Vulvovaginal Candidiasis Infections Research Articles

A systematic review and meta-analysis on the prevalence of vulvovaginal candidiasis in Southeast Asian countries

Vulvovaginal candidiasis (VVC) is a disease caused by pathogenic Candida species. This disease typically affects women of reproductive age with high sexual activity (i.e., sex workers), poor educational attainment and economic status, and infrequent hygiene practices. VVC remains a major public health concern. VVC prevalence across Southeast Asian countries remains poorly understood. To address this concern, the current study estimated the current prevalence of VVC infections among women in Southeast Asian countries by conducting a systematic review and meta-analyses. All studies reporting the prevalence of VVC in Southeast Asia were obtained from Ovid Medline, Scopus, and CINAHL. A review of titles and abstracts was done independently by three reviewers. The quality of the studies was assessed using the Newcastle-Ottawa scale. Meta-analysis was performed in R v.4.1,1 using the ‘meta’ package (version 4.19-0). Based on the results of the current study, the pooled estimated prevalence of VVC among Southeast Asian women is 23.0% (95% CI: 18.0% to 28.0%). Across countries, Laos had the highest estimated prevalence at 33.0% (95% CI: 22.0% to 46.0%). Subgroup analysis based on pregnancy status and occupation revealed a higher estimated prevalence among non-pregnant women (32.0%, 95% CI: 25.0% to 40.0%) and non-sex workers (33.0%, 95% CI: 20.0% to 48.0%). Based on the diagnostic method, the prevalence was higher for the combinatorial approach using microscopy, a culture-based approach, and molecular techniques (51.0%) and lowest when solely based on clinical diagnosis (9.0%, 95% CI: 1.0% to 22.0%) or an exclusively culture-based approach (11%, 95% CI: 6.0% to 18.0%). Overall, further study is necessary to accurately characterize the current distribution of VVC across Southeast Asian countries. Developing more effective diagnostic and management strategies is to improve the health of affected women.

Prevalence and Antifungal Resistance Profile of Vulvovaginal Candidiasis Infections in Pregnant Women in Maroua, Far North Region of Cameroon

Prevalence and Antifungal Resistance Profile of Vulvovaginal Candidiasis Infections in Pregnant Women in Maroua, Far North Region of Cameroon

Role of vulvovaginal candidiasis infection in infertility: systematic review and meta-analysis.

To evaluate the relationship between fungal infection in the female genital tract and infertility. A systematic review was carried out, and the search was conducted in Medline, Embase, Web of Science, Google Scholar, and Cochrane Library databases until August 2022. The search strategy used standardized keywords such as "candidiasis" and "infertility," combined with their respective synonyms. The search was limited to human studies, with no language restrictions. Primary articles that evaluated women of reproductive age with and without infertility and related to the presence or absence of candidiasis were included. For the analyses, the odds ratio association measure was used with a confidence interval of 95% using RevMan software (version 5.4). Eight studies, published between 1995 and 2021 in different countries around the world, were included in this systematic review. Two studies were excluded after sensitivity analysis. A total of 909 participants were included in the group of infertile women and 2363 women in the control group. The age of the evaluated women varied between 18 and 50 years. The random effect model was used and showed no significant difference when comparing candidiasis between fertile and infertile women (odds ratio: 1.44; 95% confidence interval 0.86, 2.41 p= 0.17). There was no association between candidiasis and female sterility.

Occurrence and Antifungal Susceptibility of Candida Species Isolated from Pregnant Women in a Tertiary Hospital

Candida is the leading cause of infection among pregnant women. This study was aimed to determine the occurrence and antifungal susceptibility of Candida species isolated from apparently healthy pregnant women receiving antenatal care at Bingham University Teaching Hospital. High vaginal swab was inoculated onto Sabouraud Dextrose Agar and Gram staining was carried out. Candida isolates were sub- cultured on Himedia CHROM Candida differential agar and identified according to their color, morphology, and appearance. Disc antifungal susceptibility test was carried out using standard protocols. The occurrence rate of vulvovaginal candidiasis (VVC) in this study was 42.5%. In this study, Candia albicans was the most predominant Candida species (51.2%) isolated. Pregnant women within the age range of 20-24 years had the highest infection occurrence of 100% while the lowest occurrence of the infection (25%) was observed among women within the age range of 40-44 years. There was a significant relationship between age and VVC infection (P>0.05). In relation to trimester, pregnant women in the second trimester had a high infection rate of 87.5% while women in the third trimester had the least occurrence rate of 10.9%. There was a significant relationship between vulvovaginal candidiasis infection and trimester (P>0.05). All Candida species were resistant to the antifungal drugs tested except for Candida kefyr which was susceptible to fluconazole and voriconazole. Therefore, early diagnosis and appropriate treatment among pregnant women receiving antenatal care can reduce the infection and prevent complications during childbirth

Vaginal homeostasis features of Vulvovaginal Candidiasis through vaginal metabolic profiling.

