Vulvovaginal candidiasis: A global perspective through systematic review and meta-analysis

Vulvovaginal candidiasis (VVC) is a highly prevalent and clinically impactful infection with complex pathophysiology and shifting microbiological patterns. A deeper understanding of its epidemiology is essential to improving outcomes for the millions of women affected worldwide.

This systematic review and meta-analysis, conducted in accordance with PRISMA guidelines, investigated the prevalence of VVC using studies published from 1995 to 2023. Multiple databases, including PubMed, Embase, Scopus, and Web of Science were searched. Original English-language, population-based studies were included. Data extraction was done using a standardized Excel checklist, and statistical analysis was performed with SPSS. Heterogeneity and publication bias were assessed using the I² index and funnel plot, respectively.

Out of 7716 records screened, 114 studies involved 1,222,829 women from 36 countries met the inclusion criteria. The global pooled prevalence of VVC was estimated at 32.59 % (95 % CI: 0.29-0.36), with high heterogeneity (I² = 99.8 %). Candida albicans (79/114) was the predominant pathogen in most studies. Pregnancy (26/114) and oral contraceptive use (22/114) were the most common risk factors. Curd-like discharge (21/114) and genital itching (19/114) were the leading clinical symptoms. A wide range of diagnostic methods, including morphological, culture, biochemical, and molecular techniques, were reported.

This meta-analysis suggests a substantial global burden of VVC; however, the wide heterogeneity across studies indicates that true prevalence likely varies considerably by region. Common symptoms like curd-like discharge and genital itching support symptom-based diagnosis, especially in low-resource settings. The diversity of diagnostic methods underscores the need for context-specific approaches. These findings may support improved awareness, while emphasizing the need for more standardized epidemiological methods.