Importance of Candida infection and fluconazole resistance in women with vaginal discharge syndrome in Namibia

Abstract

AbstractBackgroundVaginal discharge syndrome (VDS) is a common condition. Clinical management targets sexually transmitted infections (STIs) and bacterial vaginosis (BV); there is limited focus onCandidainfection as cause of VDS. Lack ofCandidatreatment coverage and, if present, antifungal resistance may result in VDS treatment failure. This study aimed to determine the prevalence ofCandidainfection, antifungal resistance, and coinfections in Namibian women with VDS.MethodsA cross-sectional study was performed using 253 vaginal swabs from women with VDS in Namibia. Demographic data was collected, and phenotypic and molecular detection ofCandidaspecies was performed followed by fluconazole susceptibility testing ofCandidaisolates. BV was diagnosed using Nugent score microscopy; molecular detection ofChlamydia trachomatis,Neisseria gonorrhoeaeandTrichomonas vaginaliswas performed.ResultsCandidaspecies was detected in 110/253 women (43%). Ninety women (36%) hadCandida albicansand 24 (9.5%) had non-albicansCandidaspecies. The non-albicans species detected were 19 (17%)Candida glabrata, 4.0 (3.5%)Candida krusei, and 1.0 (0.9%)Candida parapsilosis.Candida albicanswere more frequently isolated in younger (p = 0.004) and pregnant women (p = 0.04) compared to non-albicansCandidaspecies. Almost all (98%)Candida albicansisolates were susceptible to fluconazole while all non-albicansCandidaspecies were fluconazole resistant. STIs were diagnosed in 92 women (36%): 30 (12%) withC. trachomatis, 11 (4.3%)N. gonorrhoeae, and 70 (28%)T. vaginalis; 98 (39%) women had BV.Candidainfection alone was diagnosed in 30 women (12%), combined with STIs in 42 women (17%) and was concurrent with BV in 38 women (15%).Candidainfection was more often detected in swabs from women withoutC. trachomatisdetected (6.4% vs. 16%; OR 0.30; 95% CI 0.10–0.77,p = 0.006).ConclusionsThe high prevalence ofCandidainfection, especially those due to non-albicansCandidaspecies that are resistant to fluconazole, is a great concern in our setting and may lead to poor treatment outcomes. Access to microbiological testing forCandidaspecies in the context of syndromic management is warranted.