Study of Glucose Tolerance Test and Some Risk Factors in Recurrent Vulvovaginal Candidiasis

Document Type : Original Article

Authors

1 Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Islamic Azad University, Mashhad, Iran.

2 Assistant Professor of Internal Medicine, Faculty of Medicine, Islamic Azad University, Mashhad, Iran.

3 MD., Faculty of Medicine, Islamic Azad University, Mashhad, Iran.

Abstract

Introduction: More than 75% of females would have at least one episode of vulvovaginal candidiasis (VVC)during their life while half of these patients would be affected for the second time but less than 5% of cases evolves into recurrent or chronic vulvovaginal candidiasis (RVVC or CVVC) with failure of our therapeutic interventions .
 
One cause of recurrent VVC is hyperglycemia .The aim of this study was assessment of the correlation between RVVC and impaired glucose metabolism and other risk factors of recurrent VVC such as BMI, parity in non diabetic fertile women.
 
Methods: This case-control study enrolled30 non diabetic women in reproductive age with recurrent VVC (study group) and 20 non diabetic women with normal vaginal examinations (control group). FBS, OGTT (blood glucose level 2 hours after 75gr glucose load) and HbAlc were measured in all cases and other risk factors were evaluated by a questionnaire.Based on the lab data 10 patients in the study group were diabetic and were excluded from the study. Case and control groups were compared by T test, Chi square and Fischer exact tests.
 
Results: OGTT results were impaired in 25% of patients in the study group while 0% of control group showed abnormal OGTT. (P=0.047). FBS was abnormal (ranged between 110 mgldl to 125 mg/dl) in 15% of patients in study group patients while none of women in the control group had abnormal FBS (P=0.231). HbAlc level in recurrent VVC patients was significantly higher than control group (P=0.007). BMI more than 25 was also more common in the study group compared with control group (P=0.004). The numbers of parity, gravity, the history of diets enriched with sweets were also more common in case group. (P=0.001, P=0.004).
 
Conclusion: The results of the present study show that OGTT in addition to FBS is useful in the workup of patients with recurrent vulvovaginal candidiasis.

Keywords

References

1. Eschenbach.DA. Pelvic infections and sexually transmitted diseases.In: Scot JR., Gibbs
RS, Karlan Beth Y. Haney A. Danforth's obstetric and gynecology. 9th ed.
Philadelphia:Lippincott Williams and Wilkins;2003:P.585-7.
2. Markusen. Tricia E, Barclay DL. Benign disorders of the vulva & vagina.In:
Decherney AH, Nathan L. Current obstetric & gynecologic diagnosis & treatment. 9th
ed. New York:McGraw-Hill;2003: P.652-4.
3. Soper DE. Genitourinary infections and sexually transmited diseases. In: Berek JS.
Novak's gynecology. 13th ed. Philadelphia:Lippincott Williams and
Wilkins;2002:P.456-8.
4. Management of genital candidiasis. Working Group of the British Society for Medical
Mycology. BMJ 1995 May 13;310(6989):1241-4.
5. Lanchares JL, Hernández ML. Recurrent vaginal candidiasis changes in
etiopathological patterns. Int J Gynaecol Obstet 2000 Dec;71 Suppl 1:S29-35.
6. Ringdahl EN. Treatment of Recurrent vulvovaginal candidiasis. Am Fam Physician
2000 Jun 1;61(11):3306-12, 3317.
7. Chaim W, Foxman B, Sobel JD. Association of recurrent vaginal candidiasis and
secretory ABO and Lewis phenotype. J Infect Dis 1997 Sep;176(3):828-30.
8. Nawrot U, Grzybek-Hryncewicz K, Zielska U, Czarny A, Podwińska J. The study of
cell-mediated immune response in recurrent vulvovaginal candidiasis. FEMS Immunol
Med Microbiol 2000 Oct;29(2):89-94.
9. Mårdh PA, Novikova N, Stukalova E. Colonisation of extragenital sites by Candida in
women with recurrent vulvovaginal candidosis. BJOG 2003 Oct;110(10):934-7.
10. Ferrer J. Vaginal candidiasis: epidemiological and etiological factors. Int J Gynecol
Obstet 2000;71:521-7.
11. Fidel PL Jr, Ginsburg KA, Cutright JL, Wolf NA, Leaman D, Dunlap K, et al. Vaginalassociated
immunity in women with recurrent vulvovaginal candidiasis: Evidence for
vaginal Th-1-type responses following intravagmal challenge with Candida antigen. J
Infect Dis 1997;176(3)728-39.
12. Reinhart H, Muller G, Sobel JD. Specificity and mechanism of in vitro adherence of
Candida albicans. Ann Clin Lab Sci 1985 Sep-Oct;15(5):406-13.
13. Samaranayake LP, MacFarlane TW. The effect of dietary carbohydrates on the in-vitro
adhesion of Candida albicans to epithelial cells. J Med Microbiol 1982 Nov;15(4):511-7.
14. Bohannon NJ. Treatment of vulvovaginal candidiasis in patients with diabetes. Diabetes
Care 1998 Mar;21(3):451-6.
15. Goswami R, Dadhwal V, Tejaswi S, Datta K, Paul A, Haricharan RN, et al. Speciesspecific
prevalence of vaginal candidiasis among patients with diabetes mellitus and its
relation to their glycaemic status. J Infect. 2000 Sep;41(2):162-6.
16. Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J
Obstet Gynecol 1985 Aug 1;152(7 Pt 2):924-35.
17. Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. Vulvovaginal
candidiasis: epidemiologic, diagnostic, and therapeutic considerationsAm J Obstet
Gynecol. 1998 Feb;178(2):203-11.
18. Odds, FC. Candida and candidiasis: a review and bibliography. 2nd
ed.
London:Baillière Tindall;1988:95-9.
 