Vulvovaginal candidiasis (VVC) is an inflammatory disease primarily infected by Candida albicans. The condition has good short-term treatment effects, high recurrence, and seriously affects the quality of life of women. Metabolomics has been applied to research a variety of inflammatory diseases. In the present study, the vaginal metabolic profiles of VVC patients and healthy populations (CTL) were explored by a non-targeted metabolomics approach. In total, 211 differential metabolites were identified, with the VVC group having 128 over-expressed and 83 under-expressed metabolites compared with healthy individuals. Functional analysis showed that these metabolites were mainly involved in amino acid metabolism and lipid metabolism. In addition, network software analysis indicated that the differential metabolites were associated with MAPK signaling and NF-κB signaling. Further molecular docking suggested that linoleic acid can bind to the ACSL1 protein, which has been shown to be associated with multiple inflammatory diseases and is an upstream regulator of the MAPK and NF-κB signaling pathways that mediate inflammation. Therefore, our preliminary analysis results suggest that VVC has a unique metabolic profile. Linoleic acid, a significantly elevated unsaturated fatty acid in the VVC group, may promote VVC development through the ACSL1/MAPK and ACSL1/NF-κB signaling pathways. This study's findings contribute to further exploring the mechanism of VVC infection and providing new perspectives for the treatment of Candida albicans vaginal infection.

Using Artificial Neural Network to Predict Predisposing to Vulvovaginal Candidiasis among Vaginitis Cases

Background: Vulvovaginal candidiasis (VVC) is a common fungal infection caused by Candida species in the female genital tract. Objectives: This study attempts to predict predisposition to VVC related to risk factors and clinical symptoms among vaginitis cases using the artificial neural network (ANN) model. Methods: This cross-sectional study was performed on 250 women referred to gynecology clinics in Birjand, Iran. A questionnaire was used to record participants' demographic information. Swabs were used for wet mounts and culture. Candida species were identified by morphological and physiological methods. The performance of the optimal neural network model was assessed by the sensitivity, specificity, and accuracy area under the ROC curve (AUC). Descriptive statistics were used for the statistical description of data, and chi-square test, t-test, and ANN analysis using SPSS application tools (Statistical Product and Service Solutions) version 22 software at 0.05 significant level. Results: The prevalence of vulvovaginal candidiasis was 41.0%, and Candida albicans was the most frequently identified species (55.9%). The descriptive statistics (chi-square test and t-test) revealed no significant difference between the frequencies of Candida infection with demographic factors and clinical presentations. However, factors such as abortion history, number of sexual intercourse, dyspareunia, education, natural vaginal delivery (NVD), and lower abdominal pain included in our ANN model had significant differences (P < 0.05). Conclusions: The result of the ANN model revealed that using demographic factors and clinical symptoms can predict VVC infection. Therefore, this model can identify the effect of the clinical presentations and symptoms of infection.

Epidemiological Profile of Patients with Vulvovaginal Candidiasis from a Sexually Transmitted Infection Clinic in Southern Spain.

Epidemiological data on women suffering from vulvovaginal candidiasis and its recurrence are outdated and vague. The aim of this study was to identify the prevalence of women diagnosed with vulvovaginal candidiasis, as well as the epidemiological profile and associated risk factors in the province of Granada (Spain). Data from the Centre for Sexually Transmitted Infections of the Granada province between 2000 and 2018 (N = 438) were used in this study. Associations between sociodemographic and sexual behaviour variables with vulvovaginal candidiasis were analysed using the Chi-square test and bivariate logistic regression. The prevalence of candidiasis was 14.6%. The sociodemographic profile corresponded to a woman aged 25.14 ± 4.8 years on average, who is of Spanish nationality (60.9%), a student (55.7%), in non-active employment (59.7%), with a higher education (56.7%), single (93.5%), and under 30 years of age (79.7%). Variables associated with this diagnosis were the absence of oro-genital contact (OR = 1.99; 95% CI = 0.25-0.74), having a regular partner (OR = 1.99; 95% CI = 1.05-3.75), and age of sexual debut, with the probability increasing by 12% (95% CI = 1.00-1.24) with each year. In this context, vulvovaginal candidiasis infection is common, and its epidemiological profile is contradictory, so our results do not suggest a relevant role of sexual risk behaviours in the diagnosis. Further research is needed to improve the estimates and factors associated with this infection.

