Vulvovaginal Candidiasis Research Articles

Integrating Clinical and Microbiological Expertise to Improve Vaginal Candidiasis Management

Integrating Clinical and Microbiological Expertise to Improve Vaginal Candidiasis Management

Effective correction of manifestations of vaginal microflora disorders

Pathological vaginal discharge is one of the main reasons for visiting gynecologists. Despite the abundance of drugs, not all are compliant and quickly effective for pronounced itching and swelling in the introitus area. One of the most common causes of pathological leukemia is vaginal infections, which are represented by three main clinical forms: bacterial vaginosis (BV) – up to 50% of all cases; vulvovaginal candidiasis (CVV) – 20–25% and trichomonas vaginitis (TV) – 15–20% of cases, respectively. In this regard, retrospective analysis shows that patients with BV, KV, TV most often actively turn to a gynecologist or venereologist However, the fact that the cause of pathological whites in more than 30% of cases can be a mixed infection creates problems in treatment with the use of monodrugs (many relapses up to 40% or more). Therefore, for their treatment, it is considered rational to use the concept of the etiotropic approach, based on the local effect of combined vaginal drugs. The role of a combined topical drug, including those with a rapid anesthetic effect, was evaluated. Neo-Penotran Forte L is a logical combination of antibacterial agents and a local anesthetic used to treat manifest forms of vaginal infections and provide rapid relief of intolerable symptoms.

Evaluation of the Vaginal Panel Realtime PCR kit (Vircell, SL) for diagnosing vaginitis: A comparative study with routinely used diagnostics.

Vaginitis is a prevalent clinical disorder associated with several adverse health consequences, prompting women to seek medical care. In this study we evaluate the Vaginal Panel Real-Time PCR kit (qPCR test) against routinely used diagnostics for detection of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis. A total of 1011 vaginal swab specimens were analyzed. The routinely diagnostic methods for BV was Gram stain-based Nugent score. VVC presence was detected by culture, and Candida species were identified using MALDI-TOF MS. Trichomonas vaginalis was identified by culture in a selective medium. Molecular analyses were conducted on the MagXtract® 3200 System and analyzed using the CFX96™ Real-Time PCR Detection System. The sensitivity, specificity, positive predictive value, and negative predictive value of the qPCR test compared to the reference method for BV diagnosis was 93.1%, 88.8%, 90.1% and 92.2%, respectively, with a Kappa value of 0.82. For Candida species, sensitivity, specificity, positive predictive value, and negative predictive value were 96.0%, 98.4%, 95.3%, and 98.7%, respectively. The qPCR test detected 32 additional positive samples for Candida not reported by the routinely used diagnostics. For trichomoniasis, the qPCR test identified T. vaginalis in fifteen specimens, despite no microscopic detection in cultured specimens. Our results demonstrate that the Vaginal Panel Real-Time PCR kit shows optimal concordance with routinely used diagnostics for diagnosing vaginitis. Furthermore, enhancing detection of T. vaginalis. However, further validation studies are necessary to confirm its full diagnostic accuracy. The use of nucleic acid amplification tests (NAATs) provides rapid and accurate diagnosis, crucial for early detection and treatment of vaginitis.

Detection of Mutated erg11 and fks1 Genes among Resistant Candida Species Isolated in Pregnant Women in Mbarara, Uganda

