Laboratorial Aspects of Cytolytic Vaginosis and Vulvovaginal Candidiasis as a Key for Accurate Diagnosis: A Pilot Study

Sanches, José Marcos; Giraldo, Paulo César; Bardin, Marcela Grigol; Amaral, Rose; Discacciati, Michelle Garcia; Rossato, Luana

doi:10.1055/s-0040-1715139

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article, Sexually Transmitted Infections • Rev Bras Ginecol Obstet. 42 (10) • Oct 2020 • https://doi.org/10.1055/s-0040-1715139 copy

Laboratorial Aspects of Cytolytic Vaginosis and Vulvovaginal Candidiasis as a Key for Accurate Diagnosis: A Pilot Study

Aspectos laboratoriais da vaginose citolítica e candidíase vulvovaginal como uma chave para o diagnóstico preciso: Um estudo piloto

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To identify clinical, microscopic, and biochemical characteristics that differentiate cytolytic vaginosis (CV) from vulvovaginal candidiasis (VVC).

Methods

The present cross-sectional study analyzed the vaginal contents of 24 non-pregnant women aged 18 to 42 years who were attended at the Genital Infections Clinic at Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM-UNICAMP). They were diagnosed either with (CV = 8, VVC = 8) or without vulvovaginitis or vaginal dysbiosis (controls). The socio-demographic, clinical, and gynecological data were obtained from a detailed patient interview. Samples of the vaginal contents were collected for analysis of vaginal pH, gram stain, and specific fungal culture. The Kruskal-Wallis and Fisher exact tests were used to compare the differences between the groups. Odds ratios were used to compare the categorical variables. The significance level was considered at p < 0.05.

Results

Both women with CV and VVC had a lumpy vaginal discharge (p = 0,002) and vaginal hyperemia (p = 0.001), compared with controls. The inflammatory process was more intense in the VVC group (p = 0.001). In the CV group, there was statistical significance for the lactobacillus amount (p = 0.006), vaginal epithelium lysis (p = 0.001), and vaginal pH (p = 0.0002).

Conclusion

Cytolytic vaginosis and VVC diagnoses rarely differ on clinical characteristics but have different laboratorial findings. The present study highlights the importance of conducting an accurate investigation through laboratory tests rather than clinical criteria to avoid misdiagnosis.

Keywords
cytolytic vaginosis; dysbiosis; gram stain; vaginal bacterioscopy; vulvovaginal candidiasis

Characteristics		VVC	CV	nl	p-value^* * p-value according to the Kruskal-Wallis test for comparison of values among the 3 groups, followed by Dunn test for multiple comparisons ( p < 0.05).
Age in years^ Age average per group.		36	34.75	31.13	0.379
White		62.5%; (5)	37.5%; (3)	62.5%; (5)
					0.378
Non-white		37.5%; (3)	62.5 (5)	37.5%; (3)
Years of schooling		16.13	11.63	13.88	0.058
	0	62.5%; (5)	12.5%; (1)	50%; (4)
Pregnancies	1	25%; (2)	50%; (4)	12.5%; (1)	0.283
	> 1	12.5%; (1)	37.5%; (3)	37.5%; (3)
	0	87.5%; (7)	62.5%; (5)	100%; (8)
Abortions	1	12.5%; (1)	25%; (2)	0%;	0.273
Abortions	> 1	0%;	12.5%; (1)	0%;
Recent sex partners (last 6 months)	0	12.5%; (1)	0%;	0%;
	1	87.5%; (7)	62.5%; (5)	87.5%; (7)	0.273
	> 2	0%;	37.5%; (3)	12.5%; (1)
Use of condoms	Never	75%; (6)	37.5%; (3)	75%; (6)
	Sometimes	12.5%; (1)	37.5%; (3)	0%;	0.385
	Always	12.5%; (1)	25%; (2)	25%; (2)
Smoking	No	87.5%; (7)	100%; (8)	87.5%; (7)	1.000
Smoking	Yes	12.5%; (1)	0%;	12.5%; (1)	1.000

