An Epidemiologic Analysis of Vulvovaginal Candidiasis and Antifungal Susceptibilities

Abstract Inflammation of the vagina and vulva caused by Candida is called vulvovaginal candidiasis (VVC). Risk factors for VVC include pregnancy, diabetes mellitus, frequent oral sexual intercourse, and the use of tight synthetic underwear and systemic antibiotics. Candida albicans, which belongs to the normal flora of the vagina, is the most common cause of VVC. However, an increase in VVC episodes caused by non-albicans Candida species, including Candida glabrata, Candida tropicalis, Candida krusei and Candida parapsilosis, has been reported. In this study, a total of 100 Candida isolates obtained from patients with vaginitis symptoms were evaluated. The susceptibility of the Candida strains to amphotericin B, itraconazole, fluconazole, ketoconazole, voriconazole and caspofungin was investigated using the reference broth microdilution method. Risk factors and demographic characteristics of the patients and the identified Candida species were also investigated. Among the 100 Candida strains isolated from vaginal samples, 47 (47%) were C. albicans, 43 (43%) C. glabrata, 5 (5%) C. kefyr, 2 (2%) C. krusei, 2 (2%) C. tropicalis and 1 (1%) was Candida guilliermondii. The incidences of Candida susceptibility to caspofungin, fluconazole, itraconazole, voriconazole, ketoconazole and amphotericin B were 75%, 35%, 27%, 80%, 97% and 100%, respectively. Also, there was a significant difference in antifungal susceptibility among patients belonging to certain risk groups, such as patients previously using antibiotics and recurrent cases. Prevalence of non-albicans Candida species and antifungal resistance, especially against azoles, are both increasing, and certain risk factors should be monitored strictly.