Vulvovaginal Candidiasis in Pregnancy


Prevalence studies indicate that Candida species colonize the vagina in at least 20 % of all women, rising to 30 % in pregnancy. Although, some studies concluded that pregnant women were more likely to have symptomatic vaginal infections caused by Candida, yet other studies found a high prevalence of asymptomatic infection only during pregnancy. Most episodes of symptomatic vulvovaginal candidiasis (VVC) occur during the second and third trimesters. The increased risk of VVC in pregnancy is likely sustained by pregnancy-related factors, such as immunologic alterations, increased estrogen levels, and increased vaginal glycogen production. Although evidence is incomplete, there is some emerging data which suggests that candidiasis in pregnancy may be associated with increased risk of pregnancy complications, such as premature rupture of membranes, preterm labor, chorioamnionitis, and congenital cutaneous candidiasis. In contrast to nonpregnant women, there are no formal studies, evaluating the use of long-term suppressive maintenance oral azoles in the treatment of recurrent VVC (RVVC) in pregnancy. Most clinicians do not offer suppressive therapy in pregnancy and prefer to treat individual symptomatic episodes only utilizing a topical imidazole vaginally for 7 days to minimize systemic exposure to medications.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Jaeger M, Plantinga TS, Joosten LA, Kullberg B, Netea M. Genetic basis for recurrent vulvo-vaginal candidiasis. Curr Infect Dis Rep. 2013;15:136–42.

    Article  PubMed  Google Scholar 

  2. 2.

    Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369:1961–71.

    Article  PubMed  Google Scholar 

  3. 3.

    Mendling W, Brasch J. Guideline vulvovaginal candidosis (2010) of the German Society for Gynecology and Obstetrics, the Working Group for Infections and Infectimmunology in Gynecology and Obstetrics, the German Society of Dermatology, the Board of German Dermatologists and the German Speaking Mycological Society. Mycoses. 2012;55:1–13.

    Article  PubMed  Google Scholar 

  4. 4.

    Fardiazar Z, Ronaci F, Torab R, Goldust M. Vulvovaginal candidiasis recurrence during pregnancy. Pak J Biol Sci. 2012;15:399–402.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Galask RP. Vaginal colonization by bacteria and yeast. Am J Obstet Gynecol. 1988;158:993–5.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Akerele J, Abhulimen P, Okonofua F. Prevalence of asymptomatic genital infection among pregnant women in Benin City, Nigeria. Afr J Reprod Health. 2002;6:93–7.

    Article  PubMed  Google Scholar 

  7. 7.

    de Oliveira JM, Cruz AS, Fonseca AF, Vaz CP, Rodrigues A, Aurea F, et al. Prevalence of Candida albicans in vaginal fluid of asymptomatic Portuguese women. J Reprod Med. 1993;38:41–2.

    PubMed  Google Scholar 

  8. 8.•

    Leli C, Mencacci A, Meucci M, Bietolini C, Vitalli M, Farinelli S, et al. Association of pregnancy and Candida vaginal colonization in women with or without symptoms of vulvovaginitis. Minerva Ginecol. 2013;65:303–9. This study found that pregnancy is independently associated with a lower probability of having symptoms of Candida vulvovaginitis. The possible explanation is the modulation of maternal immune system and the anti-inflammatory state present during pregnancy.

    CAS  PubMed  Google Scholar 

  9. 9.

    Nelson DB, Bellamy S, Nachamkin I, Ruffin A, Allen-Taylor L, Friedenberg FK. Characteristics and pregnancy outcomes of pregnant women asymptomatic for bacterial vaginosis. Matern Child Health J. 2008;12:216–22.

    Article  PubMed  Google Scholar 

  10. 10.

    Sobel JD. Genital candidiasis. In: Bodey GP, editor. Candidiasis: pathogenesis, diagnosis and treatment. 2nd ed. New York, NY: Raven; 1993. p. 225–47.

