Fluconazole-resistant vulvovaginal candidiasis in reproductive-age women: a study from Himalayan country

Vulvovaginal candidiasis is the second most common fungal infections among reproductive-age women. These conditions are commonly treated with the azole derivatives administered locally or systemically, most commonly fluconazole (FCZ). This study aimed to determine the prevalence of Candida spp. infection, access antifungal resistance, and detect different enzymes in Nepalese women of reproductive-age.

A cross-sectional study was conducted from Narayani Hospital, Parsa, Nepal. Duplet 345 high vaginal swabs and mid-steam urine samples, demographic, comorbidities, and symptoms, were collected from reproductive-age Nepalese women suffering from vaginitis. Bacteria and Candida spp. were isolated by culture, and further identification of Candida spp. was achieved through molecular sequencing of the Internal Transcribed Spacer region using universal primer sets. Antifungal susceptibility tests, followed by Kirby-Bauer disk diffusion method, and minimum inhibitory concentration of FCZ were determined according to Clinical Laboratory and Standards Institute guidelines. Enzymatic activity was also determined using a semi-quantitative method.

The prevalence of vulvovaginal candidiasis was 6.9%, and Candida albicans (44%) was the leading cause of infection, followed by C. metapsilosis (36%) and C. tropicalis (8%). A correlation was established between vulvovaginal candidiasis and douching, spraying, or washing (COR 0.36, 95% CI 0.13, p value = 0.05). All isolated Candida spp. were resistant to FCZ, and 8% of C. albicans and 4% of C. metapsilosis produce hemolysin, esterase and phospholipase activity.

Vulvovaginal candidiasis is a significant cause of morbidity, and resistance to FCZ, as well as enzyme produced, indicate a potential challenge for standard treatment approaches. Besides C. albicans, non-albicans Candida are also a possible threat to vulvovaginal candidiasis.