Downloaded from www.microbiologyresearch.org by IP: 54.224.121.223 On: Wed, 04 May 2016 00:01:53 Premenstrual vaginal colonization of Candida and symptoms of vaginitis Cathy J. Watson, 1 Danilla Grando, 2 Suzanne M. Garland, 3 Stephen Myers, 4 Christopher K. Fairley 5 and Marie Pirotta 1 Correspondence Cathy Watson cathyw@unimelb.edu.au Received 9 March 2012 Accepted 21 July 2012 1 General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton 3053, Australia 2 Microbiology Dept, Building 223 Level 1, RMIT University Bundoora Campus, School of Applied Sciences, RMIT University, PO Box 71, Bundoora 3083, Australia 3 Dept Microbiology Infectious Diseases, Royal Women’s Hospital, Department of Obstetrics and Gynaecology, University of Melbourne, Carlton 3053, Australia 4 NatMed-Research, The Natural and Complementary Medicine Research Unit School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia 5 School of Population Health, University of Melbourne, Melbourne, Australia; and Melbourne Sexual Health Centre, Alfred Health, Carlton 3053, Australia Although premenstrual exacerbation of vulvovaginal symptoms attributed to Candida spp. is well documented, the causation of these symptoms is not well understood. This study describes the daily vaginal colonization of Candida in three women. A single pilot study was designed to test the methodology of the proposed randomized controlled trial, Garlic and Candida. This study reports the colonization of Candida spp. in three women. Ten women aged 18–50 who reported at least one episode of vulvovaginal candidiasis were recruited by the University of Melbourne. Each participant took daily vaginal swabs for 2 weeks during the luteal phase of their menstrual cycle, which were analysed for quantitative colony counts of Candida spp. Of these, three women were colonized with Candida spp. For the first time, to our knowledge, daily colonization of Candida during the luteal phase of the menstrual cycle is described in three women, demonstrating an increase in the colony count preceding symptom development. This small study demonstrated the colonization of Candida spp. during the luteal phase of the menstrual cycle in three women. Candida colonization is poorly understood, yet investigating the relevance of the link between symptom exacerbation and the menstrual cycle in those women who experience recurrent episodes of vulvovaginal candidiasis may influence the management of this condition. INTRODUCTION Recurrent vulvovaginal candidiasis (VVC), defined as four or more symptomatic episodes in a 12-month period, is notoriously difficult to manage, causes women consid- erable suffering and is poorly understood (Sobel, 2007). Understanding the mechanism of how vaginal Candida change from commensal to pathogenic organisms may be a step further in improving the management of candidiasis. Some studies suggest that colonization rises in the luteal phase of the menstrual cycle (Engberts et al., 2007; Eschenbach et al., 2000; Odds et al., 1988); consequently, it is often thought to be associated with hormonal changes in the menstrual cycle. Several studies have documented point prevalence of vaginal colonization of Candida spp. (Beigi et al., 2004; Goldacre et al., 1979) and others have shown that colony counts of Candida spp. vary from month to month and from day to day within individuals (Sautter and Brown, 1980). Despite previous validation of consistency between multiple swabs from the same indi- vidual (Odds et al., 1987), no published reports have been found that document the daily colonization pattern during the luteal phase of the menstrual cycle using quantitative methods. We undertook a pilot study to refine the methods and establish the feasibility for a randomized controlled trial investigating the use of oral garlic to prevent VVC, as garlic has been shown in vitro to have antifungal effects against Candida spp. (Lemar et al., 2002). The self-collection of swabs by participants is a method used in previous studies (Schwebke et al., 1997; Passos et al., 2007; Pirotta et al., 2004). Self-collection of swabs has been validated, dem- onstrating a similar sensitivity and specificity for detecting Abbreviation: VVC, vulvovaginal candidiasis. Journal of Medical Microbiology (2012), 61, 1580–1583 DOI 10.1099/jmm.0.044578-0 1580 044578 G 2012 SGM Printed in Great Britain