Belgian study finds seasonal variance in Candida infections

Candida infections are among the most common reasons patients visit their providers. What increases the likelihood of these infections? In a 10-year, lab-based cohort study, researchers examined how seasonal variations and changes in diet, clothing, exposure to the sun, and temperature play a role in Candida infections.

Gilbert G G Donders, MD, PhD, of Femicare, Clinical Research for Women in Tienen, Belgium, and also the departments of obstetrics and gynecology at both Regional Hospital Heilig Hart (also in Tienen), and University Hospital in Antwerpen, Belgium, and colleagues conducted the study. Researchers examined 12,941 vaginal cultures from vulvovaginitis clinic patients from the Department of the Regional Hospital Heilig Hart in Tienen, Belgium from September 2007 to August 2017. Seventy percent of the women were from the area local to the hospital and 30% were from more rural areas, Donders and colleagues reported. Five percent were from non-European countries. “At this consultation, mainly patients presenting with recurrent vulvovaginal symptoms, with vague and undetermined symptoms, or for follow up during treatment regimens were seen,” researchers reported.1

Swab samples were collected from the upper lateral vaginal vault using a speculum and immediately placed into a liquid Amies preservation medium, then transported to a lab and examined for Candida. Researchers comparedthe presence of albicans and non-albicans species monthly to look for seasonal variation in the winter and summer using Chi-square and chi-square for trend analysis.

Donders and colleagues reported that in 2019, 16% of samples were positive with albicans versus non-albicans species only varying between 1-2% per month and no large differences on a monthly basis.1 For the 10-year period, researchers said June was the month with the highest number of infections (19.0%, p = 0.008) and December had the lowest number (14.5%, p = 0.04).1 Summer had the most number at 15.5% from June, July, and August, while the winter months of December, January, and February had 14%.1

“Change in temperature, dietary habits, and bodily adaptations due to increased amount of sunlight were discussed as potential pathophysiological mechanisms to explain the excess of Candida in summertime. Further confirmatory research would be beneficial. Women at risk for Candida vulvovaginitis should pay more attention to living habits in summertime to avoid recurrences,” Donders and colleagues reported.1

In an interview with Contemporary OB/GYN® Donders said caring for women with recurrent Candida vaginitis is very difficult. “Very often, physicians and other health care providers don’t know how to handle the disease and start to provide personal advice,” he said. This can include changing underwear, avoiding soap use on the genitals, refraining from bathing, and changing their diet, Donders explained. “Unfortunately, most of these ‘don’t do’s’ only accumulate and make a woman’s life miserable. They seldomly solve or improve the problem of recurrent vulvovaginitis,” Donders said.

Donders told Contemporary OB/GYN® that there is vast experience in taking care of patients lasting over several decades, with a large quantity of lab test results and clinical data. “This allowed us to study in more detail several host factors such as the influence of genetic predisposition, concomitant skin disease, glucose metabolism, and multiple site colonization with candida in women with recurrent vulvovaginal candidiasis,” he said. He added that the nature of the infecting organism and symptom severity may differ from person to person. The organism can also give closer insight into the development of both antimycotic resistance of C albicans as well as the shift from C albicans towards more non-albicans Candida infections in women taking antimycotic regularly.

“We had the clinical impression that Candida vaginitis presented more often during summertime, and less in wintertime, but this has never been studied before to our knowledge,” Donders explained to Contemporary OB/GYN®. “We studied the seasonal influence on an undeniable standard: the number and proportion of positive vaginal cultures per month, over a period of 10 years.” He said this showed a peak of Candida vaginitis is present in June-July and a dip in winter. “Being able to use a large database from a single lab, using an unchanged technique over that period of time, we were able to find a difference in rates in winter versus summertime and speculated about the hypothetical reasons for this. We could also determine that non-albicans strains were not the cause of the differences found,” Donder said.

Reference

Donders GGG, Ruban K, Donders F, Reybrouck R. Lab-Based Retrospective 10-Year Analysis Shows Seasonal Variation of Vaginal Candida Infection Rates in Belgium. J Clin Med. 2022;11(3):574. Published 2022 Jan 24. doi:10.3390/jcm11030574