Vulvovaginal candidiasis and antifungal susceptibility pattern of isolated Candida spp. among women in Aden Governorate, Yemen

BACKGROUND: Vulvovaginal Candidiasis is a complicated inflammatory infectious disease of the female genital tract caused by the genus Candida. Most studies dealing with VVC in Yemen did not involve both risk factors and antifungal sensitivity. So, this study was performed to evaluate risk factors contributing to VVC and to evaluate the antifungal susceptibility patterns of Candida spp. among women in Aden, Yemen. METHODS: One hundred and two women were enrolled in this cross-sectional study. Two high vaginal swabs were collected, tested microscopically, and inoculated in SDA. A chromogenic medium was used to identify and differentiate Candida species. Six available antifungal agents were used for sensitivity testing included: Itraconazole, Fluconazole, Ketoconazole, Clotrimazole, Nystatin and Miconazole by disc diffusion method. The data was finally analyzed by using SPSS software (Version 21). RESULTS: A total of 102 women were included in this study. The mean age was 27.36 ± 7.7 years, with a range of 16–47 years. The overall frequency of VV among women was 39.2%. The highest rate was 44.9% (22/49) in the age group < 25 years. Five species of Candida were isolated, with C. albicans being the most frequent (55%), followed by C. krusei (17.5%), C. glabrata (12.5%), C. tropicalis (10%) and C. parapsilosis (5%). Symptom severity was significantly associated with VVC (p = 0.0001), whereas the association with pregnancy did not reach statistical significance (p = 0.066). In terms of antifungal susceptibility testing, the overall resistance was 20% to Clotrimazole, 15% to Nystatin, 7.5% to both Ketoconazole and Miconazole and the lowest resistance rate (2.5%) was to Fluconazole. All five isolated species were 100% sensitive to Itraconazole. CONCLUSION: It can be concluded from this study that the overall frequency of VVC among women in Aden-Yemen is higher than that reported among Yemeni women, while slightly lower than that reported globally. The infection was high among women in the age group < 25 years. C. albicans and C. krusei were the most frequent species. The pregnancy may increase the risk of VVC. Resistance was found to Clotrimazole, Nystatin, Ketoconazole, Miconazole, and Fluconazole, while no resistance was detected to Itraconazole among those species. The resistance among non-albicans Candida (NAC) species has increased.