Elevated nitric oxide in recurrent vulvovaginal candidiasis - association to clinical findings.
Acta Obstet Gynecol Scand. 2017 Jan 04;:
Authors: Alvendal C, Ehrström S, Brauner A, Lundberg JO, Bohm-Starke N
INTRODUCTION: Recurrent vulvovaginal candidiasis (RVVC) is defined as 3-4 episodes per year and causes substantial suffering. Little is known about the mechanisms leading to relapses in otherwise healthy women. Nitric oxide (NO) is part of the non-specific host defense and is increased during inflammation. NO levels were measured and the expression of inducible nitric oxide synthase (iNOS) was analyzed in the vagina during an acute episode of RVVC and after treatment with fluconazole.
MATERIAL AND METHODS: Twenty-eight women, with symptoms of RVVC were enrolled together with 31 healthy controls. NO was measured with an air-filled 25 ml silicon catheter balloon incubated in the vagina for 5 min and then analyzed by chemiluminescence technique. Vaginal biopsies were analyzed for the expression of iNOS. Symptoms and clinical findings were surveyed using a score system. The measurements and biopsies were repeated in patients after six weeks fluconazole treatment.
RESULTS: NO levels were increased during acute infection (median 352 ppb) compared to controls (median 6 ppb), p<0.0001. The levels decreased after treatment (median 18 ppb) but were still higher than in controls. Increased expression of iNOS was observed in the epithelial basal layer in patients before and after treatment compared to controls. Before treatment, there were positive correlations between NO and symptom (rs =0.644) and examination scores (rs = 0.677), p<0.001.
CONCLUSIONS: NO is significantly elevated in patients with RVVC during acute episodes of infection and decreases after antifungal treatment. The results illustrate the pronounced inflammatory response in RVVC correlating to symptoms of pain and discomfort. This article is protected by copyright. All rights reserved.
PMID: 28052314 [PubMed - as supplied by publisher]