Abstract:

Objective To investigate the correlation between vaginal Candida virulence factors，host immune response and the recurrence of candidal vaginitis. Methods The clinical data of 150 patients with candidal vaginitis in Shaoxing Central Hospital from January 2019 to December 2022 were collected. The patients were classified into recurrent vulvovaginal candidiasis（RVVC） group，vulvovaginal candidiasis（VVC） group and asymptomatic vaginal Candida colonization（AC） group based on their conditions. The differences in clinical data，the abilities of biofilm formation，the expression levels of virulence factors in vitro，the immune status of the host's vaginal fluid and the differences in the vaginal inflammatory process among the 3 groups were compared. Results The ability of Candida in RVVC group to form biofilms was higher than those in VVC and AC groups（P<0.05）. The levels of secreted aspartyl proteinase（SAP）-Pz，phospholipase（PL）-Pz and lipase（Lip）-Pz in RVVC group were lower than those in VVC and AC groups（P<0.05），and the in vitro expression level of HWP1 gene in RVVC group was higher than those in VVC and AC groups（P<0.05）. The levels of interferon-gamma（IFN-γ），tumor necrosis factor-alpha（TNF-α） and TNF-α/interleukin（IL）-10 in RVVC group were lower than those in VVC group（P<0.05），and the levels of IL-10 and IL-4 were higher than those in VVC group（P<0.05）. The incidence rate of vaginitis in VVC group（96%）was higher than those in RVVC group（78%）and AC group（82%）（P<0.05）. Conclusions The levels of SAP，PL，Lip and HWP1 are positively correlated with the abilities of biofilm frormation. A weakened inflammatory response will increase the recurrence rate of candidal vaginitis.

Key words: Candida albicans, Candidal vaginitis, Biofilm, Virulence factor, Humoral immunity