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Evaluation of the effect of contraceptives on the prevalence of Candida species on vaginal candidiasis in Dhaka, Bangladesh

Authors:
  • National Institute of Neurosciences and Hospital, Dhaka, Bangladesh

Abstract

p>This study was designed to find out the relationship between uses of different contraceptives and the prevalence of vaginal candidiasis. High vaginal swabs were obtained from 350 women in the age group of 15-45 years with vaginal discharge attending at Sir Salimullah Medical College Hospital, Dhaka, which comprised of 247 contraceptive users & 103 non-contraceptive users. A detailed clinical history and a thorough examination of all the cases were done. After making the clinical diagnosis, appropriate tests for diagnosing Candidiasis were done by using standard procedures. Of the 247 women of contraceptive users, Candida species was isolated in 140 (56.7%) cases compared to 32 (31.1%) from 103 non-contraceptive users (p value <0.001). Different species of Candida were isolated from 172 (49.1%) cases among 350 women of which C. albicans was found in 125 (72.7%) cases, C. glabrata in 29 (16.9%) cases, C. tropicalis in 13 (7.5%), and C. krusei in 5 (2.9%) cases. Among 173 oral contraceptive users, the isolation rate of Candida species was 120 (69.4%). This was followed by injectables (17, 12.2%) and IUCD (03, 2.1%) cases (p value <0.05). The study revealed a strong association between use of contraceptives and the prevalence of vaginal infection by Candida species of which C. albicans was the most common species (72.7%). Among all contraceptives, use of oral contraceptive pills (OCP) was found as the most common cause of vaginitis, next to which were injectables and IUCDs. Bangladesh J Med Microbiol 2007; 01 (02): 61-64 DOI: http://dx.doi.org/10.3329/bjmm.v1i2.21511 </p
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Bangladesh Journal of Medical Microbiology, 2007, vol.1, no.2 ISSN 2070-1810
Original Article
Evaluation of the Effect of Contraceptives on the Prevalence of Candida Species on Vaginal
Candidiasis in Dhaka, Bangladesh
Yusuf MA1, Chowdhury MAK2, Sattar ANI3, Rahman MM4
Abstract
Objectives: The aim of this study was to find out the relationship between the uses of different
contraceptives and the prevalence of vaginal candidiasis. Methods: High vaginal swabs were obtained
from 350 women in the age group of 15-45 years with vaginal discharge attending at Sir Salimullah
Medical College, Dhaka which comprised 247 contraceptive users & 103 non-contraceptive users. A
detailed clinical history and a thorough examination of all the cases were done. After making the
clinical diagnosis, appropriate tests for diagnosing candidiasis were done by using standard
procedures. Results: Of the 247 women of contraceptive users, Candida species was isolated in
140(56.7%) cases compared to 32(31.1%) from 103 non-contraceptive users. This is statistically
highly significant (P<0.001). Candida species were isolated 172(49.1%) cases among 350 women of
which Candida albicans was in 125(72.7%) cases, Candida glabrata was in 29(16.9%) cases,
Candida tropicalis was in 13(7.5%), and Candida krusei was in 5(2.9%) cases. Among 173 oral
contraceptives users, the isolation rate of Candida species was 120(69.4%). This was followed by
injectables 17(12.2%) and IUCD 03(2.1%) cases. This is statistically significant (P<0.05).
Conclusion: There is a strong association between use of contraceptives and the prevalence of vaginal
infection by Candida species of which Candida albicans was the most common species. Among all
contraceptives, OCP is the most common cause of vaginitis, next to which was injectables and IUCD.
[Bangladesh J Med Microbiol. 2007;1(2):61-66]
Keywords: Contraceptives; Candida albicans; Vulvovaginal Candidiasis; Non-contraceptive users;
Introduction
Vulvovaginal candidiasis is a common cause of vaginal infection. It is a primary or secondary
infection of the vagina involving Candida species with Candida albicans being a leading cause1. This
disease condition could be exacerbated by a change in the normal vaginal ecology2. At least one
episode of vulvovaginal candidiasis is reported in up to 75% of premenopausal women3.