    Google Scholar 

  11. 11.

    Ilkit M, Guzel AB. The epidemiology, pathogenesis, and diagnosis of vulvovaginal candidosis: a mycological perspective. Crit Rev Microbiol. 2011;37:250–61.

    Article  PubMed  Google Scholar 

  12. 12.•

    Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. N Engl J Med. 2014;370:2211–8. This article discusses evolving concepts of immunologic alterations during pregnancy that may help explain the altered severity of and susceptibility of infectious diseases in pregnancy.

    Article  PubMed  Google Scholar 

  13. 13.

    Cvoro A, Tatomer D, Tee MK, Zogovic T, Harris HA, Leitman DC. Selective estrogen receptor-beta agonists repress transcription of proinflammatory genes. J Immunol. 2008;180:L630–6.

    Article  Google Scholar 

  14. 14.

    Straub RH. The complex role of estrogens in inflammation. Endocr Rev. 2007;28:521–74.

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Robinson DP, Klein SL. Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Horm Behav. 2012;62:263–71.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. 16.

    Szekeres-Bartho J, Wegmann TG. A progesterone-dependent immunomodulatory protein alters the Th1/Th2 balance. J Reprod Immunol. 1996;31:81–95.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol. 2010;62:425–33.

    Article  Google Scholar 

  18. 18.

    Pazos M, Sperling RS, Moran TM, Kraus TA. The influence of pregnancy on systemic immunity. Immunol Res. 2012;54:254–61.

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Kraus TA, Engel SM, Sperling RS, Kellerman L, Lo Y, Wallenstein S, et al. Characterizing the pregnancy immune phenotype: results of the Viral Immunity and Pregnancy (VIP) study. J Clin Immunol. 2012;32.

  20. 20.

    Zoller AL, Schnell FJ, Kersh GJ. Murine pregnancy leads to reduced proliferation of maternal thymocytes and decreased thymic emigration. Immunology. 2007;121:207–15.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. 21.

    Clarke AG, Kendall MD. The thymus in pregnancy: the interplay of neural, endocrine and immune influences. Immunol Today. 1994;15:545–51.

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Forbes RL, Gibson PG, Murphy VE, Wark PAB. Impaired type I and III interferon response to rhinovirus infection during pregnancy and asthma. Thorax. 2012;67:209–14.

    Article  PubMed  Google Scholar 

  23. 23.

    Medawar P. Some immunological and endocrinological problems raised by the evolution of viviparity in vertebrates. Symp Soc Exp Biol. 1953;7:320–38.

    Google Scholar 

  24. 24.

    Lissauer D, Piper K, Goodyear O, Kilby MD, Moss PA. Fetal-specific CD8+ cytotoxic T cell responses develop during normal human pregnancy and exhibit broad functional capacity. J Immunol. 2012;189:1072–80.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Sperling RS, Engel SM, Wallenstein S, Kraus TA, Garrido J, Singh T, et al. Immunogenicity of trivalent inactivated influenza vaccination received during pregnancy or postpartum. Obstet Gynecol. 2012;119:631–9.

    Article  PubMed Central  PubMed  Google Scholar 

  26. 26.

    Ohfuji S, Fukushima W, Deguchi M, Kawabata K, Yoshida H, Hatayama H, et al. Immunogenicity of a monovalent 2009 influenza A (H1N1) vaccine among pregnant women: lowered antibody response by prior seasonal vaccination. J Infect Dis. 2011;203:1301–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. 27.

    Healy CM. Vaccines in pregnant women and research initiatives. Clin Obstet Gynecol. 2012;55:474–86.

    Article  PubMed  Google Scholar 

  28. 28.

    Munoz FM, Bond NH, Maccato M, Pinell P, Hammill HA, Swamy GK, et al. Safety and immunogenicity of Tdap vaccine in healthy pregnant women, safety in their neonates, and effect of maternal immunization on infant immune responses to DTaP vaccine. Presented at the 2nd International Maternal Neonatal Immunization Symposium, Antalya, Turkey, March 1–3, 2013. abstract.