Background: Vulvovaginal candidiasis is estimated to range between 35-60% among pregnant women worldwide. The emergency of anti-fungal resistance in Candida species against azoles and caspofungin is a rising concern because there is a limited range of choices of antifungals to be used in pregnant women with low toxicity. In Uganda, the burden of vulvovaginal candidiasis is estimated to be 48%. However, there is limited data regarding in vitro phenotypic and genotypic anti-fungal susceptibility patterns among candida species isolated from pregnant women. Thus, this study aimed to screen for the two mutated famous erg11 and fks1 genes that lead to anti-fungal resistance among clinical candida isolates. Methods: A cross-sectional study involving 90 Candida species isolates previously collected from a larger study carried out from Mbarara regional referral hospital. Phenotypic susceptibility methods (Kirby-Bauer and minimum inhibitory concentration) while Polymerase chain reaction method and gel electrophoresis were used for detection of the amplified mutated ERG11 and FKS1 genes. Mean and chi-square tests were used to evaluate the associations of resistance patterns between resistant and susceptible isolates. Results: Out of the 90 Candida isolates recovered, 56% were Candida albicans, C.glabrata were 31.11% (28/90), C. parapsilosis and C.famata accounted for 4.44% (4/90) each, C. krusei accounted for 3.33% (3/90) while C. tropicalis accounted for 1.11% (1/90). All the Candida isolates were susceptible to caspofungin while fluconazole resistance was 34.4%. The FKS1 mutated gene was not detected in randomly selected caspofungin susceptible isolates. The ERG11 mutated gene was detected in 80.6% of the fluconazole-resistant isolates and 87.5% of the isolates with intermediate activity towards fluconazole. Conclusion: This study provides evidence that mutated erg11 gene causes reduced fluconazole drug susceptibility (p-value 0.001). Susceptible dose dependence should not be ignored as it may be associated with ERG11 gene mutation leading to resistance to fluconazole.

Effects of intravaginal curcumin gels combined with electroporation on vulvovaginal candidiasis

Effects of intravaginal curcumin gels combined with electroporation on vulvovaginal candidiasis

Long-term outcomes of prolonged fenticonazole therapy in patients with recurrent vulvovaginal candidiasis

Long-term outcomes of prolonged fenticonazole therapy in patients with recurrent vulvovaginal candidiasis

Highlight signatures of vaginal microbiota and metabolome contributed to the occurrence and recurrence of vulvovaginal candidiasis.

This study enhances our knowledge of the vaginal microbiota dynamics and the role of associated metabolites in individuals with vulvovaginal candidiasis (VVC) and recurrent vulvovaginal candidiasis through shotgun sequencing and multi-omics analysis. The relationship between metabolites and vaginal microbiota and disease state was revealed. The accumulation of L-glutamate generated in glycogen metabolism, which is governed by Lactobacillus iners or bacterial vaginosis-associated bacteria, may contribute to the incidence and recurrence of VVC. Such insights have the potential to impact the treatment and prevention strategies for these common yet distressing conditions, potentially leading to targeted therapies and improved patient outcomes.

Fungal disease incidence and prevalence in Iraq – Preliminary estimates

BackgroundThe surveillance of serious and superficial skin fungal infections in Iraq has not been conducted. Limited information exists on their incidence and prevalence. ObjectivesThis study aimed to analyze, compute and estimate the prevalence and burden of fungal infections, as no previous data is available and no studies has been attempted in Iraq. MethodsIn the present study the data were collected and reviewed from published data on epidemiology of fungal infections nationally, internationally, from unpublished postgraduate master and PhD theses, hospital records and private clinic records. External sources of data from other countries were used for diseases which lacked sufficient local data. ResultsWe estimated 985,628 annual serious infections comprising of 2.26 % of the total population. When including superficial fungal infections group of the skin, this rises to 2,075,113 infections at 4.76 % of the total population. The most common serious and skin infections were recurrent Candida vaginitis, fungal rhinosinusitis and tinea capitis comprising 61.5 %, 21.8 %, and 22.4 % of all infections although the total incidence of superficial fungal infections was also high at 1,071,485. Respiratory fungal disease is also common comprising 14.0 % of infections. We predicted the following annual burden per 100,000; oral candidiasis at 247.9, esophageal candidiasis at 6.04, candidemia at 5.0, Candida peritonitis at 0.75, recurrent Candida vaginitis at 5461, allergic bronchopulmonary aspergillosis at 35, severe asthma with fungal sensitisation at 46, invasive aspergillosis at 7.9, chronic pulmonary aspergillosis at 11.7, chronic fungal rhinosinusitis at 496, mucormycosis at 0.99, fungal keratitis at 14.0, and total dermatophytosis at 1631, the most severe being tinea capitis at 366. Many of these estimates were made with data sourced from other nations, so additional data from Iraq is required to validate or modify these estimates. ConclusionRecurrent Candida vaginitis, fungal rhinosinusitis, and tinea capitis are considered to be the most frequent fungal diseases present in Iraq.

