economic burden over the next decade. This highlights the need for further research on in vivo and in vitro treatment methods.
Reference
Sun Z, Ge X, Qiu B, et al. Vulvovaginal candidiasis and vaginal microflora interaction: Microflora changes and probiotic therapy. Front Cell Infect Microbiol. 2023;13:1123026. doi:10.3389/fcimb.2023.1123026