Yeast is always present in the vagina in small numbers, and symptoms only appear with overgrowth.
Several factors are associated with the overgrowth of Candida species leading to symptomatic
infection in women. These include broad spectrum antibiotics, steroids, being in the luteal phase of the
menstrual cycle, nulliparity, the use of spermicides, uncontrolled diabetes mellitus, T-cell dysfunction,
1Dr. Md. Abdullah Yusuf, Lecturer, Department of Pathology, Government H.D.C., Mirpur-14, Dhaka
2 Prof. Md. Abul Quashem Chowdhury, Professor, Department of Microbiology and Immunology, BSMMU, Dhaka
3Dr. Abu Naser Ibne Sattar, Department of Microbiology and Immunology, BSMMU, Dhaka
4Dr. Md. Mostaqimur Rahman, Lecturer, Department of Microbiology, Rangpur Medical College, Rangpur
Corresponding Author
Dr. Mohammad Abdullah Yusuf, House# 271/8, Niribily Housing, Shankor, West Dhanmondi, Dhaka-1207,
Bangladesh. Phone numbers: +880-2-9146101; +880-1-817565830; E-mail: ayusuf75@yahoo.com.
Evaluation of Effect of Contraceptives on Vaginal Candidiasis Yusuf et al
62
pregnancy, high dose estrogens and contraceptives4. Recent therapy with broad-spectrum antibiotics
such as tetracycline, ampicillin, and oral cephalosporin is also a risk factor, presumably because it
eliminates the protective vaginal flora, especially lactobacilli5. Other factors that may increase the
incidence of yeast infection include using douches, perfumed feminine hygiene sprays, and topical
antimicrobial agents, and wearing tight, poorly ventilated clothing and underwear6. Contraceptives are
chemical substances used for birth control measures which include oral contraceptive pills,
intrauterine contraceptive devices, and injectable contraceptives-Depo-Provera, jellies, creams, foams,
vaginal tablets and cervical caps4. The contraceptives containing oestrogen and progesterone hormone
increase the glycogen in the vagina which converted into lactic acid by lactobacilli. Thus overgrowth
of Candida species occurs due to decreased pH. The most frequent symptoms of yeast infection in
women are itching, burning, and irritation of the vagina. Vaginal discharge is not always present and
may be minimal. The thick, whitish-grey discharge is typically described as cottage-cheese-like in
nature, although it can vary from watery to thick in consistency.
Hormone containing contraceptives especially injectable contraceptives and oral contraceptive pills
are very popular method of contraception in Bangladesh7. Its services are widely available in our
country. Depo-Provera (DMPA) is used by more than 15 million women in more than 90 countries
worldwide7. Thus, there is a great chance of vaginal candidiasis in the women using this contraceptive
method. The aim of this study was to find out the role of contraceptives on the prevalence of vaginal
infection caused by different Candida species.
