Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes

BMC Infectious Diseases

Betsy Foxman²  Jack D Sobel¹  Scott J Jacober¹  Ella M de Leon² 

[1] Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA;Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA

关键词: Vaginitis;    Candida;    Diabetes;   

Others  :  1177168
DOI  :  10.1186/1471-2334-2-1

 received in 2001-11-06, accepted in 2002-01-30,  发布年份 2002

【 摘 要 】

Background

Diabetes mellitus increases the rate of vaginal colonization and infection with Candida species

Methods

We surveyed women with diabetes receiving care at either an urban or suburban diabetes clinic to examine the relationship between vaginal Candida colonization, diabetes type and duration, and HbA_1c level. 101 participants completed the self-administered questionnaire and self-collected a vaginal swab for Candida culture. Candida colonization was similar by age and race.

Results

Type 1 diabetics were three times as likely as type 2 diabetics to be colonized with any Candida species (OR = 3.4; 95% CI: 1.03, 11.41; p = 0.04); even after adjusting for abnormal HbA_1c, which had an independent effect (OR = 1.4; 95% CI: 1.04, 1.76; p = 0.02). Recent antibiotic use (OR = 4.5; 95% CI: 1.18, 16.79; p = 0.03), lifetime history of chlamydia (OR = 5.8; 95% CI: 1.09, 30.54; p = 0.04), and performing oral sex during the past 2 weeks (OR = 4.9; 95% CI:0.84, 28.27; p = 0.08) were also associated with Candida carriage after adjusting for diabetic type and abnormal HbA_1c. C. albicans was isolated from the majority of colonized type 1 participants (56%), while C. glabrata was the most common isolate among colonized type 2 participants (54%).

Conclusions

Improving glucose control and possibly modifying sexual behavior may reduce risk of Candida colonization, and potentially symptomatic infection, among women with diabetes.

