The signs and symptoms were similar to vulvovaginal candidiasis. Although not mentioned in the article, remaining cases could have been diagnosed as cytolytic vaginosis, if further investigations were carried out. In one more study of 271 patients with vulvovaginal complaints, 29 (10.7%) were diagnosed as having suggestive vulvovaginal candidiasis, but only 16 (5.9%) had a confirmed diagnosis of candidiasis. In yet another study, the number of patients diagnosed with cytolytic vaginosis was defined as only five in 101 women with abundant vaginal discharge. Five were in the luteal phase, with enhanced complaints of discharge and pruritus. All of these cases were in the reproductive age groups of 25–40 years. , in their study of 210 women with vaginal discharge and other symptom/signs of genital pathology, suggestive of vulvovaginal candidiasis, observed that fifteen patients (7.1%) were diagnosed with cytolytic vaginosis. Cyclical increase in symptoms is more pronounced during luteal phase. It has also been observed that symptoms will be more during luteal phase and it has been suggested that in the luteal phase there is remarkable rise in the number of colonizing Lactobacilli.Ĭytolytic vaginosis is characterized by pruritus, dyspareunia, and vulval dysuria. Patients who have diabetes mellitus may also develop cytolytic vaginosis as it has been claimed that the Lactobacilli are more abundant in women with high serum glucose levels. These individuals are misdiagnosed as candidiasis and do not respond to repeated antifungal therapy regimens for suspected recurrent vulvovaginal candidiasis. This dissolution causes dysuria in individuals with cytolytic vaginosis. In these patients, Lactobacilli alone or in combination with other bacteria, may cause damage to the vaginal intermediate epithelium that may result in dissolution of the cells. Sometimes, a few individuals within the reproductive age group may have overgrowth of Lactobacilli. As mentioned earlier, Lactobacilli builds up a barrier against candidal overgrowth by blocking the adhesion of candidal yeast cells to vaginal epithelial cells, through competition for nutrients. Further, Lactobacilli in low numbers (five bacilli per ten squamous cells) in vaginal discharges have been considered as protective factors against vaginal candidiasis. Normal vaginal flora in adult women within the reproductive age group usually consists of Lactobacilli. According to several studies, Lactobacilli builds up a barrier against candidal overgrowth by blocking the adhesion of yeast to vaginal epithelial cells through competition for nutrients. The protective role of various other antimicrobial products such as lactacin B and lactocidin are not clearly established. It has also been suggested that H 2O 2 positive strains of Lactobacilli may also protect against human immunodeficiency virus (HIV) infection. coli, Candida species, Gardnerella vaginalis and Mobilincus species. This may prevent overgrowth of organisms such as E. Some species of Lactobacilli also produce hydrogen peroxide (H 2O 2), which is toxic to various microorganisms. Lactobacillus converts glucose to lactic acid. After puberty under the influence of oestrogen, glycogen is deposited in the vaginal epithelial cells, which is metabolized by vaginal epithelial cells to glucose. Lactobacilli produce lactic acid from glucose, keeping the vagina at an acidic pH. It is also suggested that the presence of oestrogen and lactobacillus are needed to achieve an optimal vagina pH of 4.0–4.5%. Healthy women of reproductive age groups are usually colonized by lactobacillus and Gardnerella vaginalis. Doderlein, first described the normal vaginal flora as, consisting of predominantly of the acid producing gram-positive rods, now referred as lactobacillus species.
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