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Effect of Antibiotics on Vulvovaginal Candidiasis: A MetroNet Study

Department of Family Medicine and Public Health Sciences, Division of Practice-Based Research (JX, KS, MB, JM, RKS), Wayne State University School of Medicine, Detroit, Michigan
Department of Internal Medicine, Division of Infectious Diseases (JDS), Wayne State University School of Medicine, Detroit, Michigan

Correspondence: Corresponding author: Jinping Xu, MD, MS, Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, 101 E. Alexandrine, 2nd Floor, Detroit, MI 48021 (E-mail: jxu{at}med.wayne.edu)

Purpose: Vulvovaginal candidiasis (VVC) is believed common after systemic antibiotic therapy, yet few studies demonstrate this association. In this pilot study, we evaluate the effect of short-course oral antibiotic use on VVC.

Methods: Nonpregnant women aged 18 to 64 years who required 3 days oral antibiotics for nongynecological diseases were recruited from a family medicine office. Age-matched (±5 years) women seen in the same clinic for noninfectious problems were recruited as controls. The main outcomes are incidence of symptomatic VVC and prevalence of positive vaginal Candida culture 4 to 6 weeks after antibiotics.

Results: Eighty (44 in antibiotic group) women were recruited; 14 of 79 (95% CI, 0.11–0.28) had asymptomatic vaginal Candida cultures positive at baseline. During follow-up, 10 of 27 (95% CI, 0.22–0.56) women in antibiotic group were Candida culture positive. In contrast, 3 of 27 (95% CI, 0.04–0.28) women in the control group were Candida culture positive (relative risk, 3.33; P = .03). Meanwhile, 6 of 27 (95% CI, 0.11–0.41) women in antibiotic group developed symptomatic VVC whereas none (95% CI, 0–0.12) of the women in the control group developed vaginal symptoms (relative risk, ; P = .02). Baseline Candida culture did not predict subsequent symptomatic VVC after antibiotics.

Conclusion: In this pilot study, the use of short courses of oral antibiotics seems to increase prevalence of asymptomatic vaginal Candida colonization and incidence of symptomatic VVC. Larger cohort studies are needed to confirm these findings.

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