		nl x CV	p-value	nl x VVC	p-value	CV x VVC	p-value
White		1.0.	0.619	1.0.	1.000	1.0.	0.619
Non-white		2.78; IC95%;: (0.37; 21.03)	0.619	1.00; IC95%;: (0.13; 7.57)	1.000	0.36; IC95%;: (0.05; 2.73)	0.619
Number of pregnancies	0	1.0.	0.223	1.0.	0.648	1.0.	0.231
	1	16.00; IC95%;: (0.72; 354.78)		1.60; IC95%;: (0.10; 24.70)		0.10; IC95%;: (0.01; 1.54)
	> 1	4.00; IC95%;: (0.27; 60.32)		0.27; IC95%;: (0.02; 3.65)		0.07; IC95%;: (0.01; 1.51)
Number of abortions	0	1.0.	0.200.	1.0.	1.000	1.0.	0.569
	1	7.73; IC95%;: (0.31; 193.44)		3.40; IC95%;: (0.12; 96.70)		0.36; IC95%;: (0.03; 5.11)
	> 1	4.64; IC95%;:(0.16;135.57)		0		0.24; IC95%;: (0.01; 7.21)
Recent sex partners (last 6 months)	0	0	0.569	1.0.	1.000	1.0.	0.200.
Recent sex partners (last 6 months)	1	1.0.		0.33; IC95%;: (0.01; 9.57)		0.45; IC95%;: (0.02; 13.41)
	>2	4.20; IC95%;: (0.33; 53.12)		0.11; IC95%;: (0.01;10.27)		0.05; IC95%;: (0.01; 3.73)
Use of condoms	Never	0.50; IC95%;: (0.05; 5.51)	0.256	2.00; IC95%;: (0.14; 28.42)	1.000	4.00; IC95%;: (0.25; 63.95)	0.413
	Sometimes	7.00; IC95%;: (0.22; 218.95)		5.00; IC95%;: (0.11; 220.62)		0.67; IC95%;: (0.03; 18.06)
	Always	1.0.		1.0.		1.0.
Smoker	No	1.0.	1.000.	1.0.	1.000	1.0.	1.000.
Smoker	Yes	0.29; IC95%;: (0.01; 8.37)	1.000.	1.00; IC95%;: (0.05; 19.36)	1.000	3.40; IC95%;: (0.12; 96.70)	1.000.
Discharge aspect	Liquid	1.0.	0.010.	1.0.	0.010	1.0.	1.000.
Discharge aspect	Lumpy	49.00; IC95%;: (2.53; 948.62)	0.010.	49.00; IC95%;: (2.53; 948.62)	0.010	1.00; IC95%;: (0.05; 19.36)	1.000.
Vulvar hyperemia	Yes	1.0.	0.119	1.0.	0.569	1.0.	0.619
Vulvar hyperemia	No	11.67; IC95%;: (0.92; 147.53)	0.119	4.20; IC95%;: (0.33; 53.12)	0.569	0.36; IC95%;: (0.05; 2.73)	0.619
Vaginal hyperemia	Yes	1.0.	0.007	1.0.	0.001	1.0.	1.000.
Vaginal hyperemia	No	44.20; IC95%;: (1.80; 1,088.14)	0.007	4.20; IC95%;: (0.33; 53.12)	0.001	2.33; IC95%;: (0.17; 32.58)	1.000.
Lactobacilli amount	Normal	1.0.	0.007	1.0.	1.000	26.71; IC95%;: (1.14; 624.23)	0.026
Lactobacilli amount	High	44.20; IC95%;: (1.80; 1,088.14)	0.007	1.80; IC95%;:(0.21; 15.41)	1.000	1.0.	0.026
Vaginal epithelium lysis	Low	1.0.	0.001	1.0.	1.000	187.0; IC95%;:(3.21;10884.8)	0.001
	Moderate	1.00; IC95%;: (0.01; 999.99)		1.80; IC95%;: (0.21; 15.41)		119.0; IC95%;:(1.95; 7,273.18)
	High	221.00; IC95%;: (3.85;12,694.7)		0		1.0.
Inflammatory process	None	1.0.	1.000.	1.0.	0.001	1.0.	0.001
	1-4	0.29; IC95%;: (0.01; 8.37)		35.0; IC95%;: (1.12;1,094.7)		119.0; IC95%;: (1.95; 7,273.2)
	> 4	0		165.0; IC95%;: (2.81; 9,675.7)		187.0; IC95%;: (3.21; 10,884.8)
pH	3.8	63.00; IC95%;: (0.98; 4,042.07)	0.003	1.00; IC95%;: (0.01; 999.99)	0.239	1.0.	0.013
	4	81.00; IC95%;: (1.30; 5,046.33)		0.07; IC95%;: (0.01; 2.33)		2.33; IC95%;: (0.07; 76.67)
	4.4	3.00; IC95%;:(0.09; 95.17)		0.20; IC95%;: (0.01; 5.45)		7.00; IC95%;: (0.17; 291.34)
	4.5	1.0.		1.0.		63.00; IC95%;: (0.98; 4,042.1)
	4.7	0				35.00; IC95%;: (0.50; 2,435.7)
Nugent score	0-3	Homogeneous sample	No test	1.0.	0.077	1.0.	0.077
	3-6			13.22; IC95%;: (0.55; 316.64)		13.22; IC95%;: (0.55; 316.64)
	7-10			5.67; IC95%;: (0.19; 169.53)		5.67; IC95%;:(0.19;169.53)

Characteristics		VVC	VC	nl	p-value
Discharge aspect	Liquid	12.5%; (1)	12.5%; (1)	87.5%; (7)	0.002
Discharge aspect	Lumpy	87.5%; (7)	87.5%; (1)	12.5%; (1)	0.002
Vulvar hyperemia	Yes	37.5 (3)	62.5 (5)	12.5 (1)	0.171
Vulvar hyperemia	No	62.5 (5)	37.5 (3)	82.5 (7)	0.171
Vaginal hyperemia	Yes	87.5 (7)	75 (6)	0	0.001
Vaginal hyperemia	No	12.5 (1)	25 (2)	100 (8)	0.001
Lactobacillus amount	Normal	62.5%; (5)	0%;	75%; (6)	0.006
Lactobacillus amount	High	37.5%; (3)	100%; (8)	25%; (2)	0.006
Vaginal epithelium lysis	Low	62.5%; (5)	0%;	75%; (6)
	Moderate	37.5%; (3)	0%;	25%; (2)	0.001
	High	0%;	100%; (8)	0%;
Inflammatory process	None	0%;	100%; (8)	87.5 (7)
	1-4	37.5%; (3)	0%;	12.5%; (1)	0.001
	> 4	62.5%; (5)	0%;	0%;
pH	3.8	0%;	37.5%; (3)	0%;	0.0002
	4	12.5%; (1)	50%; (4)	0%;
	4.4	12.5%; (1)	12.5%; (1)	50%; (4)
	4.5	50%; (4)	0%;	50%; (4)
	4.7	25%; (2)	0%;
Nugent score	0-3	50%; (4)	100%; (8)	100%; (8)
	03-06	37.5%; (3)	0%;	0%;	0.015
	07-10	12.5%; (1)	0%;	0%;

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[1] Address for correspondence José Marcos Sanches, Department of Morphology and Genetics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil (e-mail: ms.marcossanches@gmail.com).