Vaginal yeast colonisation, prevalence of vaginitis, and associated local immunity in adolescents
Barousse, M.M.; Van Der Pol, B.J.; Fortenberry, D.; Orr, D.; Fidel, P.L.
Sexually Transmitted Infections 80(1): 48-53
2004
ISSN/ISBN: 1368-4973 PMID: 14755036 DOI: 10.1136/sti.2002.003855Document Number: 232378
Objectives: To evaluate point prevalence vaginal yeast colonization and symptomatic vaginitis in middle adolescents and to identify relation of these yeast conditions with reproductive hormones, sexual activity, sexual behaviours and associated local immunity. Methods: Middle adolescent females (n=153) were evaluated for sexually transmitted infections (STIs), asymptomatic yeast colonization, and symptomatic vulvovaginal candidiasis (VVC) by standard criteria between May 1999 and September 2001 in the USA. Local parameters, including vaginal associated cytokines, chemokines and antibodies, vaginal epithelial cell antifungal activity, and Candida specific peripheral blood lymphocyte responses were also evaluated. Correlations between yeast colonization/vaginitis and local immunomodulators, reproductive hormones, douching, sexual activity, condom use and STIs were identified. Results: The rates of point prevalence asymptomatic yeast colonization (22%) were similar to adults and similarly dominated by Candida albicans, but with uncharacteristically high vaginal yeast burden. In contrast with the high rate of STIs (18%), the incidence of symptomatic VVC was low (<2%). Immunological properties included high rates of Candida-specific systemic immune sensitization, a Th2 type vaginal cytokine profile, total and Candida-specific vaginal antibodies dominated by IgA, and moderate vaginal epithelial cell anti-Candida activity. Endogenous reproductive hormones were in low concentration. Sexual activity positively correlated with vaginal yeast colonization, whereas vaginal cytokines (Th1, Th2, proinflammatory), chemokines, antibodies, contraception, douching or condom use did not. Conclusion: Asymptomatic vaginal yeast colonization in adolescents is distinct in some ways with adults, and positively correlates with sexual activity, but not with local immunomodulators or sexual behaviours. Despite several factors predictive for VVC, symptomatic VVC is low compared to STIs.