The rectal carriage of yeast in patients with vaginal candidiasis

Reinfection from the lower gastrointestinal tract is a possible source of recurrent vulvo-vaginal candidiasis. A prospective study to assess the prevalence of yeast carriage in various orifices (including the rectum) in controls and patients, and the relationship to acute vaginitis, was conducted. Cultures for yeast were obtained from the mouth, rectum, vulva, and vagina every 1-2 months for 1 y from the patients. The prevalence of yeast carriage in healthy controls was 3/37 (8.1%) from the vulva, vagina, and rectum, and 4/37 (10.8%) from the mouth. In patients, yeast carriage during episodes of vaginitis was: from the vagina, 190/193 (98.4%); from the vulva, 107/193 (55.4%); from the rectum, 93/193 (48.2%); and from the mouth, 52/193 (26.9%). During visits without vaginitis, yeast carriage was lower: in the rectum, 59/587 (10.1%); in the vulva, 53/459 (11.6%); in the vagina, 77/587 (13.1%); and in the mouth, 89/587 (15.2%). Yeast in the lower bowel during symptomatic vaginitis is higher (p = 0.0001) than in controls, but not significantly greater during asymptomatic periods. Recurrence of Candida vaginitis is not dependent on yeast reservoir in the lower gut between symptomatic episodes.