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ORIGINAL RESEARCH article
Front. Microbiol.
Sec. Infectious Agents and Disease
Volume 16 - 2025 | doi: 10.3389/fmicb.2025.1566171
This article is part of the Research Topic Women in Infectious Agents and Disease: 2024 View all 10 articles
New insights in the role of Candida biofilm in the pathogenesis of recurrent vulvovaginal candidiasis: A prospective clinical study
Provisionally accepted
María Guembe 1*
Marta Díaz Navarro 1
Alvaro Irigoyen-von-Sierakowski 1
Imani Delcán 2 Ariadna Monte 2 María Palomo 1
Pilar Escribano 1
Jesus Guinea 1
Almudena Burillo 1 Alicia Galar 1
Patricia Munoz 1- 1 Gregorio Marañón Hospital, Madrid, Spain
- 2 Complutense University of Madrid, Madrid, Madrid, Spain
Background. Despite the pathogenesis of vulvovaginal candidiasis (VVC) is multifactorial, this study aimed to assess whether phenotypic characteristics, such as biofilm production and quality, along with clinical symptoms, are associated with recurrent VVC (RVVC). Methods. Over one year (Oct 2021-Oct 2022), we prospectively included 271 patients ≥18 years who attended our institution, had Candida spp. isolated in vaginal swabs, and provided informed consent. Patients were followed for one year. Candida spp. isolates were tested by the following techniques: crystal violet (CV) for biomass quantification, XTT for metabolic activity quantification, and microscopy for biofilm area quantification. Clinical and microbiological data were also collected.Results. Overall, 55 (20.3%) patients experienced at least one recurrence, with 19 (7.0%) meeting the criteria for RVVC (≥3 episodes/year), with 65 episodes in total. Demographic and clinical characteristics were similar in both study groups. Most isolates were C. albicans (90.0%). Median (interquartile, [IQR]) absorbance values for CV and XTT in 18/19 RVVC and 238/252 non-RVVC isolates were as follows: CV, 1.850 (1.578-2.156) vs. 1.426 (1.081-1.823), p=0.005; XTT, 0.184 (0.116-0.293) vs. 0.228 (0.147-0.331), p=0.253. Median (IQR) biofilm occupation area percentage in 16/19 RVVC and 16/252 non-RVVC isolates was, respectively: 13.15 (8.54-16.9) and 10.73 (5.88-17.73), p=0.710.Conclusion. RVVC was associated to high biomass production. Additionally, RVVC clinical isolates exhibited a tendency toward lower metabolic activity, which may contribute to treatment failure.
Keywords: Biofilm, Recurrent vulvovaginal candidiasis, Pathogenesis, biomass, metabolic activity
Received: 27 Jan 2025; Accepted: 17 Mar 2025.
Copyright: © 2025 Guembe, Díaz Navarro, Irigoyen-von-Sierakowski, Delcán, Monte, Palomo, Escribano, Guinea, Burillo, Galar and Munoz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
María Guembe, Gregorio Marañón Hospital, Madrid, Spain
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