Single-pathogen and Mixed Vulvovaginal Infections Among Women of Reproductive Age Consulting Gynecologists: A Cross-Sectional Study

Abstract

Vulvovaginal infections are a public health problem that accounts for 20% of gynecological consultations. However, there are no clear data on the prevalence of the different types of vulvovaginal infections, including vaginal mixed infections, that make women seek care from gynecologists. We aimed to determine the prevalence of vulvovaginal infections and to evaluate the therapeutic approach of symptomatic women of reproductive age consulting gynecologists. A cross-sectional study was conducted among 103 women with vulvovaginitis of probable infectious etiology at 25 gynecology outpatient clinics. Women underwent clinical diagnosis following standard clinical practice. Signs and symptoms were registered as well as the therapeutic strategy prescribed by the gynecologists and self-treatment habits of the women before consultation. A microbiological culture of the vaginal discharge was performed in all women to confirm the diagnosis. According to the microbiological studies, 68% of women had an infection, being candidiasis the most prevalent (54.3%), followed by bacterial vaginosis (25.7%), mixed infection (14.3%), and nonspecific vulvovaginitis (5.7%). Most of the candidiasis involved a single pathogen, however 19.4% were mixed infections also involving other pathogens. Leukorrhea and pruritus were the most prevalent symptoms (82.5% and 81.6% respectively). Mixed infections produced vaginal odor changes more often than single candidiasis (40% vs. 24%). Among the 103 women, 71.8% received pharmacological treatments, mostly antifungals, being fenticonazole the most frequently prescribed; 48.5% received nonpharmacological treatments, either alone or as adjuvant therapy. Candidiasis is the most prevalent vulvovaginal infection in symptomatic women of reproductive age consulting gynecologists. Candidiasis usually presents as a single-pathogen infection, but additional pathogens may coexist in many women. Clinical diagnosis of mixed infections is challenging because the most prevalent symptoms are the same as for candidiasis, so prescription of antifungals with a broad spectrum of antimycotic and antimicrobial activity is an adequate alternative for women.