BACKGROUND It is commonly stated that Candida in the vagina prefers a low pH to develop infection. However, mixed infections of Candida with bacterial vaginosis (BV) and aerobic vaginitis (AV) are rather common and may challenge the rule that Candida should only be looked for in low vaginal pH settings. In this study we tested whether the vaginal pH in acute vaginal candidosis is lower than in women successfully treated to prevent Candida recurrences. METHODS Vaginal pH and microscopy findings of vaginal microbiota were recorded during 12 visits over 1.5 years in 117 patients medically monitored during a degressive fluconazole maintenance regimen for proven recurrent vulvovaginal candidosis (ReCiDiF trial). The fluctuation of the mean pH of and microscopic findings of the vaginal smears were studied before, during and after the treatment. RESULTS The mean vaginal pH of women with acute infection before or after ending maintenance treatment was (4.7±0.8 and 4.8 ±1.0, respectively, p>0.05). During maintenance treatment with fluconazole, the pH dropped significantly to 4.5±0.8 (p=0.01). Depression of Lactobacilli spp. (increased lactobacillary grades) was more frequent during the acute, pre-treatment period (30.0%) than during the treatment period (23.1%, p=0.03). Aerobic vaginitis type flora was also more prevalent pre-treatment than during treatment (30.0% vs 22.2%, OR=0.7 (95%CI 0.5-0.9), p=0.01). DISCUSSION In women with RVVC, acute vaginal Candida infection is associated with an increased pH, and disturbed vaginal bacterial microbiota. During fluconazole maintenance treatment, the pH drops to normal levels and the lactobacillary grade improves. CONDENSATION Acute Candida vulvovaginitis can be associated with a disturbance of the vaginal microbiota. In patients with recurrent vulvovaginal candidosis, decrease of pH, and increase of Lactobacilli spp. were observed during fluconazole maintenance treatment. This pH drop was seen in all response groups. This contradicts the common belief that active vaginal Candida infection is related to low pH.

中文翻译：

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氟康唑维持治疗复发性阴道阴道念珠菌病（RVVC）期间的阴道pH和微生物群。

背景技术通常认为阴道中的念珠菌偏爱低pH值来发展感染。但是，念珠菌与细菌性阴道病（BV）和好氧性阴道炎（AV）的混合感染相当普遍，并且可能挑战仅在低阴道pH值条件下寻找念珠菌的规则。在这项研究中，我们测试了急性阴道念珠菌病中的阴道pH是否低于成功治疗以预防念珠菌复发的女性。方法在1.5年的12次随访中，对117例患者进行了阴道pH值检查和阴道镜检查，该患者在氟康唑降级维持治疗方案中接受了医学检查，以确诊复发性阴道阴道念珠菌病（ReCiDiF试验）。在治疗前，治疗中和治疗后，研究了阴道涂片的平均pH值的波动和显微镜下的发现。结果在结束维持治疗之前或之后，急性感染妇女的平均阴道pH值分别为（4.7±0.8）和4.8±1.0，p> 0.05。在用氟康唑维持治疗期间，pH显着下降至4.5±0.8（p = 0.01）。乳酸杆菌属的抑郁症。（乳酸菌等级升高）在急性治疗前期（30.0％）比治疗期（23.1％，p = 0.03）更频繁。有氧性阴道炎类型菌群在治疗前也比治疗期间更为普遍（30.0％vs 22.2％，OR = 0.7（95％CI 0.5-0.9），p = 0.01）。讨论在患有RVVC的女性中，急性阴道念珠菌感染与pH升高和阴道细菌群受到干扰有关。在氟康唑维持治疗期间，pH降至正常水平，乳酸菌等级提高。凝结急性念珠菌性外阴阴道炎可与阴道微生物群紊乱有关。在复发性阴道阴道念珠菌病患者中，pH降低，乳酸杆菌属增加。在氟康唑维持治疗期间观察到。在所有应答组中均观察到该pH下降。这与人们普遍认为活动性阴道念珠菌感染与低pH有关。