New insights into the immune pathogenesis of recurrent vulvovaginal candidiasis
Genome-Wide Association Study
Nucleic Acid Amplification Techniques
Recurrent vulvovaginal candidiasis remains an unsolved challenge for gynaecologists and other clinicians. Although treatment of a current candidal vaginal infection with a variety of antifungal agents is generally effective there are at present no means of determining which women are susceptible to frequent recurrences of vulvovaginal candidiasis, the reason(s) for increased susceptibility and how to prevent repeated infections from occuring. Evidence is mounting that susceptibility to recurrent vulvovaginal candidiasis is related to an inability of the cell-mediated immune system to effectively limit Candida growth in the vagina. This may be due to a genetic or acquired propensity towards induction of a humoral (Th2) immune response to this organism, the presence of a vaginal allergic response to Candida or another allergen present in the vagina which results in prostaglandin E2 production and a localized immunosuppression, and/or induction of heat shock proteins which downregulate cell-mediated immune activation. Development of new treatments aimed at bolstering protective Th1 immune responses and/or inhibiting the localized vaginal immunosuppression are necessary to reduce the frequent recurrences of vulvovaginal candidiasis in susceptible women.