Pathogenicity of non-albicans yeasts in the vagina.

OBJECTIVE: It is hypothesized that vaginal non-albicans yeasts (NAYs) do not require treatment. The objective was to determine whether women (presenting with a range of vulvovaginal complaints) found to be harboring NAY, which is left untreated (no antifungals), have similar clinical outcomes to women with comparable presentations but who do not harbor NAY. DESIGN: This is a case-control study design comparing patient outcomes between women with untreated non-albicans Candida on vaginal swab cultures and those who were swab culture-negative. SETTING: A Melbourne metropolitan, private gynecologic and obstetric practice. POPULATION: Women presenting with vulvovaginal symptoms or management of pregnancy, who attended the above practice between 2001 and 2006. METHODS: Fifty-two women were found to have NAY on culture of their vaginal swabs. They were prospectively studied to determine the effect of leaving the NAY untreated (no antifungals) but with appropriate attention to their other diagnoses. Seventy-eight symptomatic women with negative swab cultures were used as the comparison group, and descriptive statistics was computed to compare patient outcomes between the groups. A subanalysis was also carried out, only looking at women who presented with pruritus. MAIN OUTCOME MEASURE: Proportion of patients self-reporting improvement in symptoms. RESULTS: Of the 44 women with NAY who presented with symptoms, 86% reported experiencing improvement. Approximately 77% of the women in the comparative group reported improvement. CONCLUSIONS: Non-albicans yeasts found on culture of a vaginal swab can probably be ignored. The clinician's efforts should be concentrated on making a correct diagnosis without assuming that NAY are pathogenic.

Cytology in the differential diagnosis of vaginitis.

Vaginal discharge, vulvar pruritus, and dyspareunia are among the most common symptoms that prompt women to seek medical advice. They are frequently assumed to be due to vaginitis resulting from infection and are treated with anti-infective agents without further investigation. Such empirical treatment may be successful, but on the frequent occasions when such treatment is inappropriate, the stage is set for deteriorating genital health. I believe that most cases of "vulvodynia" could be prevented by a correct diagnosis and treatment at the onset of symptoms.