A comparison of differenct extracts of Candida albicans in agar gel double diffusion techniques.

A preliminary comparative study, by 4 independent groups, of certain extracts of Candida albicans, showed variation in their antigenicity. Different agar gel double diffusion tests were used by each group; two groups used micro-methods and two used macro-methods. The number of positive precipitin reactions detected by these methods was shown to vary greatly.

Candida precipitins in pregnant women: validity of the test systems used.

Sera from 200 pregnant women, with symptoms suggestive of vaginitis and harbouring yeast in the vagina, were examined for precipitating antibodies to three antigens of C. albicans, using a gel double diffusion test. A high overall incidence of precipitin-positive sera (47.5%) was found compared with an incidence of 18% in the unselected pregnant population previously studied (Stanley, Hurley, and Carroll 1972). Using the clinicopathological criteria of Carroll, Hurley, and Stanley (1973), a final aetiological diagnosis of C. albicans mycosis was reached in 75 cases and precipitins were demonstrated in 64%. Forty-eight women harbouring C. albicans responded favourably to a single course of antifungal treatment, and probably had mycotic vaginitis. The incidence of precipitins in this group was 42%. C. albicans was isolated from a further 55 of 62 patients, in whom the incidence of precipitins was 32%.;Booking' sera were investigated from 50 of the 200 women studied. Sixty-four per cent of women had symptoms of vaginitis at booking and 32% were precipitin positive. Twenty-eight per cent had precipitins on both occasions, and a further 24% acquired candida precipitins during pregnancy. None of the seven newborn with oral or skin thrush had precipitins to C. albicans.The results indicate that the detection of precipitating antibodies to C. albicans, particularly to all three of the antigens described in this paper, would be a useful additional criterion in the diagnosis of candida vaginitis, particularly if the vaginitis were persistent, recurrent, or unresponsive to therapy. The sensitivity of the test system used was 64%, and its specificity 87%; as such, the test is valid and may be reasonably useful as a screening procedure.

Microbial flora of the lower genital tract during pregnancy: relationship to morbidity.

Nineteen genera and groups of micro-organisms were isolated from the lower genital tract of 280 women at their first antenatal visit. Chlamydia, viruses, and T-strain mycoplasmas were not sought, and only routine methods of anaerobic culture were used. Growth was recorded as scanty, moderate or heavy. The population studied was grouped according to age, parity, gestational stage at booking, presence and degree of severity of lower genital tract morbidity, past history of vulvovaginitis, and suspicion of lower genital tract morbidity as evidenced by a request for a report on the microbiological findings. The frequency of isolation of the various microbes in health and in disease is given. The grading of Gram-stained smears bore no relation to the isolation rates of lactobacilli, but there was a significant increase (p less than 0-001) in the isolation rates of each of the following: Mycoplasma hominis, Bacteroides spp., Trichomonas vaginalis, Gram-variable cocco-bacilli, and anaerobic streptococci in those patients with smears in which lactobacilli were adjudged to be absent. The isolation of faecal streptococci was increased (p less than 0-001) in women aged more than 34 years. Escherichia coli (p less than 0-05) and anaerobic and microaerophilic streptococci (p less than 0-02) were isolated more frequently from those booking after the 25th week of pregnancy. The incidence of M. hominis (p less than 0-02) and of anaerobic streptococci (p less than 0-05) increased between the first and third trimesters. No significance positive correlations were established between the isolation rates of the various microbes and objective assessment of lower genital tract morbidity or the demonstration of pus cells, but lactobacilli were isolated less frequently (p less than 0-01) from those with morbidity. The isolation of Candida albicans (p less than 0-02), T. vaginalis (p less than 0-05), and M. hominis (p less than 0.05) was increased in patients in whom vulvovaginitis was suspected, and that of T. vaginalis (p less than 0-05) was increased in those with a past history of vulvovaginitis. The study indicates that, other than the pathogens T. vaginalis and C. albicans, only M. Hominis could be suspected, on statistical grounds, of being associated with disease of the lower genital tract during early pregnancy.

Morbidity of the lower genital tract during pregnancy.

The lower genital tract of 280 pregnant women was studied in detail, and symptoms relevant to its morbidity were elicited and recorded. The study was contemporaneous with a study of microbial flora in the genital tract of these women (de Louvois et al, 1975). Complaint was made frequently of discharge (42%), irritation (15%), or both (11%). Apart from these symptoms, 14% admitted a past history of vulvovaginitis, emphasizing the importance of this condition in obstetric and gynaecological practice. The notorious discrepancy between the complaint, and the objective demonstration of discharge, was confirmed, but a significant difference in observations, varying with the clinical observer (P less than 0-001), was also demonstrated. This illustrates the necessity of even more accurate grading of signs when clinicopathological correlations are to be attempted. Only 30% of women had no evidence of vulvovaginitis or cervicitis. Morbidity did not relate to age, gestation or parity, but there was a significant correlation between clinical acumen, as evidenced by a request for a microbiological report with a view to treatment, and morbidity (P less than 0-001), between past vulvovaginitis and present morbidity (P less than 0-01), and between cervicitis and the presence of pus cells in the smear (P less than 0-001). The results indicate that microbiological investigations should be requested when there is past history of vulvovaginitis, and that lesions of the cervix, if not already noted, should be suspected if pus cells are demonstrable in stained smears.