Methodology
The present study was carried out to investigate the prevalence of vaginal discharge caused by
Candida species among the contraceptives users. High vaginal swabs were obtained from 350 sexually
active women in the age group of 15-45 years with the complains of vaginal discharge attending at
OPD of Obstetrics and Gynaecology department Sir Salimullah Medical College, Dhaka which
comprised 247 contraceptive users & 103 non-contraceptive users. A detailed clinical history and a
thorough examination of all the cases were done by using a Cusco's speculum which was inserted into
the vagina to visualize the vagina and cervix. Any pathology of vagina and cervix like vaginitis,
discharge, cervicitis, cervical erosions were looked for. The amount, colour, character and smell of the
vaginal discharge in the vagina were noted. The discharge was then collected by three sterile swabs
from the upper part of the posterior fornix and lateral vaginal walls. The swabs of vaginal discharge
were processed as under: One swab was used for inoculation into culture media; Second swab was
used for wet mount microscopic examination; Third swab was used for making smears for Gram
staining. Laboratory procedures: (a) KOH preparation: A drop of 10% KOH was added to the
vaginal secretions taken on a clean glass slide and mounted with a cover slip. Candida was identified
as highly refractile, round or oval budding yeast cells; (b) Gram staining: Smears were prepared by
the specimen and was fixed by flaming. Then the slide was stained by Gram’s Method8. The slide was
examined under microscope at 40× for the detection of strongly gram positive budding yeast cell,
hyphae and pseudohyphae; (c) Cultures: Culture was done on Sabouraud's dextrose agar media at 370
C for 24 and 48 hours which showed a growth of creamy, greyish moist colonies. Saline wet mount
preparation of the colony showed budding cells and pseudohyphae; (d) Species identifications: Then
the species identification was based on germ tube test8, sugar assimilation test9, and sugar fermentation
test9. Data analysis: All statistical analysis was carried out with the Statistical Package for the Social
Sciences (SPSS, version 10.0; SPSS Software Ltd. Bangladesh). A P value of <0.05 was considered
statistically significant. The significance value of isolation rate of Candida species from contraceptive
users and non-contraceptive users were determined by unpaired Student’s ‘t’ test and the prevalence of
Candida species among the different types of contraceptive were done by one-way ANOVA test.
Evaluation of Effect of Contraceptives on Vaginal Candidiasis Yusuf et al
63
Results
Of the 247 women of contraceptive users, Candida species was isolated in 140(56.7%) cases
compared to 32(31.1%) from 103 non-contraceptive users. There was a statistically highly significant
relationship (P<0.001) between the contraceptive and non-contraceptive users. This is shown in the
table I. Candida species were isolated from 172(49.1%) cases from 350 women. Out of 172 Candida
species, Candida albicans was the most frequently isolated species accounting for 125(72.7%) cases.
The second most isolated species was Candida glabrata which was in 29(16.9%) cases.
Table I: Rate of isolation of Candida species from 350 samples.
P<0.001 (Highly significant)
Candida tropicalis and Candida krusei was isolated in 13(7.5%) and 5(2.9%) cases respectively. This
is shown in the table II. The highest prevalence of vaginal candidiasis was found in OCP users which
was 120(85.7%) in out of 173 patients. This was followed by injectables and IUCD which was
17(12.2) and 03(2.1%) respectively. There was a significant relationship (P=0.002) between the type
of contraceptive used and the prevalence of vaginal infections by Candida species. This is shown in
the table III.
Table II: Different Candida species isolated from contraceptives and non-contraceptives users
Name of Candida
species
Candida spp. from
Contraceptive users
(n=140)
Candida spp. from Non-
contraceptive users
(n=32)
Total
(n=172)
No
%
No
Candida albicans
107
76.4
18
125(72.7%)
Candida glabrata
21
15
08
29(16.9%)
Candida tropicalis
09
6.4
04
13(7.5%)
Candida krusei
03
2.1
02
5(2.9%)
Total (n=172)
140(100%)
32(100%)
172(100%)
Discussion
The present study was carried out to investigate the prevalence of vaginal discharge caused by
Candida species among the contraceptives users. A total number of 350 women were selected of
which contraceptive users were 247 women and non-contraceptive were 103 women.
Patient group
(n=350)
Isolation of
Candida spp.
Negative
cultures
Total
No
%
No
%
Contraceptive users
(n=247)
140
56.7
107
43.3
247(100%)
Non-Contraceptive users
(n=103)
32
31.1
71
68.9
103(100%)
Total (n=350)
172(49.1%)
178(50.9%)
350(100%)
Evaluation of Effect of Contraceptives on Vaginal Candidiasis Yusuf et al
64
Table III: Prevalence of Candida species among Contraceptives users.
