Medical Mycology: Open Access

Keywords

Vaginal mycosis; Leucorrhoea; Vaginal sampling; Risk factors

Introduction

Vaginal candidiasis is a mycosis caused by the presence of a fungus of the genus Candida in the vagina [1-3]. It is the most common genital infection in women. It affects almost 75% of sexually active women and pregnant women [4-7]. This fungus, considered saprophytic, can become pathogenic through a combination of factors. These factors may include an increase in estrogens secondary either to oral contraception or pregnancy; the presence of poorly balanced diabetes, which favors Candida adhesion to epithelial cells; the use of local or systemic broadspectrum antibiotic therapy; the existence of HIV/AIDS infection. Other factors, such as genetic factors (race, blood group), factors linked to women's behavior (clothing hygiene, intimate hygiene, frequency of certain sexual practices), mechanical contraception (intra-uterine device, vaginal ring) [8].

With the aim of improving patient care and raising awareness of the risk factors for Vaginal Candidiasis (VC), we conducted this study to determine the prevalence and risk factors associated with the occurrence of vaginal candidiasis in women referred to the parasitology-mycology laboratory at the Brazzaville University Hospital (CHUB) for vaginal swab analysis.

Materials and Methods

We conducted a descriptive and analytical cross-sectional study from July 15 to October 31, 2019 at the CHUB parasitology-mycology laboratory. All patients who came to the sampling room during the study period for vaginal swab analysis were included after completing a consent form. Sociodemographic data (age, profession, level of education), clinical data (medical and gynaecological history, symptoms) and the result of the mycological analysis were collected using a survey form.

Each sample collected was measured for vaginal pH using a colorimetric strip and examined macroscopically to assess the appearance of the leucorrhoea and vaginal mucosa. Direct microscopic examination for yeasts and culture on Sabouraud chloramphenicol medium were performed.

Culture media were incubated at 37°C in an aerobic atmosphere for 24 hours. The data collected were analyzed using Epi-info 7.2.2.6 software. Qualitative variables were described in terms of headcount and percentage of data completed; quantitative variables were described in terms of means and standard deviation. Proportion comparisons were made using Pearson's chisquare test or Fisher's exact test, depending on applicability. Logistic regression was used to determine factors associated with the occurrence of vaginal candidiasis. The test was significant when the p was less than 0.05.

Results

A total of 152 patients were enrolled in this study. The median age of the patients was 32 years, with q1: 24 years and q3: 40 years. Table 1 shows the socio-demographic characteristics of patients with vaginal candidiasis. One hundred and fifty-two samples were collected, of which 88 were positive on direct examination (48.7%) and 34 were positive after culture (22.4%).

Table 1: Socio-demographic characteristics of patients with vaginal candidiasis.

The age groups most affected by candidiasis were and with 29.4% and 26.5% respectively. Unemployed patients were most likely to suffer from vaginal candidiasis, with a frequency of 52.9%. Most were single and unemployed. Antibiotic and corticosteroid use were not significantly associated with vaginal candidiasis (p=0.077; p=0.417). Gyneco-obstetrical characteristics were not significantly associated with the occurrence of vaginal candidiasis (Table 2) [9].

Table 2: Gyneco-obstetrical characteristics of patients with vaginal candidiasis.

Among hygienic characteristics, only the method of cleaning after defecation was significantly associated (p=0.003) with the occurrence of vaginal candidiasis (Table 3).

Table 3: Hygienic characteristics of patients who have had vaginal candidiasis.

Table 4 shows that leucorrhoea, burning sensation and genital pruritus were the symptoms most significantly associated with vaginal candidiasis (p=0.000; p=0.003: p=0.016).

Table 4: Symptoms of patients with vaginal candidiasis.

After logistic regression, the risk factors associated with the occurrence of vaginal candidiasis are shown in Table 5 [10].

Table 5: Risk factors associated with the occurrence of vaginal candidiasis in patients who consulted the CHUB parasitology-mycology laboratory.

After multiple logistic regression, two factors were identified as being associated with the occurrence of vaginal candidiasis: The method of cleaning after defecation and the existence of leucorrhoea. Patients with leucorrhoea were 4 times more likely to develop vaginal candidiasis than other patients. Those with a back-to-front and front to back cleaning pattern were 28 times more likely to develop vaginal candidiasis than other patients [11-13].

Discussion

Vaginal candidiasis, a vaginal infection caused by the development in women of a usually saprophytic yeast of the genus Candida, is a frequent infection in women of childbearing age. These yeasts were present in almost half of all women on direct examination. However, they were present in less than 20% of cases after culture. Several authors, on the other hand, isolated more Candida yeasts after culture than in the fresh state. This difference could be explained either by the greater carriage of Candida yeasts by women in our study or by differences between microscopists, as microscopy is an operator dependent technique [14].

The onset of vaginal candidiasis is multifactorial. Predisposing hormonal, metabolic, immune, genetic and behavioral factors have been incriminated [8]. These factors are found in varying degrees in different populations. Thus, in our study, we isolated factors related to hygiene and clinical signs. Leucorrhoea was a risk factor in women with vaginal candidiasis. In several studies, leucorrhoea has been considered one of the cardinal clinical signs of vaginal candidiasis in both Candida albicans and Candida non-albicans infections. But few authors have shown that they represent a risk factor for the onset of CV. This was the case for Konate A, et al., in Abidjan, who did not find leucorrhoea to be a risk factor for the onset of VC [15]. Ane- Anyangwe I, et al., showed that clinical signs were not a risk factor for vaginal candidiasis. However, by showing leucorrhoea as a risk factor, our study indicates that, in our environment, the presence of leucorrhoea in the event of a lower genital infection should suggest candidiasis. However, this is a finding that should be investigated by analyzing this sign in vaginal candidiasis and genital infections on a larger scale, as it may be at the origin of probabilistic prescribing, a practice that is currently outlawed due to the emergence of antimicrobial resistance.

The intestinal flora contains yeasts. These yeasts can be found in the vagina not only through certain sexual practices, but also through the way a woman cleans herself when she returns from the bathroom. This is because faecal germs can be found in the vagina or urine when faecal hygiene is not good. This is why cleaning after defecation has been considered a risk factor for vaginal candidiasis in the population of women consulting the laboratory. In the literature, we have not found this to be a risk factor. Zeng X, et al., in China, evaluated back-to-front and frontto- back cleansing and showed that cleansing was not a risk factor, but did not evaluate back-to-front and front-to-back cleansing as we did. However, Guzel AB, et al., in Turkey reported that patients with a short ano-vaginal distance had more vaginal candidiasis than others [16].

Conclusion

There are many risk factors for the onset of vaginal candidiasis. They vary according to the population studied. The factors associated with the occurrence of vaginal candidiasis in our context were the presence of leucorrhoea and the coupled front to back/back-to-front cleaning method.

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