  29. 29.

    Carvalho LP, Bacellar O, Neves N, de Jesus AR, Carvalho EM. Downregulation of IFN-gamma production in patients with recurrent vaginal candidiasis. J Allergy Clin Immunol. 2002;109:102–5.

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Dekel N, Gnainsky Y, Granot I, Mor G. Inflammation and implantation. Am J Reprod Immunol. 2010;63:17–21.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. 31.

    Mor G. Inflammation and pregnancy: the role of toll-like receptors in trophoblast-immune interaction. Ann N Y Acad Sci. 2008;1127:121–8.

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Mazor M, Chaim W, Shinwell ES, Glezerman M. Asymptomatic amniotic fluid invasion with Candida albicans in preterm premature rupture of membranes. Implications for obstetric and neonatal management. Acta Obstet Gynecol Scand. 1993;72:52–4.

    Article  CAS  PubMed  Google Scholar 

  33. 33.•

    Roberts CL, Rickard K, Kotsiou G, Morris JM. Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: an open label pilot randomized controlled trial. BMC Pregnancy Childbirth. 2011;11:18. This pilot study demonstrated a tendency towards a reduction in spontaneous preterm birth among women with asymptomatic candidiasis who were treated with clotrimazole.

    Article  PubMed Central  PubMed  Google Scholar 

  34. 34.

    Meizoso T, Rivera T, Fernandez-Acenero MJ. Intrauterine candidiasis: report of four cases. Arch Gynecol Obstet. 2008;278:173–6.

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Friebe-Hoffman U, Bender D, Sims C, Rauk P. Candida albicans chorioamnionitis associated with preterm labor and sudden intrauterine demise of one twin, a case report. J Reprod Med. 2000;45:354–6.

    Google Scholar 

  36. 36.

    Chaim W, Mazor M, Wiznitzer A. The prevalence and clinical significance of intraamniotic infection with Candida species in women with preterm labor. Arch Gynecol Obstet. 1992;251:9–15.

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    Bean LM, Jackson JR, Dobak WJ, Beiswenger TR, Thorp JA. Intra-amniotic fluconazole therapy for Candida albicans intra-amniotic infection. Obstet Gynecol. 2013;121:452–4.

    CAS  PubMed  Google Scholar 

  38. 38.

    Sfamemi SF, Talbot JM, Chow SL, Brenton LA, Scurry JP. Candida glabrata chorioamnionitis following in vitro fertilization and embryo transfer. Aust NZ J Obstet Gynaecol. 1997;37:88–91.

    Article  Google Scholar 

  39. 39.

    Fidel Jr PL, Vasquez JA, Sobel JD. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans. Clin Microbiol Rev. 1999;12:80–96.

    PubMed Central  PubMed  Google Scholar 

  40. 40.

    Ibara AS, Marcorelles P, Le Martelot MT, Touffet N, Moalic E, Hery-Arnaud G, et al. Two cases of systemic Candida glabrata infection following in vitro fertilization and embryo transfer. Eur J Clin Microbiol Infect Dis. 2004;23:53–6.

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Khan ZU, Ahmad S, Al-Obaid I, Al-Sweih NA, Joseph L, Farhat D. Emergence of resistance to amphotericin B and triazoles in Candida glabrata vaginal isolates in a case of recurrent vaginitis. J Chemother. 2008;20:488–91.

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Ozer E, Unlu M, Ersen A, Gulekli B. Intrauterine fetal loss associated with Candida glabrata chorioamnionitis: report of two cases. Turk Patoloji Derg. 2013;29:77–9.

    PubMed  Google Scholar 

  43. 43.

    Darmstadt GL, Dinulos JG, Miller Z. Congenital cutaneous candidiasis: clinical presentation, pathogenesis, and management guidelines. Pediatrics. 2000;105(2):438.

