Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India

doi:10.1016/j.ejogrb.2008.12.020

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 144, Issue 1, May 2009, Pages 68-71

https://doi.org/10.1016/j.ejogrb.2008.12.020 Get rights and content

Abstract

Objectives

The objectives were to determine the frequency of Candida species in women of different age groups as well as to suggest the criteria for the diagnosis of vulvovaginal candidiasis (VVC).

Study design

A prospective study of vulvovaginal candidiasis was carried out using laboratory diagnosis, with the estimation of vaginal pH and the direct microscopic and biochemical examination of vaginal discharge/secretions. Vaginal cultures for Candida species were collected from 1050 women with vulvovaginal symptoms.

Results

Out of 1050 women, 215 (20.47%) were positive for Candida species. Of 215 women, 172 (80%) had pH within the normal range and 167 (77.67%) were showing yeast cells and mycelia on direct microscopic examination. Candida albicans accounted for 46.9% of cases, Candida glabrata 36.7%, Candida parapsilosis 10.2%, Candida tropicalis 2.8%, Candida krusei 1.4%, and Candida kiefer 1.9%. The frequency of culture positivity was related to pregnancy (P < 0.001), an increase in parity (P < 0.001), and use of oral contraceptives (P < 0.001) and antibiotics (P < 0.001). The most common signs and symptoms in 215 women with positive cultures were pruritus with or without vaginal discharge and vaginal erythema.

Conclusion

Our study suggests that vulvovaginal candidiasis can only be diagnosed by using clinical criteria in correlation with vulvovaginal symptoms and Candida cultures.

Introduction

Every year almost 10 million women visit physicians with the common gynecological disorder, vaginitis [1]. Most of the women who attend health care clinics have the common problem of vulvovaginal candidiasis (VVC). Nearly 75% of all women have fungal vulvovaginitis at least once or more in their lives. Moreover, nearly 40–50% women may have a second episode of vulvovaginal candidiasis in their life, whereas 5% of women have reported having recurrent vulvovaginal candidiasis (RVC). It has also been reported previously that 75% of women are affected by VVC during their child-bearing years [2].

The most common clinical manifestations of vulvovaginal candidiasis are pruritus, hyperemia, vaginal discomfort and leucorrhea, burning, soreness, abnormal vaginal discharge, dyspareunia, and vaginal and vulvar erythema, which may cause problems in marital and sexual relations. The most common predisposing host factors are uncontrolled diabetes mellitus, immunosuppression, pregnancy, and hormone replacement therapy [3]. In addition to the other factors, immunity due to the local defense mechanism of the vaginal compartment and actual hormonal status are potential candidates for pathogenesis [4].

The rate of colonization with Candida and symptomatic vaginitis is higher during pregnancy. Moreover, the use of contraceptives has been widely accepted as a potential risk factor for Candida colonization [5]. In a study in which vulvovaginal candidiasis was self-diagnosed, more than half of the patients did not have yeast confirmed as a causative organism [6]. Most of the patients fail to respond to antifungal therapy, which is mainly due to an incorrect diagnosis [7]. The majority of true cases are caused mainly by Candida albicans. The mechanisms of defense in the host against VVC remain controversial [8]. The most common defense mechanism in the vagina against C. albicans is the innate immune response. C. albicans is a part of the normal vaginal flora in about 20–30% of women of childbearing age.

In view of the above background information, this study was undertaken to determine the frequency of Candida species in women of different age groups and to suggest criteria for the diagnosis of vulvovaginal candidiasis (VVC).

Section snippets

Materials and methods

One thousand and fifty women aged 15–60 years attending the obstetrics and gynecology outpatient department (OPD) with complaints of vaginal discharge and/or vaginal itching and irritation were studied. After recording their personal medical symptoms and reproductive history, vaginal swabs were collected with the help of sterile transportable cotton swabs provided by Hi-Media, followed by microscopic examination. Vaginal samples were collected from the outer third of the vaginal wall with the

Results

Of 1050 women, 215 (20.47%) tested positive for Candida. Of these 215 women, 172 (80%) had normal vaginal pH (4.0–5.0), whereas the remaining 43 (20%) had a pH value above 5. Our microscopic study for yeast cells and pseudohyphae was found to be positive in 167 out of 215 women with positive culture (77.67%). The ages of the women studied fell within the range 15–60 years. The present study showed that the women of the 21–25 age group had the highest frequency of Candida-positive cultures

Discussion

For the diagnosis of VVC, vaginal culture is the most sensitive and accurate method of diagnosis compared with other methods [12]. Moreover, pH and microscopic studies of vaginal secretions could also be performed. In this study, 20.47% women were found to have VVC, which has also been reported in earlier studies [13].

Vaginal pH estimation is a simple and economical test; it has been widely used in cases of suspected VVC [14]. Previous studies have shown that in VVC, the pH of the vagina

Conclusion

The culture positivity of Candida species in 20.47% of women suggests that vulvovaginal candidiasis cannot be diagnosed only by using clinical criteria; rather, vulvovaginal symptoms and Candida cultures are also required. The incidence of VVC caused by albicans and non-albicans species are common in women of reproductive age. The important relationship between VVC and certain epidemiological factors emphasizes the need to educate women regarding genital hygiene, precise diagnosis, and punctual

Acknowledgements

We are thankful to the central instrumentation facility of the IBU, AMU. This work was supported by the CSIR sanction no. 37(1209)04 EMR II to AUK. The author is grateful to Prof. S. Akhtar Husain, JMI New Delhi, Prof. Zakia Arshad, and Dr. Naheed Khan for their valuable suggestions.

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Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India

Abstract

Objectives

Study design

Results

Conclusion

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusion

Acknowledgements

Eur J Obstet Gynecol Reprod Biol

Int J Gynecol Obstet

Trends Microbiol

Am J Obstet Gynecol

Am J Obstet Gynecol

Sex Transm Dis

J Surg Res

Am J Obstet Gynecol

Indian J Med Microbiol

J Infect

Am J Obstet Gynecol

Recurrent vulvovaginal candidiasis

Clin Microbiol Newsl

An intravaginal live Candida challenge in humans leads to new hypotheses for the immunopathogenesis of vulvovaginal candidiasis

Infect Immun

Significance of candida culture in women with vulvovaginal symptoms

J Obstet Gynecol India