Vulvovaginal candidiasis and vaginal microflora interaction: Microflora changes and probiotic therapy.

Vaginal microbiome is mutually beneficial to the host and has a significant impact on health and disease. Candida species, including Candida albicans, are part of the mucosal flora of most healthy women. Under suitable conditions, they can live in the vulvovaginal mucosa, resulting in symptomatic vulvovaginal candidiasis (VVC). Based on the analysis of 16S ribosomal RNA gene sequences, great progress has been made in exploring the composition and structure of vaginal bacterial community. Moreover, researchers have conducted several studies on whether vaginal microbiome will change during VVC infection. In addition, it has been reported that vaginal colonization of probiotics in vaginal microorganisms, especially Lactobacillus, can effectively reduce the risk of VVC and treat VVC. This review aims to summarize the changes of vaginal microflora during VVC infection, and further point out the possibility of using lactic acid bacteria as probiotics to treat VVC, so as to reduce the adverse consequences of VVC infection and reduce the expensive treatment cost.

Effectiveness of Nursing Intervention Protocol on Recurrence of Vulvovaginal Candidiasis Infection Associated Pregnancy

Effectiveness of Nursing Intervention Protocol on Recurrence of Vulvovaginal Candidiasis Infection Associated Pregnancy

Phase 3 study evaluating the safety and efficacy of oteseconazole in the treatment of recurrent vulvovaginal candidiasis and acute vulvovaginal candidiasis infections

Recurrent vulvovaginal candidiasis affects nearly 138 million women globally each year. In the United States, fluconazole is considered the standard of care for acute vulvovaginal candidiasis, but until recently there was no US Food and Drug Administration-approved drug for the treatment of recurrent vulvovaginal candidiasis. Oteseconazole is a novel oral selective inhibitor of fungal lanosterol demethylase (sterol 14α-demethylase cytochrome P450, an enzyme required for fungal growth) approved for the treatment of recurrent vulvovaginal candidiasis. This study was conducted to evaluate the efficacy and safety of oral oteseconazole (VT-1161) in the prevention of recurrent culture-verified acute vulvovaginal candidiasis episodes through 50 weeks in participants with recurrent vulvovaginal candidiasis and to compare the efficacy of oteseconazole and fluconazole in the treatment of the presenting acute vulvovaginal candidiasis episode. Women and postmenarcheal girls aged ≥12 years with a history of recurrent vulvovaginal candidiasis (N=219) were enrolled at 38 US sites. Eligible participants presenting with an active vulvovaginal candidiasis infection entered an induction phase in which they were randomly assigned 2:1 to receive 600 mg oral oteseconazole on day 1 and 450 mg on day 2, with matching placebo capsules, or to 3 sequential 150-mg oral doses (once every 72 hours) of fluconazole, with matching placebo capsules. Following the 2-week induction phase, the 185 participants with resolved acute vulvovaginal candidiasis infection (a clinical signs and symptoms score of <3) entered the maintenance phase and received 150 mg of oteseconazole or placebo weekly for 11 weeks. Participants were observed for an additional 37 weeks. In the induction phase, oteseconazole was noninferior to fluconazole in the proportion of participants in the intent-to-treat population with resolved acute vulvovaginal candidiasis infection at the week 2 (day 14) test-of-cure visit, with 93.2% of participants on oteseconazole vs 95.8% on fluconazole achieving resolution. In the maintenance phase, oteseconazole was superior to placebo in the proportion of participants in the intent-to-treat population with ≥1 culture-verified acute vulvovaginal candidiasis episode through 50 weeks, 5.1% compared with 42.2%, respectively (P<.001). Overall, treatment-emergent adverse event rates were similar in both groups: 54% for participants who received oteseconazole in the induction and maintenance phases vs 64% for participants who received fluconazole in the induction phase and placebo in the maintenance phase. Most treatment-emergent adverse events in each group were mild or moderate, with 3.4% of treatment-emergent adverse events graded as severe or higher in the OTESECONAZOLE/oteseconazole group vs 4.2% in FLUCONAZOLE/placebo group. In participants with recurrent vulvovaginal candidiasis, oteseconazole was safe and efficacious in the treatment and prevention of recurrent acute vulvovaginal candidiasis episodes and was noninferior to vulvovaginal candidiasis standard-of-care fluconazole in the treatment of the presenting acute vulvovaginal candidiasis infection.

Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis.

Vulvovaginal candidiasis is a common infection associated most often with the overgrowth of the fungal species Candida albicans. Although most women will have at least one episode of vulvovaginal candidiasis in their lifetime, some will experience recurrent infections. Recurrent vulvovaginal candidiasis can significantly impact quality of life, causing both physical and psychological symptoms, and poses a substantial financial burden for women and the health care system. Acute vulvovaginal candidiasis infections are often diagnosed symptomatically by clinicians or self-diagnosed by patients themselves; this can result in over- and underdiagnosis, as well as misdiagnosis, and has the potential to lead to ineffective treatment and incomplete infection resolution. Clinical diagnosis should include confirmatory laboratory tests, including microscopy and fungal culture, especially in women with a history of recurrent vulvovaginal candidiasis, who are more likely than women with vulvovaginal candidiasis to be infected with less-common Candida species or with azole-resistant strains. With proper diagnosis, most acute vulvovaginal candidiasis episodes can be successfully treated; however, women with recurrent vulvovaginal candidiasis may require long-term maintenance therapy. US-based guidelines recommend ⩽6 months of maintenance fluconazole treatment, but infection recurs in up to 50% of women treated. There are currently no US Food and Drug Administration–approved treatments for recurrent vulvovaginal candidiasis; however, several promising treatments for recurrent vulvovaginal candidiasis are in development.

Effect of nursing intervention on the recurrence of Vulvovaginal candidiasis infection

Effect of nursing intervention on the recurrence of Vulvovaginal candidiasis infection

Protective Roles of Honey in Reproductive Health: A Review.

Nowadays, most people who lead healthy lifestyles tend to use natural products as supplements, complementary medicine or alternative treatments. Honey is God’s precious gift to mankind. Honey has been highly appreciated and extensively used since ancient history due to its high nutritional and therapeutic values. It is also known to enhance fertility. In the last few decades, the important role of honey in modern medicine has been acknowledged due to the large body of convincing evidence derived from extensive laboratory studies and clinical investigations. Honey has a highly complex chemical and biological composition that consists of various essential bioactive compounds, enzymes, amino and organic acids, acid phosphorylase, phytochemicals, carotenoid-like substances, vitamins and minerals. Reproductive health and fertility rates have declined in the last 30 years. Therefore, this review aimed to highlight the protective role of honey as a potential therapeutic in maintaining reproductive health. The main role of honey is to enhance fertility and treat infertility problems by acting as an alternative to hormone replacement therapy for protecting the vagina and uterus from atrophy, protecting against the toxic effects of xeno-oestrogenic agents on female reproductive functions and helping in the treatment of gynaecological disorders, such as vulvovaginal candidiasis infection, that affect women’s lives.

Mrr2 mutations and upregulation are associated with increased fluconazole resistance in Candida albicans isolates from patients with vulvovaginal candidiasis.

