Skip to main content
SpringerLink
Log in

Lower genital tract infections in diabetic women

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

The influence of glucose metabolism is seen in many infectious diseases, making diabetic patients more vulnerable to sepsis and other serious sequelae of bacterial invasion. Vaginal candidiasis is a common problem if the glycemia is poorly controlled. The level of glucose concentration in the blood after ingestion of sugar seems to explain an increased likelihood of recurrent infection. Specific immune aberrations, such as an elevated T-helper 2 response and a blunted T-helper 1 response, leading to tolerance, may result in chronic recurrent vulvovaginal candidiasis. In such patients, a low-grade infection with frequent exacerbations is seen, and treatment should be based on 24-hour glycemic control and long intermittent treatment with antifungals. Besides candidiasis, there is also evidence of an increased likelihood of cystitis. Upper urinary tract infections (UTIs) are also a frequent result of bladder colonization. Lethal emphysematous nephritis due to Candida albicans or gas-forming bacteria such as Escherichia coli, Klebsiella, Proteus, streptococci, or enterococci are known to occur in diabetic patients. Furthermore, UTIs in diabetic patients are difficult to eradicate and need longer and intense antibiotic therapy. Awareness of the increased likelihood of UTIs, frequent screening, and prolonged treatment in case of cystitis are warranted. For the prevention of UTI and bacterial vaginal infections (bacterial vaginosis, vaginal atrophy with bacterial colonization, aerobic vaginitis) estrogen therapy may be as important as antibiotic therapy. Catheterization should be limited since it promotes infection more in diabetic patients than in nondiabetic patients. In the case of recurrent vaginal candidiasis, tight control of glycemia is crucial, in addition to prolonged, intermittent therapy with antifungals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Rayfield EJ, Ault MJ, Keusch GT, et al.: Infection and diabetes: the case of glucose control. Am J Med 1982, 72:439–442. Combination of physiologic principles, good overview, and data from an era when experiments could be done that would now be difficult to get approval for. Even after 20 years, this paper is a recommended source of information.

    Article  PubMed  CAS  Google Scholar 

  2. Rayfield EJ, Curnow RT, Reinhard D, Kochicheril NM: Effects of acute endotoxemia on glucoregulation in normal and diabetic subjects. J Clin Endocrinol Metab 1977, 45:513–519.

    Article  PubMed  CAS  Google Scholar 

  3. Esman V: The diabetic leukocyte. Enzyme 1972, 13:32.

    Google Scholar 

  4. Bagdade JD, Root RK, Dulgar RJ: Impaired leukocyte function in patients with poorly controlled diabetes. Diabetes 1974, 23:9.

    PubMed  CAS  Google Scholar 

  5. Perillie PE, Nolan JP, Finch SC: Studies of the resistance to infection in diabetes mellitus: local exudative cellular response. J Lab Clin Med 1962, 59:1008.

    PubMed  CAS  Google Scholar 

  6. Brayton RG, Stokes PE, Swartz MS, Louria DB: Effect of alcohol and various diseases on leukocyte mobilization, phagocytosis and intracellular bacterial killing. N Engl J Med 1970, 280:123.

    Article  Google Scholar 

  7. McGuish AC, Urbaniak SJ, Campbell CJ: Phytohemagglutinin transformation and circulating lymphocyte subpopulation in insulin-dependent diabetic patients. Diabetes 1974, 23:708–712.

    Google Scholar 

  8. Casey JI, Heeter BJ, Klyshevich KA: Impaired response of lymphocyte s of diabetic subjects to antigen of Staphylococcus aureus. J Infect Dis 1977, 136:495–499.

    PubMed  CAS  Google Scholar 

  9. Pometta D, Rees SB, Younger D, Kass EH: Asymptomatic bacteriuria in diabetes mellitus. N Engl J Med 1967, 276:1118.

    Article  PubMed  CAS  Google Scholar 

  10. O’Sullivan DJ, FitzGerald MG, Meymell MJ, Malins JM: Urinary tract infection: a comparative study in the diabetic and general population. Br Med J 1961, I:786.

