Candida Torulopsis glabrata

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C. (Torulopsis) glabrata is a vaginal yeast infection that causes vulvar burning. Typically, women describe constant vulvar burning without an associated increase in vaginal discharge. Usually, these women have seen multiple providers and tried many over-the-counter as well as prescription medications without relief.

On vulvar examination, the genitalia can appear normal or there can be generalized erythema. Microscopic evaluation of the vaginal discharge may be normal or numerous budding yeasts may be present. A yeast culture is necessary to identify that C. (T.) glabrata is present. Treatment can be challenging, as it is resistant to all azoles used typically for Candidal infections (8-11). Boric acid

Figure 7 VIN III: periclitoral dysplastic disease. (See color insert pp. 4 and 5.)

capsules or suppositories have shown some efficacy for the treatment of C. (T.) glabrata vaginal infections (boric acid 600 mg, in either a gelatin capsule or suppository, inserted intravaginally twice daily for 14 days). The application of 1% or 2% gentian violet intravaginally prior to initiation of the boric acid capsules has been helpful for some women. A single course of boric acid capsules may not be curative and, therefore, retreatment may be required. Other treatment regimens for C. (T.) glabrata cited in the literature include boric acid with flucytosine or combined with flucytosine and amphotericin B topically (12-14).

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