The Yeast-Like Fungi of the Human Vagina *

Much attention has been focused of late on the etiological role of yeast-like fungi in disease of the vagina and vulva. Although these organisms have long been known to inhabit the female genital tract, they were thought to be but rarely the inciting agent in diseases of these organs. Recent work has shown, however, that they occur with comparative frequency, especially in pregnant and diabetic individuals and that they may cause vulvovaginitis. Castellani2 cites what probably is the first description of infection of the vagina by a yeast-like fungus when he refers to the report of Wilkinson23 who, in 1840, described such an organism in a vaginal discharge. Mayer,18 v. Haussmann,6 and v. Winkel24 later described a number of cases from which they were able to recover and identify yeast-like organisms from the secretions of the vagina. Since the work of these authors there have been many case reports mentioning fungi as possible causes of vulvovaginitis. Some controversy has existed as to the r8le which the yeast-like fungi play in the vagina, some workers believing that they are pathogenic, others, finding them in cases where there is no evidence of vaginal disease, have concluded that they are essentially nonpathogenic. Thus, LeBlaye,"2 Moench,14 Davis,5 Heard,7 Popoff, Ford, and Cadmus,"8 Odland and Hoffstadt,16 and Karnakyll assumed that the yeast-like fungi which they isolated from their cases were pathogenic. Inoculation experiments in women and rabbits by v. Winkel24 and by v. Haussmann' led them to believe that these organisms were pathogenic when instilled into the vagina. Castellani and Taylor4 and Castellani' are of the opinion that many of the yeast-like fungi are non-pathogenic, since they have been able to isolate them in many instances where there was no evidence of vaginal disease. Stephan"9 has come to the conclusion that the yeast-like fungi themselves do not produce disease, but pave the way for the invasion of the vaginal mucosa by the normal flora which is potentially pathogenic through excoriation which they produce by their