19. Morton RS, Rashid S. Candidal vaginitis: natural history, predisposing factors and
prevention. Proc R Soc Med 1977;70 Suppl 4:3-6.
20. Donders GG, Prenen H, Verbeke G, Reybrouck R. Impaired tolerance for glucose in
women with recurrent vaginal candidiasis. Am J Obstet Gynecol. 2002 Oct;187(4):989-93.
21. Reed BD. Risk factors for Candida vulvovaginitis. Obstet Gynecol. Surv 1992;47:551-60.
22. Rahman T, Khan IH, Begum J. High vaginal swab, routine microscopy and culture
sensitivity in diabetic and non diabetic, a comparative retrospective study of five years.
Indian J Med Sci 1991;45:212-4.
23. Yang HX, Zhang MH, Sun WJ, Zhao Y. A prospective study of risk factors in pregnant
women with abnormal glucose metabolism. Zhonghua Fu Chan Ke Za Zhi 2005 Nov;
40(11): 725-8.
24. Reinhart H, Muller G, Sobel JD. Specificity and mechanism of in vitro adherence of
Candida albicans. Ann Clin Lab Sci 1985;15:406-12.
25. Samaranayake LP, MacFarlane TW. The effect of dietary carbohydrates on the in-vitro
adhesion of Candida albicans to epithelial cells. J Med Microbiol 1982;15:511-
26. Vexiau-Robert D. Vulvo-vaginite candidiasique récidivante. Réf Gynécol Obstet
1995;3:333–40.
27. Ehrström S, Yu A, Rylander E. Glucose in vaginal secretions before and after oral
glucose tolerance testing in women with and without recurrent vulvovaginal
candidiasis. Obstet Gynecol. 2006 Dec;108(6):1432-7.
28. Rowe BR, Logan MN, Farrell I, Barnett AH. Is candidiasis the true cause of
vulvovaginal irritation in women with diabetes mellitus?. J Clin Pathol 1990;43:644-5.
29. Horowitch B. Yeast vulvovaginitis: it is not simple anymore. Proc 5th Ann Meet Int
Infect Dis Soc Obstet Gynecol; 2000 May20-21; San Francisco, Calif..
30. Gibb D, Hockey S, Brown L, Lunt H. Vaginal symptoms and insulin dependent
diabetes mellitus. N Z Med J 1995 Jun 28;108(1002):252-3.
31. Horowitz BJ, Edelstein SW, Lippman L. Sugar chromatography studies in recurrent
Candida vulvovaginitis. J Reprod Med 1984 Jul;29(7):441-3. 

Files

Share

How to cite

Statistics