Name of
contraceptives
No of Samples
(n=247)
No of infected
(n=140)
No
%
No
%
OCP
173
70.0
120
85.7
Injectables
68
27.5
17
12.2
IUCD
06
2.5
03
2.1
Total
247
100
140
100
P<0.05 (significant)
Among 350 women, Candida species were isolated from 172(49.1%) cases. From the total of 247
women of contraceptive users, Candida species was isolated in 140(56.7%) cases compared to
32(31.1%) cases from 103 non-contraceptive users. Similar pattern of isolation was found by Enweani
et al10 who reported a prevalence of 51.5% from the contraceptives users in Nigeria. Out of 172
Candida species, Candida albicans was the most frequently isolated species accounting for
125(72.7%) cases. This is with the agreement of the result found by Hurley et al11 and Marcano et al12.
Enweani et al10 was also found a highest rate of isolation of Candida albicans (70.7%) from the
contraceptive users in Nigeria. The second most isolated species was Candida glabrata which was in
29(16.9%) cases. Candida tropicalis and Candida krusei was isolated in 13(7.5%) and 5(2.9%) cases
respectively. There was a significant relationship (P<0.001) between the type of contraceptive used
and the prevalence of vaginal infections by Candida species.
Among the women using contraceptives, a highest prevalence of 69.4% was observed in oral pill users
as compared to those using injectables and IUCD in 12.2% and 2.1% respectively coinciding with the
result of Misra et al13. Oriel et al14 reported a higher rate of prevalence of vaginal candidiasis in oral
contraceptives users than non-contraceptives users. Milson and Ferrsman15 earlier had suggested that
this could be attributed to the presence of estrogen and progesterone hormones in the contraceptives
that increased glycogen in the vagina, thus exposing it to the activities of lactobacilli. The lactobacilli
are widely believed to play a role in the conversion of glycogen to lactic acid thus decreasing the pH
of the vagina. The decreased pH reduces the activities of the bacterial biota a while favors the growth
of yeasts including Candida species10. Ryley16 postulated that the low prevalence rate in injectable
contraceptive users may be related to the induction of hormonal changes. The IUCD users accounted
for 2.1% of those from whom Candida species were isolated. This might be due to local changes and
secretions resulting from foreign body contaminating in the vagina17.
In this study, the results revealed a prevalence of 31.1% in the non-contraceptive users. This finding
suggested that there might be other causes for the high prevalence of vaginal infections in females
apart from the use of contraceptives that may further increase yeast infections. It could also be
attributed to sexual behavioral predisposition. This conformed with other reports incriminating natural
factors to be predisposing to candidiasis1. The low personal hygiene and ignorance and illiteracy in our
society may also partly explain this high prevalence.
Conclusion
Results of this study have revealed a strong association between the use of contraceptives and
prevalence of vaginal infection by Candida species. Oral Contraceptive Pill was the most influencing
contraceptives that cause vaginal candidiasis.
Evaluation of Effect of Contraceptives on Vaginal Candidiasis Yusuf et al
65
Acknowledgment: We especially thanks to Dr. Maksuda Forida Akter, Registrar, Gynaecology and
Obstetrics department, Sir Salimullah Medical College, Dhaka for the collection of the samples from
the patients.
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... albicans). Diperkirakan sekitar 20% populasi wanita di dunia tiap tahunnya mengalami kandidiasis serviks (19) . Angka prevalensi kandidiasis pada kelompok perempuan perilaku risiko tinggi adalah 11,2-28,9%, angka tersebut justru lebih rendah dari kelompok perempuan perilaku risiko rendah (23) . ...
... CI= 95% dan OR= 6,435. Penelitian ini sesuai juga dengan beberapa penelitian sebelumnya yang menunjukkan hasil serupa (4,6,13,19) . ...
