General Obstetrics and Gynecology: Gynecology
Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women

https://doi.org/10.1067/mob.2002.125897Get rights and content

Abstract

Objective: The purpose of this study was to determine the prevalence of vaginal colonization by Candida with the use of a rapid detection method, to examine the determinants of vaginal candidiasis, and to evaluate susceptibility for fluconazole. Study Design: Vaginal swabs were collected from unselected women at the outpatient clinic of the Department of Obstetrics and Gynecology. A differentiation was made between patients with a positive and a negative potassium hydroxide examination. Results: Six hundred twelve women were recruited, of whom 39 women (6.3%) had clinical candidiasis. The overall rate of yeast colonization was 20.1%. Candida albicans was isolated most frequently(68.3%), followed by C glabrata (16.3%) and C parapsilosis (8.9%). Clinical candidiasis was related positively with the state of estrogen impregnation. In vitro susceptibility testing by the National Committee for Clinical Laboratory Standards method for fluconazole revealed that 21.1% of the isolates were resistant. Conclusion: More than 20% of the unselected women were colonized with Candida species. Hyperestrogenemia was associated with an increased vulvovaginal colonization by Candida. Surprisingly, 21% of the isolates was resistant to fluconazole, according to the National Committee for Clinical Laboratory Standards method. (Am J Obstet Gynecol 2002;187:569-74.)

Section snippets

Patient population

This study was conducted at the Ghent University Hospital over a period of 14 weeks. A total of 612 consecutive patients who visited the outpatient clinic of the Department of Obstetrics and Gynecology, with or without complaints of vaginitis, consented to participate. The study was approved by the Ethical Committee of the Ghent University Hospital.

Each patient completed a standardized questionnaire about age, use of contraceptives, estrogen content of oral contraceptives (0.02-0.05 mg of

Results

From a total of 612 consecutive patients, yeasts were recovered from 123 vaginal swabs (20.1%). Patients were divided in 3 groups: a group of patients who were only colonized (without symptoms), a group with clinical symptoms of candidiasis and a positive KOH examination results, and a group with symptoms but with negative KOH examination results. Sixty-five patients were symptomatic, from which 60% (39/65 patients) had a positive KOH examination result and 40% (26/65 patients) had a negative

Comment

Yeasts were detected in 20.1% of the vaginal swabs from both symptomatic (64.6%; 42/65 women) and asymptomatic patients (11.2%; 81/547 women) with the use of a new fluorogenic procedure.4 Reported prevalences in other studies ranged from 19% to 82% in symptomatic women and from 4% to 40% in asymptomatic women.8, 9, 10, 11, 12, 13 In the present study, C albicans (68.3%) was predominant, followed by C glabrata (16.3%) and C parapsilosis (8.9%). The rather low prevalence of C albicans and the

Acknowledgements

We thank M. De Block from the department of Obstetrics and Gynecology for the coordination of the collecting of samples from patients; J. Wydooghe and N. Verbeerst for technical assistance; and and Dr J.L. Rodriguez-Tudela and Dr M. Cuenca-Estrella, the National Center of Microbiology, Madrid, Spain, for retesting the isolates by EUCAST and for their critical comments in connection with the revision of our manuscript.

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    Reprint requests: H.J. Nelis, PhD, Laboratory of Pharmaceutical Microbiology, Department of Pharmaceutical Analysis, Harelbekestraat 72, B-9000 Ghent, Belgium; e-mail: [email protected]

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