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1.
BMC Infect Dis ; 19(1): 879, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640583

RESUMO

BACKGROUND: In Yemen, the underlying causes of infectious vaginitis have been neglected. Therefore, this study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women. METHODS: A cross-sectional study was conducted among 347 non-pregnant reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. Data about sociodemographic characteristics, lifestyle-related behaviors, routine hygienic practices, menstrual care and history and type of contraceptive intake were collected using a structured questionnaire. Vaginal discharge samples were collected and examined for discharge characteristics and pH by a gynecologist. Then, samples were examined for BV, VVC and TV. Data were analyzed using suitable statistical tests. RESULTS: Vaginal infections were prevalent among 37.6% of reproductive-aged women, where BV was the most prevalent (27.2%). VVC was significantly higher among symptomatic women and significantly associated with itching (P = 0.005). Using bivariate analysis, the age of < 25 years (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.16-3.10; P = 0.010) and using intrauterine contraceptive devices (IUCDs) (OR = 1.8, 95% CI: 1.09-2.89; P = 0.020) were significantly associated with BV, while history of miscarriage was significantly associated with a lower risk of BV (OR = 0.5, 95% CI: 0.31-0.85, P = 0.009). However, polygyny was significantly associated with VVC (OR = 3.4, 95% CI: 1.33-8.66; P = 0.007). Multivariable analysis confirmed that age of < 25 years and using IUCD were the independent predictors of BV, while history of miscarriage was an independent protective factor against BV. On the other hand, marriage to a polygamous husband was the independent predictor of VVC. CONCLUSIONS: More than a third of non-pregnant reproductive-aged women seeking PHC in Sana'a have single or mixed infections with BV, VVC or TV. BV is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using IUCDs, while VVC is significantly higher among women with polygamous husbands. Health education of polygamous husbands and their wives, regular monitoring of BV among IUCD users and screening women for vaginitis before treatment are recommended.


Assuntos
Candidíase Vulvovaginal/epidemiologia , Vaginite por Trichomonas/epidemiologia , Vaginose Bacteriana/epidemiologia , Adolescente , Adulto , Candidíase Vulvovaginal/etiologia , Coinfecção , Estudos Transversais , Feminino , Humanos , Dispositivos Intrauterinos/estatística & dados numéricos , Casamento , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco , Vaginite por Trichomonas/etiologia , Vaginose Bacteriana/etiologia , Iêmen/epidemiologia , Adulto Jovem
2.
Infect Dis Obstet Gynecol ; 2019: 5016810, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467477

RESUMO

Objective: Candida species colonize the vagina in at least 20% of women, with rates rising to 30% during pregnancy. This study aimed at determining the prevalence and risk factors of vulvovaginal candidiasis (VVC) in pregnant women at 35-37 weeks of gestation. It also aims at finding possible correlations between VVC and vaginal colonization by other agents, such as Group B Streptococcus (GBS) and bacterial vaginosis. Methodology: Over a one-year period, high vaginal swabs were collected from pregnant women during their regular antenatal checkup in different polyclinics in Beirut and South Lebanon. Swabs were examined microscopically, cultured on Sabouraud Dextrose Agar, and Candida isolates were identified using Chromatic Candida medium and Germ Tube Test. Results: VVC was detected in 44.8% of samples, with C. glabrata (44.4%) and C. albicans (43.4%) being the most isolated species. Approximately, half of pregnant women (57.7%) were coinfected with Candida and bacterial vaginosis, while 26% of them carried simultaneously Candida spp. and GBS. No significant correlation was found between the occurrence of VVC and demographic, clinical, medical, and reproductive health characteristics of pregnant women. In contrast, participants with previous miscarriages and those being hospitalized during the past 12 months were more susceptible to develop vaginal C. krusei infection in comparison to other Candida species (p=0.0316 and p=0.0042, respectively). Conclusion: The prevalence of VVC in pregnant women is an increasing trend in our community. Therefore, routine medical examination and regular screening for candidiasis in the antenatal care program is highly recommended to manage the disease and its complications.