... Pada beberapa penelitian tersebut didapatkan bahwa kandungan estrogen maupun progesteron yang terdapat pada kontrasepsi hormonal dapat meningkatkan glikogen pada serviks dan vagina yang selanjutnya diubah menjadi asam laktat oleh laktobasilus. Suasana asam ini merupakan suasana pendukung bagi pertumbuhan jamur terutama spesies Candida (13,19) . Selain itu diketahui juga pada jamur Candida juga terdapat reseptor estrogen yang memiliki afinitas yang kuat terhadap komponen 17-β-estradiol dari estrogen. ...
... albicans). Diperkirakan sekitar 20% populasi wanita di dunia tiap tahunnya mengalami kandidiasis serviks (Yusuf 2007). Angka prevalensi kandidiasis pada kelompok perempuan perilaku risiko tinggi adalah 11,2-28,9%, angka tersebut justru lebih rendah dari kelompok perempuan perilaku risiko rendah (Anindita, 2006). ...
... CI= 95% dan OR= 6,435. Penelitian ini sesuai juga dengan beberapa penelitian sebelumnya yang menunjukkan hasil serupa (Cheng, 2006;Yusuf, 2007;Bakker, 2015;Shahinfar, 2016 ). ...
... Pada beberapa penelitian tersebut didapatkan bahwa kandungan estrogen maupun progesteron yang terdapat pada kontrasepsi hormonal dapat meningkatkan glikogen pada serviks dan vagina yang selanjutnya diubah menjadi asam laktat oleh laktobasilus. Suasana asam ini merupakan suasana pendukung bagi pertumbuhan jamur terutama spesies Candida (Yusuf 2007;Shahinfar 2016). Selain itu diketahui juga pada jamur Candida juga terdapat reseptor estrogen yang memiliki afinitas yang kuat terhadap komponen 17-β-estradiol dari estrogen. ...
... FGT inflammation and Th1/Th17 cell phenotype and activation are also influenced by hormonal contraceptive type (20,21), and previous observational studies have suggested that hormonal contraceptive type may influence Candida colonization, with hormonal contraceptive users experiencing higher Candida prevalence than non-users (22,23). The prevalence of asymptomatic vaginal Candida colonization and symptomatic VVC has been found to be 2-fold higher in women taking combined oral contraceptives (COC) compared to those using other barrier and hormonal contraceptives (24,25). ...
... Previous observational studies have reported that certain hormonal contraceptive types are associated with increased Candida colonization and/or infection (22)(23)(24)(25)(26)(27)29). We therefore examined this within our randomized trial. ...
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Sub-Saharan African female adolescents are globally at the highest risk of HIV acquisition, and genital inflammation, microbial dysbiosis, and cervical HIV target cell activation are thought to contribute to this risk. Previously, the relationship between these mucosal factors and subclinical vaginal Candida colonization or hyphae has not been described, and the role of HIV-susceptible Th17 cells in mediating anti- Candida immunity in the human female genital tract has not been clearly established.
... 43 The fungal species most frequently isolated from vaginal exudate samples is C. albicans with a prevalence above 80% in most publications, although some describe this etiology in just over 50%. 1,12,14,22,25,34,43,45,54 Other species are Candida glabrata complex, Candida krusei, Candida parapsilosis complex and, less frequently, Candida tropicalis, Candida guilliermondii and even Saccharomyces cerevisiae. Candida africana has also been isolated in cases of vulvovaginal candidiasis in Africa and in some European countries. ...
... albicans Candida vulvovaginitis may exceed that caused by C. albicans. 1,17,21,23,24,31,54 Resistance to oral antifungals, mainly fluconazole, which is the most widely used antifungal drug in this pathology, has been increasing over the years, particularly in recurrent VVC. 2,7,10,11,13,15,16,23,38,44,47 Numerous resistance mechanisms have been described, the main ones being the over-expression of the CDR1 gene, which would be more common in non-C. ...