Candida albicans is an opportunistic fungus, which causes vulvovaginal candidiasis (VVC). The aim of this study was to evaluate Mrr2 mutation and its expression levels and Candida drug resistance 1 (Cdr1) in C. albicans associated with fluconazole (FCA) resistance. We identified 80 isolates of C. albicans from 155 vaginal secretions and performed FCA drug sensitivity tests, using M27-A3 micro-broth dilution. We extracted DNA, sequenced Mrr2, and performed reverse transcriptase-quantitative PCR polymerase chain reaction (RT-qPCR) to detect mRNA expression levels of Mrr2 and Cdr1. In total, 40 isolates were sensitive, 10 were dose-dependently sensitive, and 30 were resistant to FCA. Mrr2 mutation occurred in 56·67% isolates, which was significantly higher than that in the FCA sensitive group (26·08%, P<0·05). The mRNA expression level of Cdr1 in the FCA resistant group was significantly higher than that in the sensitive group Cdr1 (0·42±0·294 vs 0·25±0·289, P<0·05). The odds ratio of FCA-resistant occurrence in C. albicans with Mrr2 mutation and high expression levels was 47·5 times higher than C. albicans without Mrr2 mutation and low expression levels. The results may provide new insights for improving VVC treatment. SIGNIFICANCE AND IMPACT OF THE STUDY: Significance and Impact of the Study: Candida albicans is an opportunistic fungus, which causes vulvovaginal candidiasis (VVC). Fluconazole (FCA) is the most widely used drug in VVC infection. However, the widespread use of FCA has severely increased the incidence of FCA-resistant fungus. Therefore, the mechanism underlying FCA resistance in C. albicans must be elucidated urgently. This study demonstrated that high expression of Cdr1 and Mrr2 may directly be linked to C. albicans resistance to FCA, and high expression of Mrr2 may promote high expression of Cdr1 and mediate resistance of C. albicans to FCA. The results may provide new insights for improving VVC treatment.

Changes of local vaginal immune regulation in rats infected with vulvovaginal candidiasis

Objective: To study the disease process of vulvovaginal candidiasis (VVC) infection in rat model of VVC, and to study the immuno-repairing effect of different treatments on vaginal epithelium and the ultra-structural changes of vaginal epithelial cells. Methods: The VVC model of female rats were established. After successful modeling, the rats were treated with no treatment (model control group), nystatin and Kangfu Xiaoyan suppository. The vaginal epithelium was observed by transmission electron microscopy and immunohistochemical staining. The ultra-structural changes of epithelial cells and the expression of cytokines interferon γ (IFN-γ), interleukin (IL) 4, IL-17 and IgG in epithelial cells were observed and analyzed statistically. Results: The negative conversion rate of model control group was 0, and that of nystatin group was 6/6, and that of Kangfu Xiaoyan suppository group was 5/6; significant difference existed between nystatin, Kangfu Xiaoyan suppository group and model control group (P<0.05). The ultrastructures of vaginal epithelial cells were damaged obviously after VVC infection, and the ultrastructures were repaired by nystatin and Kangfu Xiaoyan suppository under transmission electron microscope. Immunohistochemical staining showed, the expressions of IFN-γ and IgG in the four cytokines which played a protective role increased after Kangfu Xiaoyan suppository treatment, significantly different from that of model control group (P<0.05), but there were no significant differences of the IFN-γ and IgG expression between Kangfu Xiaoyan suppository group and those of nystatin group (P>0.05); the expression of IL-17 was increased after nystatin treatment, but decreased after Kangfu Xiaoyan suppository treatment, and the difference between the two groups had statistical significance (P<0.05). Conclusions: The ultrastructure of vaginal epithelial cells after VVC infection could be damaged obviously, the local immune state is disordered, and the antifungal drug nystatin has a good therapeutic effect on VVC, it could significantly repair the damaged vaginal epithelium structure after VVC infection and strengthen the protective immune function of vaginal epithelium. Kangfu Xiaoyan suppository, one of Chinese medicine, has similar therapeutic effect with nystatin.

Targeted point-of-care testing compared with syndromic management of urogenital infections in women (WISH): a cross-sectional screening and diagnostic accuracy study

