Can Candida glabrata Cause Vaginal Bleeding?
Candida glabrata infection does not typically cause vaginal bleeding as a primary manifestation. The characteristic presentation of C. glabrata vulvovaginitis includes white adherent vaginal discharge, burning, itching, vulvar edema, erythema, excoriation, and fissures—but bleeding is not described as a typical feature in major clinical guidelines 1.
Typical Clinical Presentation of C. glabrata Vulvovaginitis
The established clinical syndrome is characterized by:
- White, thick, adherent vaginal discharge (not bloody discharge) 1
- Burning and itching as primary symptoms 1
- Vulvar edema, erythema, and excoriation on examination 1
- Fissures may develop in severe cases 1
- Milder presentation compared to C. albicans infections, though symptoms tend to be more chronic or recurrent 2
Important Clinical Distinction
C. glabrata vulvovaginitis differs from C. albicans in several ways:
- Less severe acute symptoms but more treatment-resistant 3, 2
- More frequent recurrence due to azole resistance 3, 4
- Often occurs in patients with underlying chronic medical conditions 2
- The infection remains confined to mucosal surfaces in immunocompetent women 1
When to Consider Alternative Diagnoses
If vaginal bleeding is present, you must investigate other causes:
- Cervical pathology (cervicitis, cervical cancer, polyps)
- Endometrial pathology (endometritis, endometrial cancer, polyps)
- Trauma or fissures (though fissures from C. glabrata would cause spotting at most, not frank bleeding)
- Coexisting sexually transmitted infections
- Hormonal causes (breakthrough bleeding, anovulation)
Critical Caveat for Immunocompromised Patients
In severely immunocompromised patients (particularly those with myeloperoxidase deficiency), C. glabrata vaginal colonization combined with systemic symptoms warrants urgent evaluation for disseminated candidiasis 5. Disseminated disease can present with:
- Hemorrhagic skin lesions (discrete pink to red papules with potential hemorrhagic transformation if thrombocytopenia present) 5
- High fever and poor general condition 5
- This represents a life-threatening emergency requiring skin biopsy, blood cultures, and systemic antifungal therapy with echinocandins 5
Diagnostic Approach
Before attributing any symptoms to C. glabrata:
- Confirm diagnosis with wet-mount preparation using saline and 10% potassium hydroxide 1
- Verify normal vaginal pH (4.0-4.5)—elevated pH suggests bacterial vaginosis or trichomoniasis 1, 6
- Obtain vaginal cultures if microscopy is negative, as C. glabrata doesn't form pseudohyphae or hyphae, making microscopic identification difficult 7
- Perform pelvic examination to identify sources of bleeding (cervical, vaginal wall trauma, other pathology) 1
Bottom Line
Vaginal bleeding is not a recognized manifestation of C. glabrata vulvovaginitis in the medical literature or clinical guidelines. If a patient with confirmed C. glabrata infection presents with vaginal bleeding, the bleeding requires separate investigation for its actual cause. The presence of both findings is likely coincidental rather than causally related, unless severe excoriation or fissuring has led to minor spotting.