Three-Dose Antifungal Treatment Improves the Efficacy for Severe Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC) is a prevalent gynecological infection characterized by high incidence and recurrent episodes, causing significant distress in women. This study aims to assess the effectiveness of different clotrimazole and fluconazole treatment regimens for severe vulvovaginal candidiasis (SVVC). A retrospective analysis was conducted on 1303 cases of SVVC among first-time visitors to the gynecology outpatient department at Peking University Shenzhen Hospital between January 2013 and December 2022. Vaginal secretions were systematically collected for fungal culture, with species identification conducted using Chromogenic culture medium and API Candida test reagents. Mycological cure rates were assessed at days 7–14, days 25–35, and day 35 to 6 months after treatment. The three-dose clotrimazole regimen demonstrated significantly higher mycological cure rates (85.7%, 80.0% and 74.6% at three follow-up periods, respectively) compared to the two-dose clotrimazole regimen (76.0%, 61.6%, and 59.8%, all P < 0.05). The three-dose fluconazole regimen showed no significant difference to three-dose clotrimazole regimen, with cure rates of 82.8%, 79.3%, and 75.9% (all P > 0.05). The two-dose fluconazole regimen had cure rates of 74.3%, 56.4% and 51.1%, with no significant difference from two-dose clotrimazole regimen at days 7–14 and 25–35, but lower than three-dose fluconazole regimen at days 25–35 and 35 to 6 months. The three-dose clotrimazole regimen demonstrated higher cure rates in Candida albicans and non-albicans Candida SVVC cases than two-dose regimen. These findings suggest that three-dose antifungal regimens may be more efficacious than two-dose regimens for SVVC. The three-dose clotrimazole regimen could serve as a promising alternative for SVVC management.

Effects and Mechanisms of Lactobacillus Probiotics in Maintaining Women’s Vaginal Health: A Review

Probiotics are beneficial living microorganisms. They are useful to vaginal health when consumed in suitable doses. The dominant species included in probiotics are Lactobacillus. We can get these microbes naturally or commercially utilize them as functional food. Lactobacillus species form 70% of inhabitant bacteria in females compared to other warm-blooded animals. The prevalent Lactobacillus species are L. crispatus, L. gasseri, L. iners and L. jensenii. Because of the development of antibiotic resistance mechanisms, the beneficial relationship between humans and probiotics has been discussed for several years. Lactobacillus prevents the attachment of pathogens by using several mechanisms, for example, by increasing estrogen levels, production of lactic acid, lowering pH 4.0-4.5 to provide an acidic environment, release of hydrogen peroxide, bacteriocins and bacteriocins-like substances, adhesion and colonization properties. Lactobacillus prevent the entry and attachment of pathogenic bacteria, thus not only helping to control and manage different gynecological conditions like bacterial vaginosis, endometriosis, vulvovaginal candidiasis and genitourinary syndrome of menopause but also infections that can spread through sexual contacts such as gonorrhea, chlamydia, genital herpes, Human papillomavirus infections (HPV). Overall, the use of probiotics in improving vaginal health is beneficial, easy and cost-effective but the use of probiotics in HPV clearance is not quite beneficial. So, more work should be done on HPV preventive vaccines.

Rapid Molecular Diagnostics in Vulvovaginal Candidosis.