【 授权许可】

   
2002 de Leon et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [1]Bohannon NJV: Treatment of vulvovaginal candidiasis in patients with diabetes. Diabetes Care 1998, 21:451-456.
• [2]McCormack WM, Starko KM, Zinner SH: Symptoms associated with vaginal colonization with yeast. Am J Obstet Gynecol 1988, 158:31-33.
• [3]Reed BD: Risk factors for Candida vulvovaginitis. Obstet Gynecol Surv 1992, 47:551-560.
• [4]Segal E, Soroka A, Schechter A: Correlative relationship between adherence of Candida albicans to human vaginal epithelial cells in vitro and candidal vaginitis. Sabouraudia: J Med Vet Mycol 1984, 22:191-200.
• [5]Williams DN, Knight AH, King H, Harris DM: The microbial flora of the vagina and its relationship to bacteriuria in diabetic and non-diabetic women. Br J Urol 1975, 47:453-457.
• [6]Wilson RM, Reeves WG: Neutrophil phagocytosis and killing in insulin-dependent diabetes. Clin Exp Immunol 1986, 63:478-484.
• [7]Wilson RM, Tomlinson DR, Reeves WG: Neutrophil sorbitol production impairs oxidative killing in diabetics. Diabetic Medicine 1987, 4:37-40.
• [8]Zdolsek B, Hellberg D, Fröman G, Nilsson S, Mårdh PA: Vaginal microbiological flora and sexually transmitted diseases in women with recurrent or current vulvo vaginal candidiasis. Infection 1995, 23:81-84.
• [9]Sobel JD: vaginitis. New England Journal of Medicine 1997, 337:1896-1903.
• [10]Gibb D, Hockey S, Brown L, Lunt H: Vaginal symptoms and insulin dependent diabetes mellitus. N Z Med J 1995, 108:252-253.
• [11]Peer AK, Hoosen AA, Seedat MA, Van Den Ende J, Oman MAK: Vaginal yeast infections in diabetic women. S Afr Med J 1993, 83:727-729.
• [12]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 Journal of Medical Sciences 1990, 45:212-214.
• [13]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, 43:644-645.
• [14]Sonck CE, Somersalo O: The yeast flora of the anogenital region in diabetic girls. Arch Dermatol 1963, 88:214-220.
• [15]Foxman B, Barlow R, d'Arcy H, Gillepsie B, Sobel JD: Candida vaginitis: estimated incidence and associated costs. Sexually Transmitted Diseases 2000, 27:230-235.
• [16]Geiger AM, Foxman B: Risk factors for vulvovaginal candidiasis: a case control study among university students. Epidemiol 1998, 7:182-187.
• [17]Geiger AM, Foxman B, Gillespie B: The epidemiology of vulvovaginal candidiasis among university students. Am J Public Health 1995, 85:1146-1148.
• [18]Foxman B: The epidemiology of vulvovaginal candidiasis: risk factors. Am J Public Health 1990, 80:329-331.
• [19]Sobel JD: Candidal vulvovaginitis. Clin Obstet Gynecol 1993, 36:153-65.
• [20]Spinillo A, Pizzoli G, Colonna L, Nicola S, De Seta F, Guaschino S: Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis. Obstet Gynecol 1993, 81:721-727.
• [21]Fitzgerald JT, Davis WK, Connell CM, Hess GE, Funnell MM, Hiss RG: Development and validation of the Diabetes Care Profile. Evaluation & the Health Professions 1996, 19:208-230.
• [22]Fitzgerald JT, Anderson RM, Gruppen LD, Davis WK, Aman LC, Jacober SJ, Grunberger G: The reliability of the Diabetes Care Profile for African Americans. Evaluation & the Health Professions 1998, 21:52-65.
• [23]Dean AG, Dean JA, Burton AH, Dicker RC: EpiInfo, Version 6: a word processing, database and statistics program for epidemiology on microcomputers. Centers for Disease Control, Atlanta, Georgia, U.S.A. 1999.
• [24]The SAS System for Windows v 6.12. Cary: The SAS Institute, Inc., 1996.
• [25]Little RR, Wiedmeyer HM, England JD, Wilke AL, Rohlfing CL, Wians FH Jr, Jacobson JM, Zellmer V, Goldstein DE: Interlaboratory standardization of measurements of glycohemoglobins. Clin Chem 1992, 38:2472-8.
• [26]Wayne PA (Ed): Clinical Laboratory Technical Procedure Manuals Thired Edition. National Committee for Clinical Laboratory Standards; 1996.
• [27]Wayne PA (Ed): Evaluation of Precision Performance of Clinical Chemistry Devices, Approved Guideline. National Committee for Clinical Laboratory Standards,; 1999.
• [28]Wayne PA (Ed): Evaluation of the Linearity of Quantitative Analytical Methods, Proposed Guideline. National Committee for Clinical Laboratory Standards; 1986.
• [29]Wayne PA (Ed): Method Comparison and Bias Estimation Using Patient Samples, Approved Guideline. National Committee for Clinical Laboratory Standards; 1995.
• [30]Wayne PA (Ed): Preliminary Evaluation of Quantitative Clinical Laboratory Methods, Approved Guildeline. National Committee for Clinical Laboratory Standards; 1998.
• [31]Rayfield EJ, Ault MJ, Keusch GT, Brothers MJ, Nechemias C, Smith H: Infection and diabetes: the case for glucose control. Am J Med 1982, 72:439-450.
• [32]Sobel JD, Myers PG, Kaye D, Levison ME: Adherence of Candida albicans to human vaginal and buccal epithelial cells. J Infect Dis 1980, 143:76-82.
• [33]Otero L, Palacio V, Carreño F, Méndez F, Vázquez F: Vulvovaginal candidiaisis in female sex workers. Internatl J STD & AIDS 1998, 9:526-530.
• [34]Sobel JD: Vaginal infections in adult women. Med Clinics N Am 1990, 74:1573-1602.
• [35]Cotch MF, Hillier SL, Gibbs RS, Eschenbach DA: Epidemiology and outcomes associated with moderate to heavy Candida colonization during pregnantcy. Am J Obstet Gynecol 1998, 178:374-380.
• [36]Leegaard M: The incidence of Candida albicans in the vagina of "healthy young women". Acta Obstet Gynecol Scand 1984, 63:83-85.