Vulvovaginal Candidiasis in Patients presenting with Vaginal Discharge in a Sri Lankan Setting

Abstract

Background: Vulvovaginal candidiasis (VVC) is a common infection among women. Due to the emerging role of nonalbicans Candida in VVC, it is important to periodically investigate the proportions of infection caused by different Candida species and antifungal resistance patterns. Aims: This study aims to determine the frequency of occurrence of VVC in women presenting with vaginal discharge, possible risk factors associated with the disease, and antifungal susceptibility pattern of the isolates of Candida. Materials and methods: High vaginal swabs from 158 women presenting with vaginal discharge at the gynecology clinic of Colombo South Teaching Hospital were studied. Ethical approval was granted from the Ethical Review Committee of the University of Sri Jayewardenepura (No.: 722/13). After species identification, antifungal susceptibility tests were performed using a standard disk diffusion technique. Probable risk factors for the infection were assessed using an intervieweradministered questionnaire. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS), using chi-square tests. All inferential statistics were tested at p<0.05. Results: Candida albicans was isolated in 34 patients (22%), and Candida famata was isolated from one patient. All direct microscopy-positive specimens were also culture positive. All the isolates were susceptible to antifungals tested. Among the study population, oral contraceptives (OCP) were used in 11% (n=17) of patients (p=0.001). Fourteen (40%) of 35 Candida positive patients had diabetes mellitus (p<0.05). Conclusion: Candida albicans was the commonest species isolated from VVC in a Sri Lankan setting. The infection can safely be treated with commonly used antifungals. Diabetes mellitus and use of OCP are associated risk factors.