Assuntos
Candida/patogenicidade , Candidíase Vulvovaginal/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Adulto , Candida/classificação , Feminino , Humanos , Líbano/epidemiologia , Gravidez , Prevalência , Fatores de Risco , Vagina/microbiologia , Adulto Jovem
3.
BMC Pregnancy Childbirth ; 19(1): 166, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077161

RESUMO

BACKGROUND: Bacterial vaginosis (BV) is a common reproductive tract disorder in women of child bearing age, accounting for one third of vaginal infections. It is characterized by an increase in vaginal pH, decreased Lactobacilli, and overgrowth of facultative and anaerobic bacteria. Studies have consistently shown BV to be a risk factor for adverse obstetric and gynecological outcomes. BV is believed to play a critical role in the transmission of sexually transmitted infections. Its aetiology and risk factors are poorly understood. This study determined the prevalence and risk factors for BV among pregnant women in Kumba Health District (KHD) Cameroon to generate findings that could guide the design of interventions for prevention of infection and associated poor pregnancy outcomes. METHODS: A structured questionnaire was administered to 309 women seeking antenatal care (ANC) in three health facilities in KHD between May to July 2016, to capture data on demographic, gynecological and obstetric characteristics, and hygiene behavior. High vaginal swabs (HVS) collected from these women were gram stained, examined under a microscope and BV evaluated by Nugent scoring. Chi square (χ2) test was used to determine the relationship between BV and factors investigated. Statistical significance was set at p < 0.05. RESULTS: The prevalence of BV was 26.2%. Nine point 1 % of participants had a mixed infection with Candida. BV was higher (29.5%) in participants from the rural area (χ2 = 8.609. P = 0.014), those who did not use antibiotics (31.9%) prior to the study (χ2 = 12.893, P = 0.002) and women with no history of a genital tract infection (χ2 = 18.154, P = 0.001). There was a significant difference in prevalence with respect to gestation age (χ2 = 13.959, P = 0.007) with the highest occurring in women in the second trimester (31.7%). Women who practiced douching (χ2 = 23.935, P = 0.000) and those who did not wash pants with disinfectant (χ2 = 7.253, P = 0.027) had a high prevalence. CONCLUSION: BV could be a health concern among pregnant women in study area. BV prevalence was affected by some hygiene behaviors, socio-demographic and clinical factors. Screening and treatment of positive cases during antenatal visits to prevent adverse outcomes, as well as education of women on vaginal hygiene is highly recommended.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Vaginose Bacteriana/epidemiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Camarões/epidemiologia , Candidíase Vulvovaginal/epidemiologia , Coinfecção/epidemiologia , Feminino , Idade Gestacional , Humanos , Higiene , Lavanderia/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Vagina/microbiologia , Ducha Vaginal/estatística & dados numéricos , Vaginose Bacteriana/microbiologia , Adulto Jovem
4.
Mycoses ; 62(8): 692-697, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31132175

RESUMO

Vulvovaginal candidiasis (VVC) is a common infection of the genital tract affecting millions of women worldwide. Data on epidemiological trends of VVC in Greece are scarce. This study was undertaken to evaluate the prevalence of VVC among symptomatic women in Crete, Greece, identify the Candida species involved and determine their susceptibility to antifungals. Over a 6-year period (2012-2017), 10 256 symptomatic women with vaginitis were evaluated. Isolation of yeasts was performed on Sabouraud dextrose agar with chloramphenicol, and the isolates were identified using the API 20 C AUX and/or the Vitek 2 YST card. Susceptibility of the isolates to amphotericin, fluconazole, voriconazole and flucytosine was determined by the Vitek 2 automated system. The results were interpreted according to Clinical and Laboratory Standards criteria. Vaginal swab cultures of 1217 (11.9%) women yielded Candida species. Recurrent VVC was documented in 62 (5.1%) of them. Candida albicans was the most frequently isolated species (75.6%), followed by Candida glabrata (13.6%). Overall, resistance rates to amphotericin B, fluconazole, voriconazole and flucytosine were 0.2%, 6.6%, 1.4% and 2.1%, respectively. Fluconazole resistance of C. albicans significantly increased in the second period of the study (2015-2017) (P = 0.031). This study demonstrated that VVC is a common infection among women in our region, with C. albicans being the predominant species involved. Although resistance to antifungals was infrequent, resistance to fluconazole among C. albicans isolates was found to significantly increase with time. Continued surveillance of changes in species distribution and susceptibility to antifungals are necessary to guide treatment.


Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidíase Vulvovaginal/epidemiologia , Vagina/microbiologia , Vaginite/microbiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Candida/isolamento & purificação , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candida glabrata/efeitos dos fármacos , Candida glabrata/isolamento & purificação , Candidíase Vulvovaginal/microbiologia , Farmacorresistência Fúngica , Feminino , Grécia/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Recidiva , Vaginite/epidemiologia , Adulto Jovem
5.
J Mycol Med ; 29(2): 127-131, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31010729

RESUMO

Recurrent vulvovaginal candidiasis (RVVC) is a major health problem for sexually active women because of its severe effect on their quality of life. A thorough knowledge of their epidemiology leads to their efficient management. Therefore, a cross-sectional study was conducted in 2014 in women with leucorrhoea associated or not with other clinical signs. Recurrence was based on the occurrence of at least four annual episodes of Candida vulvo-vaginitis. An individual interview based on a questionnaire was conducted to identify the socio-demographic parameters that could be associated with the RVVC. Vaginal samples were collected at the obstetrical gynaecology department of the University Hospital of Cocody and at the Pasteur Institute of Côte d'Ivoire. On each sample, a direct examination and culture on Sabouraud-chloramphenicol medium with or without actidione were performed. Yeast identification was performed using chromogenic media (CandiSelect®4 [Bio-Rad]) and the study of sugar assimilation using the Auxacolor® 2 gallery (Bio-Rad). A total of 400 patients were included. The average age was 29.2 years (SD=7.2 years). Of these, 94 had recurrent vulvovaginal candidiasis, with a prevalence of 23.5% (CI95%: 19.49-28.02). Five species of the genus Candida have been identified: Candida albicans (59.6%), Candida glabrata (19.1%), Candida tropicalis (16%), Candida krusei (4.2%) and Candida inconspicua (1.1%). Some factors such as education level, history of sexually transmitted infection, type of underwear used, frequency of personal hygiene and type of product used for these hygiene have been associated with the occurrence of RVVCs. The occurrence of RVVCs is relatively high in our study population. Non-albicansCandida species occupy a significant place in this disease epidemiology. By addressing the factors associated with the occurrence and/or persistence of RVVCs, it will be possible to reduce their incidence in sexually active women.


Assuntos
Candida/isolamento & purificação , Candidíase Vulvovaginal/epidemiologia , Candidíase Vulvovaginal/etiologia , Vagina/microbiologia , Adulto , Candida/classificação , Candida albicans/isolamento & purificação , Candida tropicalis/isolamento & purificação , Costa do Marfim/epidemiologia , Estudos Transversais , Feminino , Humanos , Prevalência , Qualidade de Vida , Recidiva , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
6.
J Obstet Gynaecol Res ; 45(6): 1190-1196, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30916426

RESUMO

AIM: The aim of this study was to evaluate if thong use is associated with a higher report of urogenital infections, including urinary tract infections, yeast vaginitis and bacterial vaginosis. METHODS: A cross-sectional survey regarding underwear preferences and infectious history was designed and distributed to women via a crowdsourcing service. All survey questions related to the last 12 months. Parametric and nonparametric statistical methods were used to compare responses between thong wearers and nonthong wearers. Thong wearers were defined as women who wore a thong equal to or more than 50 % of the time. RESULTS: Nine hundred and eighty-six respondents met inclusion criteria and completed the survey; 186 (18.9%) were defined as thong wearers and 800 (81.1%) were defined as nonthong wearers in the last 12 months. Reported rates of urogenital infections in the last 12 months were not significantly different for thong wearers versus nonthong wearers. Thong use was not an independent predictor of any urogenital infection in this study. CONCLUSION: In this large cross-sectional study we found that oral sex was the only independent predictor of urinary tract infection and bacterial vaginosis, and that wearing noncotton crotch underwear was associated with yeast vaginitis. Wearing thong underwear was not associated with any urogenital infections. Medical providers should discuss sexual practices and underwear fabric, rather than style, with their patients when there is concern for urogenital infection.