Sexually transmitted and urogenital infections are typically managed by WHO-recommended syndromic algorithms in resource-poor countries, and presumptively in Europe. However, algorithms for vaginal discharge and lower abdominal pain perform poorly in women. The women's improvement of sexual and reproductive health (WISH) study in Kigali, Rwanda, sought to improve case-finding and infection management in women by introducing point-of-care tests. The main aim was to compare the performance of the WISH algorithms and the WHO vaginal discharge and lower abdominal pain algorithms with gold standard testing. This cross-sectional screening and diagnostic accuracy study recruited women aged 18 years or older with or without urogenital symptoms at risk of acquiring sexually transmitted infections in Kigali, Rwanda. Recruitment activities were implemented by study staff with the help of community mobilisers at health centres, pharmacies, markets, women's organisations, and at "umuganda" community meetings. At the study visit, participants had a face-to-face interview that included questions about current urogenital symptoms. Participants were first asked without prompting (spontaneous reporting), followed by questions about 14 specific symptoms (structural reporting). Next, the WISH algorithms were implemented. All participants had point-of-care tests for bacterial vaginosis (vaginal pH of 5·0 or above) and Trichomonas vaginalis (immunoassay) regardless of symptom reporting. Women with a positive risk score had point-of-care tests for Chlamydia trachomatis and Neisseria gonorrhoea (nucleic acid amplification tests). Vulvovaginal candidiasis was treated presumptively. Nucleic acid amplification tests for C trachomatis, N gonorrhoeae, T vaginalis, bacterial vaginosis, and vulvovaginal candidiasis were the gold standard, and all patients provided swabs for these. Participants were recruited between July 5, 2016, and March 14, 2017. 705 participants were enrolled in the study and completed a study visit, and 51 attended 53 additional visits. Prevalence by gold standard testing was 8·5% for C trachomatis, 7·1% for N gonorrhoeae, 16·1% for T vaginalis, 18·1% for bacterial vaginosis, and 8·6% for vulvovaginal candidiasis. The WISH algorithms identified similar numbers of C trachomatis, N gonorrhoeae, and T vaginalis infections, but much higher numbers of bacterial vaginosis and vulvovaginal candidiasis infections. Compared with gold standard testing, the WISH algorithms had a good sensitivity and high specificity for C trachomatis (sensitivity 71·7%, specificity 100%), N gonorrhoeae (sensitivity 76·0%, specificity 100%), and T vaginalis (sensitivity 68·5%, specificity 97·4%), high sensitivity but low specificity for bacterial vaginosis (sensitivity 95·2%, specificity 41·2%), and moderate sensitivity and specificity for vulvovaginal candidiasis (sensitivity 64·4%, specificity 69·4%). The performance of vaginal pH testing for bacterial vaginosis improved by increasing the cutoff to 5·5, followed by confirmatory testing (sensitivity 73·6%, specificity 100%). The WHO algorithms had moderate sensitivity and poor specificity for all infections compared with gold standard testing: C trachomatis sensitivity 58·3%, specificity 44·7%; N gonorrhoeae sensitivity 66·0%, specificity 45·2%; T vaginalis sensitivity 60·4%, specificity 45·6%; bacterial vaginosis sensitivity 61·6%, specificity 46·0%; and vulvovaginal candidiasis sensitivity 74·6%, specificity 50·6%. Two participants attended additional visits because they had a mild allergic reaction to metronidazole. Staff and participants considered point-of-care testing feasible and acceptable. Point-of-care testing for urogenital infections might improve case-finding and infection management and is feasible in resource-poor settings. Point-of-care tests should be further developed, including those targeting multiple conditions. Additional studies in other populations, including populations with low prevalence of sexually transmitted and urogenital infections, are warranted. European and Developing Countries Clinical Trials Partnership.

Genotypic analysis of secreted aspartyl proteinases in vaginal Candida albicans isolates

ABSTRACT Introduction: Candida albicans is the most common etiologic agent of fungal vaginitis. These yeasts produce secreted aspartyl proteinases encoded by a family of 10 genes (SAP1-10). Objective: The purpose of this study was to analyze the presence of genes SAP1-7 in vulvovaginal C. albicans. Materials and method: The study included 26 C. albicans vaginal isolates. Detection of aspartyl proteases genes (SAP1-7) was performed by polymerase chain reaction (PCR). Results: The most frequent gene in C. albicans isolated from colonization was SAP6 (93.33%), and from infection, SAP7 (100%). We observed a statistical difference (p = 0.049) in SAP1 gene frequency between isolates from vulvovaginal colonization and infection. Conclusion: High frequency of SAP genes was observed in vulvovaginal C. albicans. The results suggest SAP1 participation in vulvovaginal candidiasis infection.