Vulvovaginal candidosis (VVC) is a common condition among women, with current diagnostic methods relying on clinical evaluation and laboratory testing. These traditional methods are often limited by the need for specialized training, variable performance, and lengthy diagnostic processes, leading to delayed treatment and inappropriate antifungal use. This review evaluates the efficacy of molecular diagnostic tools for VVC and provides guidance on their application in clinical practice. A literature search was conducted using PubMed to identify studies evaluating rapid diagnostic tests specifically for vulvovaginal Candida isolates. Inclusion criteria focused on studies utilizing molecular diagnostics for the detection of Candida species in VVC. Articles discussing non-vaginal Candida infections, non-English studies, and animal or in vitro research were excluded. Twenty-three studies met the inclusion criteria, predominantly evaluating nucleid acid amplification tests/polymerase chain reaction (NAAT/PCR) assays and DNA probes. PCR/NAAT assays demonstrated high sensitivity and specificity (>86%) for VVC diagnosis, outperforming conventional diagnostic methods. Comparatively, DNA probes, while simpler, exhibited lower sensitivity. The included studies were mostly observational, with only one randomized controlled trial. Emerging diagnostic technologies, including artificial intelligence and integrated testing models, show promise for improving diagnostic precision and clinical outcomes. Molecular diagnostics offer a significant improvement in VVC management, though traditional methods remain valuable in resource-limited settings.

Clotrimazole-induced shifts in vaginal bacteriome and lipid metabolism: insights into recovery mechanisms in vulvovaginal candidiasis.

Vulvovaginal candidiasis (VVC) is a prevalent condition affecting a significant proportion of women worldwide, with recurrent episodes leading to detrimental effects on quality of life. While treatment with clotrimazole is common, the specific alterations it evokes in the vaginal bacteriome and metabolome were previously underexplored. In this prospective study, we enrolled reproductive-age women diagnosed with single VVC and conducted comprehensive analyses of vaginal fungi, bacteriome, and metabolome before and after local clotrimazole treatment. We observed a significant reduction in Candida albicans and notable improvements in vaginal cleanliness. Advanced sequencing revealed substantial shifts in the vaginal bacteriome, with an increase in Lactobacillus-dominant communities post-treatment. Our findings identified 17 differentially abundant bacterial species, including notable decreases in pathogenic anaerobes such as Gardnerella vaginalis, Dialister micraerophilus, and Aerococcus christensenii, suggesting a restoration of a healthier microbial balance. Furthermore, metabolomic analysis revealed significant changes in 230 metabolites, particularly within lipid metabolism pathways, with marked downregulation of lipid-related compounds linked to inflammation. Correlation studies indicated a strong interplay between lipid metabolites and specific bacterial species, emphasizing the influence of clotrimazole treatment on microbial and metabolic interactions. Importantly, predictive models using microbiota and metabolite signatures demonstrated high accuracy in distinguishing pre- and post-treatment states. This research highlights clotrimazole's dual role in effectively clearing Candida infection and promoting a healthier vaginal microenvironment, paving the way for novel microbial and metabolomic-based diagnostic approaches to enhance VVC management and understand its underlying mechanisms.

Development of synergistic antifungal in situ gel of miconazole nitrate loaded microemulsion as a novel approach to treat vaginal candidiasis