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... non-contraception users. The same isolation trend was discovered by [16] who registered a 140 (56.7 %) prevalence of contraception users in Dhaka, cases of 103 non-contraceptive users opposed to 32(31.1 %). [17] C. Albicans (50%) displayed the highest incidence go after by C.glabrata (21.4%), ...
... Among women who use contraceptive drugs, a high occurrence of 69.4% was detected in oral pills compared with 12.2 and 2.1% in injectable and IUCD, respectively [20]. Local research by [16] recorded that 120 (85.7%) of 173 patients were found with the highest frequency of VVC among OCP users. This was followed by 17(12.2%) ...
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Background: Vaginal discharge and itching are characteristic of Candidiasis. It is related to significant patient pain. The occurrence is increased during gestation and may lead to difficulties such as abortion, premature delivery, chorioamnionitis, and so on. In Baghdad, this study was conducted to assess the prevalence of Vulvovaginal Candidiasis(VVC) among women. Methods: The research included 195 women. These women have been taken with a high vaginal swab and exposed to grams and culture for the diagnosis of VVC. Results: Amongst the 195 women surveyed, 106 were positive (57.3%) for VVC. This suggested mainly Candida albicans (50.6%), 127 of the consumers of oral contraceptives had 93 (73.2%) and 23 to 26 years of age (37.3%). Eighty percent of women with VVC had risk factors such as diabetes, preceding oral contraceptives, intrauterine implants, oral antibiotics and previous candidiasis incidents. Conclusion: There is a clear correlation between use of contraception and the prevalence of Candida vaginal disease, the most commonly used species being C.albicans., and a screening procedure for the early detection and treatment of Candidiasis with appropriate medicines is suggested.
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... Recently, several researches were done to clarify the prevalence of different vulvovaginal Candida to age, educational level, work, personal hygiene and contraceptive method of the women (Yusuf et al., 2007;Rezaei-Matehkolaei et al., 2016 andSwaminathan et al. 2017). The current study showed that the maximum incidence of vaginal candidiasis was found between youths (20-34 age), the rate of vaginitis was decreased by increasing educational level and the douching using women were more susceptible to the risk of infection with vaginitis Candida. ...
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... A study from Bangladesh recorded the prevalence of Candida spp. in that 72.7% of C.albicans, 16.9% of C.glabrata, 7.5% of C.tropicalis and 2.9% of C.krusei were noted. They concluded that C.albicans was the most common species isolated from vaginitis (Yusuf et al., 2007). The prevalence of Candida albicans was highly noted when compared to the non albicans species such as C. glabrata, C. parapsilosis, C. tropicalis, C. krusei and C. stellatoidea (Germain et al., 1998;Jha et al., 2006;Zaini et al., 2006). ...
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Background: The incidence of fungal infections has increased significantly, which contributes to morbidity and mortality. This is caused by an increase in antimicrobial resistance and the restricted number of antifungal drugs, which retain many side effects. Candida species are major human fungal pathogens that cause both mucosal and deep tissue infections due to the presence of various virulence factors such as exo-enzymes secretion, capacity of adherence and morphogenesis. The production of exo-enzymes such as proteinase and phospholipase are factors which have been classically understood. Others such as haemolytic activity and the resistance to hydrogen peroxide are still little studied especially in urine isolates. Biofilm is the structured microbial communities that are attached and encases in a matrix of exo-polymetric material and are important for the development of clinical infection. Materials & Methods: On this background, the current study was done to analyze the virulence factors of Candida species from the urine samples (n=150) collected from unmarried girls of Vivekanandha College, Tiruchengode. Results: Forty samples were found to be positive for Candida spp., among them C.tropicalis is the prime one in its prevalence rate followed by C.glabrata 25%, C.albicans 17.5% and C.krusei 12.5%. Among the 40 positive Candida species virulence factors like biofilm formation, haemolytic activity, exo-enzyme production (proteinase and phospholipase) were studied. Biofilm formation was prominently seen in C.tropicalis whereas in exo-enzyme (proteinase and phospholipase) production C.albicans ranks the first than any other Candida species. However proteinase, phospholipase and hemolytic activity were highly expressed suggesting that these virulence factors are important for the pathogenicity. Conclusion: Generally the different isolates expressed similar virulence potential of varying range and it reinforcing the necessity to analyze the key factor of virulence in depth and also the other factors related to the yeasts are involved in the development of the disease.