    Google Scholar 

  11. Szücs S, Csehati I, Csapo G, Balazs V: The relation between diabetes mellitus and infections of the urinary tract. Am J Med Sci 1960, 240:520.

    Google Scholar 

  12. Vejlsgaard R: Studies on urinary infections in patients with diabetes mellitus. I. Bacteriuria in patients with diabetes mellitus and in control subjects. Acta Med Scand 1966, 179:173.

    Article  PubMed  CAS  Google Scholar 

  13. Kass EH: Asymptomatic infections of the urinary tract. Trans Assoc Am Physicians 1956, 69:56.

    PubMed  CAS  Google Scholar 

  14. Ooi BS, Chen BTM, Yu M: Prevalence and site of bacteriuria in diabetes mellitus. Postgrad Med J 1974, 50:497.

    Article  PubMed  CAS  Google Scholar 

  15. Forland M, Thomas V, Shelokov A: Urinary tract infections in patients with diabetes mellitus: studies on antibody coating of bacteria. JAMA 1977, 238:1924–1929.

    Article  PubMed  CAS  Google Scholar 

  16. Bruns W, Weuffen W, Godel E, et al.: Zur haufigkeit von Harnwegsinfekten beiswangeren Diabetikerinnen. Z Intern Med 1968, 23:520.

    CAS  Google Scholar 

  17. Horowitz BJ, Edelstein SW, Lippman L: Sugar chromatography studies in recurrent Candida vulvovaginitis. J Reprod Med 1984, 29:441–0.

    PubMed  CAS  Google Scholar 

  18. De Leon EM, Jacober SI, Sobel JD, Foxman B: Vaginal Candida colonisation in women with diabetes by type, duration and glucose control. In Proceedings of the 38th Annual Meeting of the Infectious Disease Society of America. New Orleans; 2000:89. This study found that among diabetics, high levels of glycosylated hemoglobin were associated with increased rates of vaginal colonization with Candida.

  19. Goswami R, Dadhwal V, Tejaswi S, et al.: Species-specific prevalence of vaginal candidiasis among patients with diabetes mellitus and its relation to their glycaemic status. J Infect 2000, 41:162–166.

    Article  PubMed  CAS  Google Scholar 

  20. Donders GGG, Prenen H, Verbeke G, Reybrouck R: Impaired tolerance for glucose in women with recurrent vaginal candidiasis. Am J Obstet Gynaecol 2002, In press. This study found that women with recurrent vaginal candidiasis had a 13% higher blood glucose than control women, and hemoglobin A1c levels were 20% higher.

  21. Sobel JD, Mueller G, Buckley H: Critical role of germ tube formation in the pathogenesis of candidal vaginitis. Infect Immun 1984, 44:576–579.

    PubMed  CAS  Google Scholar 

  22. Hostetter PW: Perspectives in diabetes: handicaps to host defence. Effects of hyperglycemia on C3 and Candida albicans. Diabetes 1990, 39:271–275.

    Article  PubMed  CAS  Google Scholar 

  23. Gilmore BJ, Retsinas EM, Lorenz JS, Hostetter MK: An iC3b receptor on Candida albicans: structure, function, and correlates for pathogenicity. J Infect Dis 1988, 157:38–43.

    PubMed  CAS  Google Scholar 

  24. Connolly JP, Mitas II JA: Torulopsis glabrata fungemia in a diabetic patient. South Med J 1990, 83:352–353.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Katholieke Universiteit Leuven, Verloskunde-Gynaecologie, UZ Herestraat 49, B-2000, Leuven, Belgium

    Gilbert G. G. Donders MD, PhD

Authors
  1. Gilbert G. G. Donders MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Donders, G.G.G. Lower genital tract infections in diabetic women. Curr Infect Dis Rep 4, 536–539 (2002). https://doi.org/10.1007/s11908-002-0042-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-002-0042-y

Keywords

Search

Navigation