Limited solubility is the main cause of the low local availability of anti-candidiasis drug, miconazole nitrate (MN). The study’s objective was to develop and characterize microemulsion (ME) based temperature-triggered in situ gel of MN for intravaginal administration to enhance local availability and antifungal activity. The solubility of MN was initially studied in different oils, surfactants, and co-surfactants. Then, pseudo-ternary phase diagrams were constructed to select the best ratio of various components. The ME formulations were characterized by thermodynamic study, droplet size, polydispersity index (PDI), viscosity, and in-vitro antifungal mean inhibition zone (MIZ). Selected MEs were incorporated into different in situ gel bases using a combination of two thermosensitive polymers (poloxamer (PLX) 407 and 188), with 0.6% of hydroxypropyl methylcellulose (HPMC K4M) and gellan gum (GG) as mucoadhesive polymer. ME-based gels (MG) were investigated for gelation temperature, gelation time, viscosity, spreadability, mucoadhesive strength, in vitro release profile, and MIZ test. Furthermore, the optimum MG was assessed for in vivo animal irritation test and FESEM investigation. Tea tree oil, lavender oil, tween 80, and propylene glycol (PG) were chosen for ME preparation for the optimal formulation; formulation ME7 and ME10 were chosen. After incorporation of the selected formulation into a mixture of P407 and P188 (18:2% w/w) with 0.6% mucoadhesive polymer, the resultant MG formulation (MG1) revealed optimum gelation temperature (33 ± 0.01℃) and appropriate viscosity with enhanced sustained release (98%) and retention through sheep vaginal mucosa, MG1 exhibited a better MIZ compared to the 2% MN gel formulation and the marketed MN product, and no rabbit vagina irritation. In conclusion, the miconazole nitrate-loaded MG-based formula sustained the duration of action and better antifungal activity than the marketed miconazole nitrate formulation.

Vulvovaginal candidiasis in pregnant women attending a tertiary care centre in North-Eastern India

BackgroundCandida colonisation in vagina was found to be 20 %, rising to 30 % during pregnancy. According to studies, the prevalence of VVC during pregnancy is higher than healthy women. During pregnancy, candidal colonisation increases, both symptomatic and asymptomatic. However, the difference between strains causing symptomatic infection and those that cause asymptomatic infection is unknown. ObjectiveThis study aimed to compare the virulence factors of Candida VVC isolates from symptomatic and asymptomatic pregnant women. MethodsThe study included 120 pregnant women- 60 symptomatic and 60 asymptomatic, who presented to the Obstetrics and Gynaecology Outpatient Department with vaginitis symptoms. High vaginal swabs from the patient and used for gram stain, direct wet mount, pH detection and fungal culture in SDA with and without antibiotics. Germ tube tests, growth in CMA, and HiCrome Candida Differential Agar were used to identify yeast colonies grown in culture. The isolates were then examined for virulence factors like biofilm formation, phospholipase, coagulase, and hemolysin. Antifungal susceptibility was determined using E-test. ResultsThe current study reveals a high prevalence of Vulvovaginal Candidiasis in pregnant women(35 %). Asymptomatic patients had lower proportion of VVC than symptomatic patients. Non albicans Candida(NAC) outnumbered Candida albicans. Although Candida albicans growth was predominant in asymptomatic patients. Virulence studies revealed that Candida spp. isolated from symptomatic patients expressed a higher proportion of virulence factors. Besides NAC has higher proportion of expressing virulence factors than Candida albicans and has higher propensity to cause infection especially in symptomatic pregnant women. Antifungal susceptibility testing shows Itraconazole to be most sensitive for VVC treatment but Candida albicans was most susceptible to fluconazole while NAC had the least. ConclusionsThe study emphasizes the importance of routine screening of symptomatic pregnant women for VVC, as syndromic treatment will increase antifungal resistance, particularly in NAC.

B-117 Rapid Classification of Cleanliness Grades of Vaginal Discharge through Computational Analysis of SERS Spectra via Variational Auto-Encoder Model And Long Short-Term Memory Networks

