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Indian Journal of Medical Microbiology, Vol. 25, No. 2, April-June, 2007, pp. 175-176 Correspondence An epidemiological study of vulvovaginal candidiasis in women of childbearing age N Jindal, P Gill, A Aggarwal Deparment of Microbiology, Government Medical College, Amritsar - 143 001, Punjab Correspondence Address: Deparment of Microbiology, Government Medical College, Amritsar - 143 001, Punjab, India (email: neerjarajender@hotmail.com) Date of Submission: 10-July-2006 Code Number: mb07054 Dear Editor, Vulvovaginal candidiasis (VVC) is an extremely common infection in women of childbearing age of all strata of society. Since it has now been excluded from the ranks of sexually transmitted diseases and is also not a notifiable disease, [1] not much information regarding its incidence and epidemiology is available. We studied 350 women of 16-45 years of age, with the complaints of vaginal discharge and/or vaginal itching. After recording their relevant personal and reproductive history, vaginal secretions were collected and subjected to direct microscopy and culture on Sabouraud dextrose agar (SDA) medium. Candida species were identified by a series of morphological and biochemical tests. [2] Statistical analysis was done by using Chi-square test. Positive culture for Candida species was obtained in 82 (23.4%) women. Of these, 61 (74.4%) were Candida albicans and 21 (25.6%) were non C . albicans. C. glabrata was the most common nonalbicans species (9, 11%) followed by C. tropicalis (5, 6%), C. krusei (3, 3.6%) and C. parapsilosis and C. guilliermondii (2, 2.43%) each. We observed a consistent increase in the incidence of VVC from second to fourth decade of life followed by a decline [Table - 1]. This could be because of the influence of sexual activity, which is at its peak during this age. In our study, women of low socioeconomic status, unsatisfactory genital hygiene and those who were using tight, poorly ventilated, nylon underclothing showed significantly higher incidence of VVC than those of middle class ( P < 0.0001), those who had satisfactory genital hygiene ( P =0.0008) and those who were using well-ventilated, cotton undergarments ( P < 0.0001). The use of tight fitting, synthetic/nylon clothing could be contributing to VVC by increasing perineal moisture and temperature. In the present study, statistically highly significant difference in incidence of VVC was observed between pregnant and nonpregnant women ( P < 0.0001) and in women of parity up to two and more than two ( P < 0.0001). VVC is commoner and more difficult to eradicate during pregnancy. [1],[3] This is probably due to high level of reproductive hormones during pregnancy which provides an excellent carbon source for growth of Candida. High incidence of VVC observed in patients on oral contraceptives, is similar to the findings of other investigators. [1],[3] Significant influence of use of antibiotics in increasing the incidence of VVC was observed in the present study. Antibiotics are known to destroy the normal protective vaginal flora and help in colonization with Candida . To conclude, VVC caused by C. albicans as well as nonalbicans species of Candida is quite prevalent in women of childbearing age of our region. Its significant association with certain epidemiological factors underscores the need for educating women regarding genital hygiene, use of wellventilated cotton underclothing and importance of accurate diagnosis and prompt treatment. There is also need for constant surveillance studies so that the incidence of infections caused by nonalbicans species of Candida could be kept under check. References
Copyright 2007 - Indian Journal of Medical Microbiology The following images related to this document are available:Photo images[mb07054t1.jpg] |
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