    Article  CAS  PubMed  Google Scholar 

  44. 44.

    Almeida Santos L, Beceiro J, Hernandez R, Salas S, Escriba R, Garcia Frias E, et al. Congenital cutaneous candidiasis: report of four cases and review of the literature. Eur J Pediatr. 1991;150(5):336.

    Article  CAS  PubMed  Google Scholar 

  45. 45.

    Workowski KA, Berman S. Centers for Disease Control and Prevention (CDC) sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1.

    PubMed  Google Scholar 

  46. 46.

    Young GL, Jewell D. Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database Syst Rev. 2001.

  47. 47.

    United Kingdom National Guideline on the Management of Vulvovaginal Candidiasis (2007). Available at (Accessed 4 Dec 2008).

  48. 48.

    Young G, Jewell D. Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database of Systematic Reviews 2001. Issue 4.

  49. 49.

    Lopez-Rangel E, Van Allen MI. Prenatal exposure to fluconazole: an identifiable dysmorphic phenotype. Birth Defects Res A Clin Mol Teratol. 2005;73(11):919.

    Article  CAS  PubMed  Google Scholar 

  50. 50.

    FDA Drug Safety Communication: use of long-term, high-dose Diflucan (fluconazole) during pregnancy may be associated with birth defects in infants

  51. 51.

    Mølgaard-Nielsen D, Pasternak B, Hviid A. Use of oral fluconazole during pregnancy and the risk of birth defects. N Engl J Med. 2013;369(9):830.

    Article  PubMed  Google Scholar 

  52. 52.

    Jick SS. Pregnancy outcomes after maternal exposure to fluconazole. Pharmacotherapy. 1999;19(2):221.

    Article  CAS  PubMed  Google Scholar 

  53. 53.

    Sorensen HT, Nielsen GL, Olesen C, Larsen H, Steffensen FH, Schønheyder HC, et al. Risk of malformations and other outcomes in children exposed to fluconazole in utero. Br J Clin Pharmacol. 1999;48(2):234.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  54. 54.

    Inman W, Pearce G, Wilton L. Safety of fluconazole in the treatment of vaginal candidiasis. A prescription-event monitoring study, with special reference to the outcome of pregnancy. Eur J Clin Pharmacol. 1994;46(2):115–8.

    Article  CAS  PubMed  Google Scholar 

  55. 55.

    Mastroiacovo P, Mazzone T, Botto LD, Serafini MA, Finardi A, Caramelli L, et al. Prospective assessment of pregnancy outcomes after first-trimester exposure to fluconazole. Am J Obstet Gynecol. 1996;175(6):1645.

    Article  CAS  PubMed  Google Scholar 

  56. 56.

    Nørgaard M, Pedersen L, Gislum M, Erichsen R, Søgaard KK, Schønheyder HC, et al. Maternal use of fluconazole and risk of congenital malformations: a Danish population-based cohort study. J Antimicrob Chemother. 2008;62(1):172.

    Article  PubMed  Google Scholar 

  57. 57.

    Wilton LV, Pearce GL, Martin RM, Mackay FJ, Mann RD. The outcomes of pregnancy in women exposed to newly marketed drugs in general practice in England. Br J Obstet Gynaecol. 1998;105(8):882–9.

    Article  CAS  PubMed  Google Scholar 

  58. 58.

    Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004;351(9):876.

    Article  CAS  PubMed  Google Scholar 

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Tina Aguin and Jack Dr Sobel have no conflict of interest.

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Correspondence to J. D. Sobel.

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This article is part of the Topical Collection on Genitourinary Infections

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Aguin, T.J., Sobel, J.D. Vulvovaginal Candidiasis in Pregnancy. Curr Infect Dis Rep 17, 30 (2015).

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  • Vulvovaginal
  • Candidiasis
  • Recurrent
  • Pregnancy