Abstract Background Classification of cleanliness grades of vaginal discharge plays a pivotal role in clinical laboratories, serving as indicators for the presence of various vaginal infections such as bacterial vaginosis and candidal vulvovaginitis, etc. The conventional method for assessing vaginal discharge cleanliness involves manual microscopy, a technique susceptible to variations based on the examiner's expertise and subjective judgment, hindering the attainment of swift and accurate diagnoses. Methods This study introduces a novel approach by integrating Surface-Enhanced Raman Spectroscopy (SERS) with a deep learning algorithm for the rapid classification of vaginal discharge cleanliness grades. The proposed classification method combines the Variational Auto-Encoder (VAE) and Long Short-Term Memory (LSTM) to process SERS spectra. The quality of the training data is assessed using the signal-to-noise ratio (SNR) as a standard indicator. Results The application of the VAE-LSTM algorithm significantly enhances classification performance, providing swift and accurate results while reducing the required time. Comparative analyses with various classical machine learning algorithms and evaluation metrics reveal the superior predictive capability and time efficiency of the VAE-LSTM algorithm, demonstrating 100% accuracy and a fitting time of 2 seconds. Blind testing of SERS spectra collected from unknown patients further validates the reliability of the proposed method. Conclusions This study presents a promising and practical approach for the rapid classification of vaginal discharge cleanliness grades. The integration of the SERS technique with the VAE-LSTM algorithm not only ensures accuracy and efficiency in clinical diagnosis but also lays the foundation for advancements in non-invasive diagnostic technologies in gynecological healthcare.

Health of Saudi Women in the Post-Pandemic Era: Candidiasis Incidence and Post COVID-19 and COVID-19-Vaccination.

Candidiasis, commonly known as yeast infection, affects people worldwide due to the overgrowth of Candida species. Of several types, genital candidiasis, particularly vulvovaginal candidiasis (VVC), primarily caused by C. albicans is frequently observed in females of reproductive age. Candidiasis has also become a serious issue in the post-pandemic era, as it occurs as a secondary infection in COVID-19 patients during or after the course of viral illness. Therefore, this study investigated the incidence of C. albicans infections in women of reproductive age, and its relationship with the incidence of COVID-19 and vaccination in Saudi Arabia. Additionally, this study aimed to determine the awareness of women on candidiasis and its subsequent impact on the occurrence of infection. A survey-based quantitative study was conducted in which primary data were collected from participants using a self-reported questionnaire. A total of 200 women aged 18-45 were selected through random sampling. Apart from their sociodemographic characteristics, the history of COVID-19 incidence, COVID-19 vaccination, and candidiasis occurrences among respondents were recorded. Their level of awareness and knowledge of candidiasis, along with their perceptions of strategies for mitigating the risk of incidence, were also evaluated. The collected data were analysed using different statistical tools. The findings of this study revealed a positive correlation between candidiasis, viral infection, and vaccination, regardless of the type and dosage of vaccine administered. Furthermore, both COVID-19 incidence and vaccination had a positive and significant impact on the occurrence of candidiasis among Saudi women. Despite certain limitations, this study has theoretical and managerial implications for improved management of candidiasis in the post-COVID era.

Cross-Sectional Study on the Correlation Between Vaginal Microecology and High-Risk Human Papillomavirus Infection: Establishment of a Clinical Prediction Model.

High-risk human papillomavirus (HR-HPV) is a significant risk factor for cervical precancerous lesions and cancer. This study aimed to investigate the relationship between vaginal microecology and HR-HPV infection and to evaluate the clinical applicability of vaginal microecology in predicting HR-HPV infection. Overall, 2000 women with simultaneously detected vaginal discharge and cervical HPV were selected between March 2022 and March 2023, including 241 and 1759 cases in the HR-HPV positive and HPV negative groups, respectively. No significant differences were found in age, vulvovaginal candidiasis, trichomonas vaginitis, and β-N-acetylglucosaminosidase between the two groups (P>0.05). Significant differences were observed in Lactobacillus deficiency, bacterial vaginitis (BV), aerobic vaginitis (AV), glucuronidase (GUS), sialidase (SNA), and leukocyte esterase (LE) between the two groups (P<0.05). In the multivariate logistic regression equation, Lactobacillus deficiency, BV, AV, SNA, LE, and GUS were risk factors for HR-HPV infection (P<0.05). Three prediction models, namely, logistic regression, decision tree, and random forest, were established to rank the importance of the predictors. BV ranked first among the three prediction models. The logistic regression model demonstrated the highest accuracy in predicting the risk of HR-HPV infection. The calibration curve of the logistic regression model showed a strong correlation between the predicted and actual probabilities, and decision curve analysis revealed that the prediction model had good clinical applicability. Overall, vaginal microecology imbalance was closely associated with cervical HR-HPV infection, particularly BV and AV. The logistic regression model for the risk of HR-HPV infection based on six predictive factors (BV, AV, LE, SNA, Lactobacillus deficiency, and GUS) had good accuracy and clinical applicability.