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Hormonal contraceptives have been on the market for over fifty years and, while their formulations have changed, the basic mechanism of action has remained the same. During this time, numerous studies have been performed documenting side effects, some of which appear over time, some within weeks or months, but all can have a serious impact on health and quality of life. An effort was made to perform a series of comprehensive literature surveys to better understand immediate and long-term side effects of these agents. The results of this literature review uncovered a number of potential side effects, some of which are acknowledged and many of which are not noted in the prescribing information for these agents. Among the unacknowledged side effects are: an increased risk of HIV transmission for depot medroxyprogesterone acetate (DMPA), and for combination contraceptives breast cancer, cervical cancer, Crohn's disease, ulcerative colitis, systemic lupus erythematosus, depression, mood disorders and suicides (especially among women twenty-five years of age and younger, in the first six months of use), multiple sclerosis, interstitial cystitis, female sexual dysfunction, osteoporotic bone fractures (especially for progesterone-only contraceptives), and fatty weight gain. Misleading prescribing information regarding cardiovascular and thrombotic risks are also noted. Women seeking birth control have a right to be informed and educated about risk avoidance through the use of effective nonhormonal methods like fertility awareness methods. In one case-that of DMPA-the increased risk of HIV acquisition has been conclusively demonstrated to be both real and unique to this drug. Considering the availability of numerous alternatives, there is no justification for the continued marketing of DMPA to the public. Summary: We reviewed the effect of hormonal contraceptives on women's health. A number of potential side effects were noted including increased risks of breast cancer, cervical cancer, inflammatory bowel disease, lupus, multiple sclerosis, cystitis, bone fractures, depression, mood disorders and suicides, fatty weight gain, and female sexual dysfunction. With the long-acting injectable contraceptives there is an increased risk of getting HIV. Misleading prescribing information regarding the risks of heart attacks, strokes and blood clotting problems were also noted. Women seeking birth control have a right to know about how to avoid these risks by using effective hormone-free Fertility Awareness Methods.
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Back ground: Vaginalcandidiasisisthesecondcommoninfectionamongchildbearingwomen.ThediseaseiscausedbyyeastorganismespeciallyCandidaalbican.Pregnancyisoneoftheriskfactorsofthedisease.Ithasbeenrevealedthatmorethan75%ofwomenmayexperienceanattachofthediseaseduringtheirlifetime.Objectives: To study the epidemiological factors of vaginal candidiasis among pregnant women attendingTikrit teaching hospital out-patient clinic.Patients and methods: The study was conducted on a sample of (120) pregnant women. The demographic and epidemiologic information was obtained according to special designed questionnaire. The study was done over a period from1/3/2017 to 16/4/2017. Vaginal swabs were taken from patients and sent to the lab for direct microscopically examination and cultured in special nutrient media. Results: About (29%) of study sample had vaginal candidiasis. There was a significant relation between a history of taking antibiotic, oral contraceptive drugs, diabetes mellitus and occurrence of the disease. The most frequent cases of vaginal candidiasis was from age group (25-35 years) (57.1%). Conclusions:About (29%) of pregnant women sample was affected by vaginal candidiasis. There was a significant relation between history of using oral contraceptive pills, broad spectrum antibiotics taking,diabetes mellitus and occurrence of the disease. (PDF) Epidemiology of vaginal candidiasis among pregnant women attending Tikrit teaching hospital/Iraq.. Available from: https://www.researchgate.net/publication/331553688_Epidemiology_of_vaginal_candidiasis_among_pregnant_women_attending_Tikrit_teaching_hospitalIraq [accessed Apr 02 2019].
