Post-menopausal recurrent vaginal candidiasis: effect of hysterectomy on response to treatment, type of colonization and recurrence rates post-treatment
Introduction
It has been estimated that by the age of 60 years, in the United States, 33% of women will have undergone a hysterectomy and 85% of those procedures will have been done for benign conditions [1]. Other developed countries share similar statistics.
Post-menopausal patients are still susceptible to be colonized by fungal organisms despite being estrogen-deprived [2]. Sexually transmitted diseases and candidiasis are frequently diagnosed in hysterectomized patients [3].
Symptomatic vulvovaginal candidiasis is a rare occurrence in post-menopausal patients because of the estrogen-dependence of this infection; nevertheless it can be diagnosed in about one third of such patients [4] and can become recurrent in some instances [5].
Findings in post-menopausal women support the importance of hormonal support, PH and glycogen content in vaginal colonization. The purpose of our study was to determine in post-menopausal patients with recurrent vulvovaginal candidiasis the effect of hysterectomy on response to treatment, the type of colonization and the recurrence rates after treatment.
Section snippets
Materials and methods
A cohort of 47 post-menopausal patients with symptomatic recurrent vulvovaginal fungal colonization were evaluated between January 1995 and August 2002. The setting was a private clinic specializing in vulvovaginal conditions (Table 1).
The study was a retrospective cohort medical record review.
The patients were selected based on being post-menopausal (1 year without menstrual bleeding and FSH level > 40 μl), having a chronic vulvovaginal condition (more than three recurrent positive cultures for
Results
The two groups were comparable regarding age (Hysterectomized = 62.5 years, Non-hysterectomized = 62.7 years), number of years of chronic infection (Hysterectomized = 3.9, Non-hysterectomized = 4.0), number of previous topical/systemic antifungals (Hysterectomized = 4.3, Non-hysterectomized = 4.2), previous use of hormone replacement therapy (Hysterectomized = 63%, Non-hysterectomized = 64%), current use of hormone replacement therapy (Hysterectomized = 13%, Non-hysterectomized = 12%). The 2
Discussion
The life cycle of the yeast Candida is characterized by rapid budding, maturation and degeneration. Attachment to the epithelial cells and subsequent formation of pseudohyphae are important for vaginal colonization. Some by-products of fungal metabolism, such as alcohol, may trigger the symptoms associated with vulvovaginal candidiasis. Women with a history of recurrent vulvovaginal candidiasis have more easily detectable Candida in their vagina, even when asymptomatic, than do other women [6].
Conclusion
Hysterectomized menopausal patients with recurrent vulvovaginal fungal colonization seems to be more propense to harbor more aggressive and resistant fungi.
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