Fungal vaginal infections/colonisations can be divided into a symptomatic vaginal candidiasis and an asymptomatic vaginal Candida-carriage.  The latter seems to be a predisposing factor for the development of a symptomatic vaginal candidiasis.  The fungal organism isolated most frequently is Candida albicans, followed by Candida glabrata,  which was previously also known as Torulopsis glabrata. To a lower extend, other Candida species such as Candida tropicalis and Candida krusei can be prevalent in the vulvovaginal region. Predisposing factors for vaginal candidiasis are pregnancy,  diabetes mellitus or a therapy with immunosuppressive agents.

Also gestagenes showed to be a pre-disposing factor for vaginal candidiasis^(1,2).  Divergent results concerning the predisposition to vaginal candidiasis or colonisation due to oral contraception have so far been reported. A study was undertaken to assess whether the vaginal flora was affected by the method of contraception considering two groups of female health volunteers (n = 2 x 60) who taking different oral contraceptives. Overall, in 17% of the subjects (20/120)  yeast could be cultured out of the vaginal secretions.

There was no evidence for a higher rate of Candida-colonisation in subjects taking oral contraceptives. Further, there was no evidence for a relationship between the duration of the oral contraceptives use and the rate of vaginal yeast-carriage. Also the type of oral contraceptive (combination or sequential contraceptive)  had no influence on the frequency of Candida-carriage.  Candida albicans was the most prevalent yeast (16/20),  followed by Candida glabrata (4/20)  ⁽¹⁾.

One thousand and two consecutive vaginal or cervical swabs from women attending a family planning centre were cultured. Candida albicans was isolated from 13% of women using no contraception,  16%  using oral contraceptives,  and from 9%,  19%  and 18%  of those using diaphragms,  intrauterine contraceptive devices (IUD)  and condoms, respectively.  These differences were not statistically significant⁽³⁾.

Women using the IUD had significantly more Gram-positive cocci cultured than women in any other group,  while those using diaphragms had significantly more Gram-negative bacilli. The clinical impression that the use of oral contraceptives led to an increase in vaginal candidiasis, was not confirmed by this study ⁽⁴⁾.

To evaluate risk factors, related to sociodemographic and clinical variables,  oral contraception and sexual behavior of women with recurrent vulvovaginal candidiasis, researchers in Italy compared data on 153 patients with recurrent vulvovaginal candidiasis with data on 306 asymptomatic patients (control group A)  and data on 306 patients with nonrecurrent symptomatic vulvovaginal candidiasis (control group B). 

Women with recurrent Candida vaginitis were more likely than asymptomatic women to have previously used any contraceptive method (odds ratio OR= 2.08 for the pill, p = 0.0032; OR = 4.15 for the IUD, p = 0.0019; OR = 2.55 for barrier methods, p = 0.014). They were also more likely to have used antibiotics, in the last month before the visit (OR = 2.1; p = 0.009), and to have more lifetime sexual partners than asymptomatic women (OR = 3.82 for 7 partners; p = 0.009). Patients with recurrent vulvovaginal candidiasis were more likely than those with nonrecurrent vulvovaginal candidiasis to have used low-dose oral contraceptives (OCs) (OR = 1.59; p = 0.036) and to have a higher rate of monthly intercourse in the last 6 months (OR =  2.51 for 10 times;  p =  0.048).  The attributable risk of hormonal contraceptives (HCs)  use for recurrent vulvovaginal candidiasis was insignificant (11-12%).  However,  these results can suggest that HCs may influence the recurrence of symptomatic vulvovaginal candidiasis (5).

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Rosa Sabatini and Raffele Cagiano
Department of Obstetrics and Gynecology
Department of Pharmacology General Hospital Policlinico-University of Bari, Italy
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REFERENCES

1.   Bernardini U.D., Pini Prato G. (1969). Vulvovaginitis and stamatitis caused by   Candida   albicans   and   stellatoidea   during   administration   of   oral contraceptives. Riv. Ital. Stomatol, 24(10), 1045-52. 
2.   Klinger G.,  Tiller F.W.,  Klinger G.  (1982).  Oral and vaginal Candida colonization under the influence of hormonal contraception.  Zahn. Mund. Kieferheilkd, 70(2),120-5. 
3.   Schmidt A.,  Noldechen C.F.,  Mendling W.,  Hatzmann W.,  Wolf M.H. (1997). Oral contraceptive use and vaginal candida colonization. Zentralbl Gynakol, 119(11), 545-9.
4.   Peddie B.A.,  Bishop V.,  Bailey R.R.,  McGill H.  (1984).  Relationship between   contraceptive   method   and   vaginal   flora.  Aust.N.  Z.  J. Obstet. Gynaecol.
5.   Spinillo A.,  Capuzzo E.,  Nicola S.,  Baltaro F.,  Ferrari A.,  Monaco A. (1995).  The impact of oral contraception on vulvovaginal candidiasis. Contraception, May, 51(5), 293-7