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Among the female patients attending the out patient clinic of the Obstetric Service of the University Hospital of Caracas, Venezuela a hundred were chosen who presented vaginal discharge and itching. The presence of C. albicans and the existence of candidiasis in the vulvo-vagina of the 100 pregnant women was investigated. Those patients where candidiasis was found, were also investigated as to the simultaneous presence of C. albicans in the mouth and the anal skin. Gyno-Pevaryl® therapy was performed by administrating one 150 mg ovule daily for three consecutive days. At the same time, their partners were treated with Pevaryl® 1% cream. The post-therapy control was made 36 hours after conclusion of treatment and further check-up were made one week and two weeks later. Only those patients who attended the post-treatment controls were taken into account for the evaluation of the results. C. albicans was identified in 60 cases by nascent culture of the vulvar secretions, using a bile-agar medium. Of these, 50 had vulvo-vaginal candidiasis (hyphae and blastospores on direct examination). 92% of the women with vulvo-vaginal candidiasis complained about pruritus at the moment of the examen. No significant differences were observed with respect to the age, the period of gestation and parity of the positive and negative patients. Of the 40 patients who attended only the first control, 23 were cured (57.5%), 9 improved (22.5%) and 8 (20%) were not cured. The cure rate increased to 70% and 72.5% taking into acount those patients, who also attended the second and the third consecutive treatment sessions, respectively. In those patients suffering from vulvo-vaginal candidiasis, 37.5% were found to be carriers of C. albicans in the mouth and 70% also in the anal region. This seems to indicate that the mouth and the anal region can constitute the source of re-infection in the majority of the cases following topical vaginal treatment.
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The effects of personal hygiene, sexual history, diet, and stress on the risk of vulvovaginal candidiasis were estimated from a case-control study of students attending a public university during 1986-87. Data from medical records and self-administered questionnaires were used to compare 85 cases to 1,245 other students using the Health Service, and to 113 subjects chosen from the total student population. Frequent sexual intercourse was the strongest risk factor (seven or more times a week versus none): OR = 4.3; 95% CI: 1.4, 12.9 (for cases versus Health Service controls).
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Although candidiasis of the female genital tract is one of the most common of the vaginitides, it is a poorly understood disease entity. Vulvovaginal candidiasis is a monoetiologic disease, but the pathways by which pathogenic expression is attained are sufficiently divergent to constitute a classification schema that influences therapy. For selection of appropriate therapy, the following three broad categories are proposed: (1) primary candidiasis, (2) antibiotic-induced candidiasis, and (3) systemically induced candidiasis.
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Candida vulvovaginitis is one of the most common infections encountered by obstetricians and gynecologists from all parts of the world. The modern treatment of vaginal candidiasis with imidazole antimycotics such as clotrimazole has been shown to be highly effective. However, there is a small group of women who experience repeated episodes of vaginal candidiasis. This article reviews possible predisposing factors related to recurrent vaginal candidiasis.
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Genital yeast infection was studied in 533 women seen in a department of venereology. Yeasts were recovered in culture from 138 patients (26% of the total). Candida albicans accounted for 112 (81%) of the isolates and Torulopsis glabrata for 22 (16%); other yeasts were uncommon. There was no evidence that the presence of yeasts was related to age. 32% of the women who were taking an oral contraceptive harboured yeasts, compared with 18% of those who were not.The symptoms and signs of the women with yeast infections were compared with those with vaginal trichomoniasis and those with no evidence of genital infection. It seems that a clinical diagnosis of vaginal mycosis cannot be made with accuracy and that positive identification of yeasts is necessary; for this, cultural methods are the most satisfactory.