Evaluation of antifungal activity of Origanum vulgare essential oil and detection of its influence on CDR1 gene expression among Candida albicans in vulvovaginal candidiasis

Evaluation of antifungal activity of Origanum vulgare essential oil and detection of its influence on CDR1 gene expression among Candida albicans in vulvovaginal candidiasis

Identifying changes in vaginal fluid using SERS: Advancing diagnosis of vulvovaginal candidiasis

Vaginal infections, medically termed vaginitis, encompass a spectrum of symptomatic presentations arising from disturbances within the vaginal microflora. The conventional diagnostic approach relies on microscopic examination of wet preparation of vaginal discharge, considered the ‘gold standard’ in clinical practice. Complementary to this, culture-based methodologies are often employed to reinforce diagnostic accuracy. However, challenges such as subjectivity in result interpretation, resource-intensive requirements regarding skilled personnel, and reagent utilization underscore the need for alternative diagnostic strategies.In this article, we demonstrate surface-enhanced Raman spectroscopy (SERS) and partial least squares regression (PLSR) techniques to elucidate the molecular signatures present in vaginal fluids, accounting for various influencing factors, including disruptions in the natural microflora, vaginal irrigation practices, and contraceptive usage. Furthermore, we investigated the spectral manifestations associated with vulvovaginal candidiasis (VVC) relative to control samples. Each clinical specimen underwent meticulous characterization encompassing microbial composition, pH levels, purity, and other pertinent parameters.Our findings unveil significant associations between extraneous inflammatory factors such as vaginal irrigation and diminished sample purity with alterations in SERS signals. Conversely, the day of the menstrual cycle phase exhibits negligible influence on spectral profiles. Notably, VVC samples demonstrated diverse spectral responses correlating with the abundance of pathogenic bacteria. These explorations hold promise in paving the path towards developing a novel intrinsic framework for the diagnosis of vaginitis.

The Increasing Trend of Triazole-Resistant Candida from Vulvovaginal Candidiasis.

Candida vaginitis is widely prevalent worldwide and is one of the common gynecological disorders. The aim of this study is to analyze the sensitivity of recurrent vulvovaginal (RVVC) candidiasis to antifungal drugs and its relationship with vaginal microbiota. We Isolated and cultured Candida from RVVC patients, mass spectrometry and broth microdilution method were used to identify and determine MIC values of antifungal drugs. Clinical medical records and vaginal microbiota of RVVC patients were also collected. The main pathogens causing RVVC are predominantly Candida albicans (70.26%), but in recent years, there has been an increasing proportion of Candida glabrata(24.46%). However, only 15.70% of Candida albicans were sensitive to Voriconazole, 35.84% to Fluconazole and 25.60% to Itraconazole. No fluconazole-resistant Candida glabrata was found. Most Candida krusei strains were sensitive to voriconazole (81.80%). More important MIC values of triazoles were increased in Candida species, when exposed to clotrimazole. In addition, we found that the vaginal microecology of candida vaginitis and bacterial vaginitis was significantly different. Triazoles resistant Candida species have emerged, leading to the failure of empirical anti-infective therapy. At the same time, the vaginal microecology of candida vaginitis and bacterial vaginitis was significantly different. In addition, a new breakpoint for Candida from RVVC needs to be established.