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Prevalence and Co-occurrence of Candida albicans and Sexually Transmitted Infections in Lactobacillus-Deficient

Samkelisiwe Beje¹, Zizipho Z A Mbulawa^2,3

¹Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha, 5100, South Africa.

|March 17, 2026

Abstract

Background:

Lactobacillus species are essential for vaginal eubiosis; their depletion often leads to dysbiosis, increasing susceptibility to sexually transmitted infections (STIs). This study investigated the prevalence of Candida albicans colonization and its associated factors among HIV-negative adolescent girls and young women (AGYW) in South Africa. Furthermore, STIs associated with C. albicans colonization and Lactobacillus deficiency were investigated.

Methods:

Secondary data analysis was performed on 138 HIV-negative AGYW of Eastern Cape province, South Africa. Secondary data included cervico-vaginal detected C. albicans, Lactobacillus species (L. crispatus, L. gasseri or L. jensenii), bacterial vaginosis, human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus type 1/2 (HSV-1/2), and Mycoplasma genitalium, and behavioural questionnaires. Univariate and multivariate logistic regression were performed using GraphPad Prism Version 8.0.1.244.

Results:

A proportion of 27.58% were positive for C. albicans, and 84.06% tested positive for at least one investigated STI (73.91% for HPV, 31.16% for C. trachomatis, 12.32% for N. gonorrhoeae, 10.87% for T. vaginalis, 7.25% for HSV-1/2, and 5.80% for M. genitalium). Frequent sexual intercourse (more than two times within the past 30 days) was associated with higher odds of C. albicans (OR: 1.84, 95% CI 1.85-3.80, p = 0.036), alcohol consumption (OR: 3.60, 95% CI 1.12-13.23, p = 0.038) and recent vaginal discharge syndrome (OR: 2.67, 95% CI 1.06-6.63, p = 0.005). Deficiency of Lactobacilli among C. albicans-positive AGYW was associated with increased odds of C. trachomatis positivity (OR: 4.37, 95% CI 1.05-17.05, p = 0.047).

Conclusion:

HIV-negative AGYW demonstrated a high burden of STIs, with C. albicans positivity associated with alcohol consumption, frequent sexual intercourse, and vaginal discharge syndrome. The absence of Lactobacilli was associated with increased odds of C. trachomatis positivity. Further research is recommended using longitudinal designs, larger sample sizes, and diverse populations to better understand these observations.

Keywords:

Candida albicans Lactobacillus species Adolescent girls and young women Cervicovaginal microbiota Human papillomavirus Sexually transmitted infections

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