Assuntos
Candidíase Vulvovaginal/etiologia , Vestuário/efeitos adversos , Higiene , Comportamento Sexual , Infecções Urinárias/etiologia , Vaginose Bacteriana/etiologia , Adolescente , Adulto , Candidíase Vulvovaginal/epidemiologia , Vestuário/estatística & dados numéricos , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Vaginose Bacteriana/epidemiologia , Adulto Jovem
7.
BMC Womens Health ; 19(1): 48, 2019 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-30925872

RESUMO

BACKGROUND: Vulvovaginal candidiasis (VVC) is a common infection affecting women worldwide. Reports of patterns/risk factors/trends for episodic/recurrent VVC (RVVC) are largely outdated. The purpose of this study was to obtain current patient perspectives of several aspects of VVC/RVVC. METHODS: Business cards containing on-line survey information were distributed to healthy volunteers and patients seeking standard, elective, or referral gynecologic care in university-affiliated Obstetrics/Gynecology clinics. The internet-based questionnaire was completed by 284 non-pregnant women (78% Caucasian, 14% African American, 8% Asian). RESULTS: The majority of the participants (78%) indicated a history of VVC with 34% defined as having RVVC. The most common signs/symptoms experienced were itching, burning and redness with similar ranking of symptoms among VVC and RVVC patients. Among risk factors, antibiotic use ranked highest followed by intercourse, humid weather and use of feminine hygiene products. A high number of respondents noted 'no known cause' (idiopathic episodes) that was surprisingly similar among women with a history of either VVC or RVVC. VVC/RVVC episodes reported were primarily physician-diagnosed (73%) with the remainder mostly reporting self-diagnosis and treating with over-the-counter (OTC) medications. Most physician-diagnosed attacks utilized a combination of pelvic examination and laboratory tests followed by prescribed antifungals. Physician-treated cases achieved a higher level of symptom relief (84%) compared to those who self-medicated (57%). The majority of women with RVVC (71%) required continual or long-term antifungal medication as maintenance therapy to control symptoms. CONCLUSIONS: Current patient perspectives closely reflect historically documented estimates of VVC/RVVC prevalence and trends regarding symptomatology, disease management and post-treatment outcomes.


Assuntos
Antifúngicos/uso terapêutico , Candidíase Vulvovaginal/tratamento farmacológico , Candidíase Vulvovaginal/epidemiologia , Adulto , Candidíase Vulvovaginal/psicologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Incidência , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Risco , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
8.
Med Mal Infect ; 49(3): 194-201, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30792037

RESUMO

OBJECTIVE: An empirical treatment of infectious vaginitis is justified because of its multiple etiologies, the frequent uncertainty of clinical diagnosis and limits of microbiological analysis. Our aim was to comparatively investigate nystatin-neomycin-polymyxin B combination (NNP, Polygynax®) and miconazole. PATIENTS AND METHODS: In this European multicenter, double-blind PRISM trial, participating women presenting with infectious vaginitis were randomized to receive one vaginal capsule containing either NNP for 12 days or miconazole for 3 days followed by 9 days of placebo. RESULTS: The clinical success rate was higher in the NNP group (n=302) than the miconazole group (n=309), with a difference between groups close to statistical significance (91.1% vs. 86.7%, P=0.0906). The risk of treatment failure was 36% lower in the NNP group (odds ratio, 0.64; 95% confidence interval, 0.38-1.07). Vaginal burning on Day 2 and vaginal discharge on Day 4 were significantly less intense in the NNP group than in the miconazole group (39.1 vs. 42.3, P=0.031 and 34.6 vs. 37.6, P=0.031, respectively). Adverse drug reactions were reported by 1.2% and 2.1% of patients in the NNP and miconazole group respectively, with the ratio of adverse drug reactions relative to total adverse events significantly higher in the miconazole group (20.3% vs. 6.9%, P=0.022). CONCLUSION: The widespread use of NNP for several decades and its good efficacy and safety profile, as well as the frequent diagnostic uncertainties due to the various pathogens sustain the initiation of this broad-spectrum empirical treatment in infectious vaginitis.


