Prevalence of VVC among nonpregnant women who attended the Gynecology Clinic at HRRH.
The prevalence of VVC in nonpregnant women who attended gynecology clinic at HRRH was 27.70%. This rate is consistent with the findings of in Uganda, who reported a rate of 27.5% among pregnant women who attended antenatal consultation at a northern Uganda district hospital (10).
A relatively low prevalence of 21% was reported in Ghana among women attending gynecology clinics (11). This discrepancy may be explained by the differences in sociodemographic characteristics and study populations. On the other hand, Abruquah and colleagues used a different technique than ours to isolate Candida species (11). Like in a study performed in Brazil, where Candida was isolated in 22% of patients attending the gynecology clinic (12).
Other authors reported a high prevalence to our findings as in a study conducted in Egypt, where the prevalence was 50% (13). This could be explained by the fact that Shawaky and colleagues used molecular analysis to isolate Candida species, and in addition, they recruited both pregnant and nonpregnant women.
In another study performed in Ghana by (14), VVC was prevalent in 36.5% of enrolled patients, but they included only pregnant women, which can explain the higher prevalence of VVC.
Factors associated with VVC among nonpregnant women who attended the Gynecology Clinic at HRRH.
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Demographic factors.
Participants aged between 20 and 34 years were 8 times more likely to present VVC (2.85–21.74; 95% CI P < 0.001). Studies in Dubai (15) and Tunisia (16) reported higher prevalence rates among patients aged 26–35 and 20–34 years, respectively.
Similarly, in Nigeria Okungbowa and collegues described VVC more frequently in individuals aged 26–30 years. Younger women are considered to be more sexually active and could have a lower degree of vaginal defense against Candida species; additionally, contraception use is more common in these groups, which may favor Candida infection (23).
However, in Ghana, (11) reported in his study that patients aged 15–20 years were more likely to present VVC, which could be explained by young women being more predisposed to negative variables, such as unsafe sexual practices and age at first sexual intercourse less than 20 years, which may explain why VVC is more prevalent in this population.
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Medical factors.
HIV-positive patients had a significantly greater risk of VVC. This finding is consistent with the findings published in the Namuwongo Project (2018) in Uganda, where a high percentage of VVC was reported among patients with HIV (25). Immunosuppression related to HIV itself may be the main factor.
In addition, the depletion of estrogen production observed in HIV patients, which is among the factors that protects against vaginal infection, may explain this association (17). The correlation between HIV and vaginal candidiasis remains understudied because several authors excluded HIV-positive individuals during their studies.
In this study, participants with previous episodes of vaginal candidiasis were 10 times more likely to have VVC. These findings are consistent with those of (18) and (6) studies conducted in Nigeria and Ethiopia, respectively. The reason was that patients with a previous history of VVC were more likely to use extended-spectrum antibiotics, which alter the population and biochemical activity of the vaginal bacterial microflora, increasing the vaginal pH as a result of decreased CO2 generation.
Antifungal susceptibility patterns of VVC among nonpregnant women who attended the Gynecology Clinic at HRRH.
Candida species were most sensitive to amphotericin B, followed by ketoconazole, at 97.40% and 79.22%, respectively.
In Japan (19) also reported a 95% sensitivity of Candida species to amphotericin B. Similar findings were reported in Egypt by (20), where amphotericin B was found to be more effective against all Candida species among women attending gynecology clinics in care. This high susceptibility to amphotericin B may be explained by the fact that amphotericin B is rarely prescribed in routine care and is used most specifically in cases of VVC resistance, which spares it from driving resistance to common Candida species.
In contrast, in western Uganda, Candida species were reported to be resistant to Amphotericin B (21). The findings of Watsemwa and colleagues were also from pregnant women, this difference in the study population may be the reason for the contrasting findings (21). On the other hand, recurrent episodes of VVC in pregnant women, probably due to inappropriate management of VVC during pregnancy, may drive resistance to antifungal treatment.
Candida species were least sensitive to miconazole, followed by griseofulvin at 70% and 68.83%, respectively. The cause could be that these antifungals are widely available and easily accessible; however, they are often used inappropriately in facilities and pharmacies, which could lead to resistance. Fluconazole was reported to be highly effective for all sp. pneumoniae strains among nonpregnant women (6, 21).
However in China, an intermediate sensitivity to miconazole was reported (24). In Japan, miconazole was reported to be effective against Candida albicans (19). The appropriate use of antifungal drugs by a selection of patients according to culture and sensitivity results while managing VVC in China may explain this discrepancy in the findings.
In general, the variation in susceptibility observed in various studies is not only due to regional differences but also because some of them did not test the same antifungal medications.