Background: Candida is a normal commensal in 25-50% of healthy asymptomatic women. 50-70% women have at least one episode of candidiasis during their reproductive life. Symptomatic episodes of vulvovaginal candidiasis (VVC) is due to Candida albicans (80%) or non candida albicans species like C.glabrata, C.tropicalis, C.krusei. Recently there is an increase in the incidence of VVC caused by non candida albicans species especially C.glabrata.
Methods: All patients with complaints of vaginal discharge attending the female sexually transmitted disease clinic were included in the study. The study period was 6 months(January2013 -June 2013) . Detailed history and clinical examination was carried out . The smears were taken from urethra , vagina and cervix. Gram staining , wet mount, vaginal pH and culture on Sabauroud’s Dextrose agar medium were performed. All the candida culture positive isolates were subjected to species identification and drug sensitivity tests.The species were identified by germ tube , corn meal agar and sugar fermentation tests. In vitro antifungal susceptibility was determined by e-strip test .The tested drugs included ketoconazole, fluconazole, voriconazole, itraconazole ,amphotericin-B and caspofungin.
Results: Out of 500 patients of vaginal discharge, 180 samples were culture positive for Candida. Among 180 Candidal isolates , 56.67 %(102) were of C.albicans, followed by 50 % ( 90) C.glabrata, 2.78 % ( 5) C.krusei and 1.67 % (3 ) C.tropicalis. Antifungal drug susceptibility patterns to various systemic antifungals showed considerable resistance of non candida albicans species especially C. glabratato various azoles.
Conclusions: Among the non candida albicans species, C.glabrata is emerging as a significant cause of vulvovaginal candidiasis. C.glabrata demonsrates intrinsically reduced susceptibility to azole drugs. Mycological cultures should be performed wherever culture facilities are available to determine the species and drug sensitivity pattern especially if there is no response to therapy.