Molecular Epidemiology and In Vitro Antifungal Susceptibility of Candida Isolates from Women with Vulvovaginal Candidiasis in Northern Cities of Khuzestan Province, Iran

Background: Vulvovaginal candidiasis (VVC) is a common infection, affecting up to 75% of women at least once during their lifetime. In addition, approximately 5% of patients may experience recurrent VVC. Candida albicans is the most common causative agent of VVC. Overall, precise identification of the causative agents of VVC is necessary for effective treatment. Objectives: The purpose of this study was to identify the molecular characteristics and antifungal susceptibility of Candida species, isolated from women with VVC in cities of Shoush, Dezful, and Andimeshk, Khuzestan Province, Iran. Methods: In this descriptive cross sectional study, vaginal samples were collected from 173 women with VVC, referred to gynecologists. The samples were cultured on Sabouraud dextrose agar, containing chloramphenicol. The ITS1-ITS4 region was amplified via polymerase chain reaction (PCR) assay and digested by MspI restriction enzyme. Antifungal susceptibility test was performed for 4 antifungal drugs (fluconazole, nystatin, itraconazole, and clotrimazole) via disk diffusion method. Results: Out of 173 patients, 95 (54.9%) showed VVC and 26 (27.4%) had recurrent VVC. The most common Candida species were C. albicans (70.5%), C. glabrata (20%), C. tropicalis (7.4%), and C. parapsilosis (2.1%), respectively. The antifungal susceptibility test showed resistance to fluconazole in 1 C. tropicalis, 2 C. albicans, and 3 C. glabrata isolates, while resistance to clotrimazole was detected in 1 C. albicans and 1 C. glabrata isolate. Conclusions: According to the results of this study, approximately 30% of VVC infections were caused by non-C. albicans species, which should be considered by gynecologists due to their azole resistance.

O020 Pilot study comparing self-collected vaginal swab with clinician taken vaginal swab for the detection of candida and bacterial vaginosis

Background/introduction Vaginal discharge and vulvitis are common presenting symptoms in both sexual health services and general practice. Due to various constrains particularly in general practice, examination of a patient may not be possible. Syndromic management is often practiced but can be unreliable. Few studies to date have specifically looked at the validity of self-collected vulvovaginal swab for the diagnosis of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) Aim(s)/objectives To describe agreement between self-collected vulvovaginal swabs and clinician taken high vaginal swabs for the detection of BV and VVC. Design Case controlled study with the patient acting as her own control. Setting An urban sexual health centre. Participants: Women aged 16–65 years attending with symptomatic vaginal discharge, vulval irritation or an offensive genital smell. Interventions: Participants took a vulvovaginal swab prior to speculum insertion and vaginal examination during which a clinician took a high vaginal swab. Main outcome measure: Diagnosis of BV or VVC infection with samples analysed in a microbiology department using both microscopy and culture. Results 104 women were enrolled in the study. Of these 45 were diagnosed with VVC. 26 were diagnosed with BV. Using the reference standard of laboratory testing, the sensitivities of self-collected vulvovaginal swabs for BV and VVC were 88.5% and 95.5% respectively. The Cohen Kappa score showed strong agreement for the detection of both BV and VVC (k = 0.842 and k = 0.878 respectively). Discussion/conclusion Self-collected vulvovaginal swabs appear to be a valid alternative to clinician taken high vaginal swabs for detecting BV and VVC infections.

Nanostructured lipid system as a strategy to improve the anti-Candida albicans activity of Astronium sp.

The genus Astronium (Anacardiaceae) includes species, such as Astronium fraxinifolium, Astronium graveolens, and Astronium urundeuva, which possess anti-inflammatory, anti-ulcerogenic, healing, and antimicrobial properties. Nanostructured lipid systems are able to potentiate the action of plant extracts, reducing the required dose and side effects and improving antimicrobial activity. This work aims to evaluate a nanostructured lipid system that was developed as a strategy to improve the anti-Candida albicans activity of hydroethanolic extracts of stems and leaves from Astronium sp. The antifungal activity against C. albicans (ATCC 18804) was evaluated in vitro by a microdilution technique. In addition to the in vitro assays, the Astronium sp. that showed the best antifungal activity and selectivity index was submitted to an in vivo assay using a model of vulvovaginal candidiasis infection. In these assays, the extracts were either used alone or were incorporated into the nanostructured lipid system (comprising 10% oil phase, 10% surfactant, and 80% aqueous phase). The results indicated a minimal inhibitory concentration of 125.00 µg/mL before incorporation into the nanostructured system; this activity was even more enhanced when this extract presented a minimal inhibitory concentration of 15.62 µg/mL after its incorporation. In vivo assay dates showed that the nanostructure-incorporated extract of A. urundeuva leaves was more effective than both the unincorporated extract and the antifungal positive control (amphotericin B). These results suggest that this nanostructured lipid system can be used in a strategy to improve the in vitro and in vivo anti-C. albicans activity of hydroethanolic extracts of Astronium sp.