Review
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World J Diabetes. Oct 15, 2022; 13(10): 809-821
Published online Oct 15, 2022. doi: 10.4239/wjd.v13.i10.809
Growing importance of urogenital candidiasis in individuals with diabetes: A narrative review
Jasminka Talapko, Tomislav Meštrović, Ivana Škrlec
Jasminka Talapko, Laboratory for Microbiology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
Tomislav Meštrović, University North, University Centre Varaždin, Varaždin 42000, Croatia
Tomislav Meštrović, Institute for Health Metrics and Evaluation, Department for Health Metrics Sciences, University of Washington School of Medicine, Seattle, Washington 98195, United States
Ivana Škrlec, Department of Biophysics, Biology, and Chemistry, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
Author contributions: Talapko J substantially contributed to the conception and design of the article, interpretation of relevant literature, article drafting, and table preparation; Meštrović T substantially contributed to the conception and design of the article, interpretation of relevant literature, article drafting, and figure preparation; Škrlec I coordinated the literature search and article preparation and revised the manuscript critically for important intellectual content; All authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ivana Škrlec, MSc, PhD, Assistant Professor, Department of Biophysics, Biology, and Chemistry, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Crkvena 21, Osijek 31000, Croatia. iskrlec@fdmz.hr
Received: May 13, 2022
Peer-review started: May 13, 2022
First decision: August 1, 2022
Revised: August 6, 2022
Accepted: September 8, 2022
Article in press: September 8, 2022
Published online: October 15, 2022
Processing time: 154 Days and 2.3 Hours
Abstract

Both diabetes and fungal infections contribute significantly to the global disease burden, with increasing trends seen in most developed and developing countries during recent decades. This is reflected in urogenital infections caused by Candida species that are becoming ever more pervasive in diabetic patients, particularly those that present with unsatisfactory glycemic control. In addition, a relatively new group of anti-hyperglycemic drugs, known as sodium glucose cotransporter 2 inhibitors, has been linked with an increased risk for colonization of the urogenital region with Candida spp., which can subsequently lead to an infectious process. In this review paper, we have highlighted notable virulence factors of Candida species (with an emphasis on Candida albicans) and shown how the interplay of many pathophysiological factors can give rise to vulvovaginal candidiasis, potentially complicated with recurrences and dire pregnancy outcomes. We have also addressed an increased risk of candiduria and urinary tract infections caused by species of Candida in females and males with diabetes, further highlighting possible complications such as emphysematous cystitis as well as the risk for the development of balanitis and balanoposthitis in (primarily uncircumcised) males. With a steadily increasing global burden of diabetes, urogenital mycotic infections will undoubtedly become more prevalent in the future; hence, there is a need for an evidence-based approach from both clinical and public health perspectives.

Keywords: Balanitis; Balanoposthitis; Candida; Candidiasis; Diabetes; Pregnancy; Urogenital infections; Vulvovaginitis

Core Tip: The global health burden of both diabetes and Candida spp. infections is on the rise, and these two clinical entities can have a compounding effect on the development of different urogenital diseases and syndromes. Pathophysiological changes observed in diabetes mellitus can predispose individuals to Candida colonization, increased virulence of this fungus, and subsequent infection. Diabetic females are more prone to recurrent vulvovaginal candidiasis that can endanger the pregnancy, while diabetic males have higher rates of balanitis/balanoposthitis. In both females and males, there is an increased risk of candiduria and urinary tract infections, with complications such as emphysematous cystitis.