Assuntos
Arsenicais/administração & dosagem , Miconazol/administração & dosagem , Neomicina/administração & dosagem , Nistatina/administração & dosagem , Polimixinas/administração & dosagem , Vaginite/tratamento farmacológico , Adolescente , Adulto , Arsenicais/efeitos adversos , Candidíase Vulvovaginal/tratamento farmacológico , Candidíase Vulvovaginal/epidemiologia , Método Duplo-Cego , Combinação de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Miconazol/efeitos adversos , Pessoa de Meia-Idade , Neomicina/efeitos adversos , Nistatina/efeitos adversos , Polimixinas/efeitos adversos , Resultado do Tratamento , Vaginite/epidemiologia , Vaginite/microbiologia , Vaginose Bacteriana/tratamento farmacológico , Vaginose Bacteriana/epidemiologia , Adulto Jovem
9.
J Matern Fetal Neonatal Med ; 32(21): 3612-3617, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29685081

RESUMO

Objectives: The aims of this study were to describe the course of vulvovaginal candidiasis (VVC), trichomoniasis, and bacterial vaginosis (BV) in pregnancy and to explore the association between these longitudinal changes and pregnancy outcomes. Methods: A total of 793 pregnant women were enrolled at the first trimester of pregnancy and were followed prospectively twice at the second and third trimester. VVC, trichomoniasis, and BV were evaluated at each trimester of pregnancy. Results were evaluated for trends of these three diseases and the association between these changes of trends and pregnancy outcomes. Results: The trend of negative at all three time points was dominant for all three diseases compared with trend of positive throughout pregnancy was the most rare. In addition, for VVC, a trend toward positive can't be ignored (7.5%). However, for BV, the distribution of other three trends (trend negative, trend positive, status random) were basically the same. Different trends of these three diseases were not associated with adverse pregnancy outcomes, with the exception of women who had a trend of BV positive throughout pregnancy were more likely to suffer from amniotic fluid infection (AFI) compared with women who were negative at all three time points (p = .016, OR: 17.29, 95% CI: 1.70-175.54). Conclusions: In this population, the trend of negative throughout pregnancy was dominant for all three diseases compared with few women were positive across their pregnancy. BV may be associated with AFI during pregnancy.


Assuntos
Candidíase Vulvovaginal/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Tricomoníase/epidemiologia , Vaginose Bacteriana/epidemiologia , Adulto , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Candidíase Vulvovaginal/diagnóstico , China/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Projetos Piloto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Dados Preliminares , Prognóstico , Tricomoníase/diagnóstico , Vaginose Bacteriana/diagnóstico
10.
J Diabetes Investig ; 10(2): 439-445, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30136398

RESUMO

AIMS/INTRODUCTION: The prevalence and risk of vaginal candidiasis before and after initiating sodium-glucose cotransporter 2 (SGLT2) inhibitors, although some clinical trials have been carried out, have not been adequately shown in real-world practice. We investigated the incidence of vaginal Candida colonization and symptomatic vaginitis, and the clinical risk factors including diabetic microvascular complications. MATERIALS AND METHODS: The participants were 114 women with type 2 diabetes who were free of vaginitis symptoms and started SGLT2 inhibitors. Vaginal candidiasis tests through self-administered swabs were carried out at baseline, 6 and 12 months. RESULTS: Before starting SGLT2 inhibitors, 17 participants (14.9%) had positive vaginal Candida colonization. Younger age and the presence of microangiopathy were significantly associated with the positive colonization in multivariate analysis. Among all participants, 23 (20.2%, 8 because of vaginitis and 15 for other reasons) discontinued SGLT2 inhibitors before reaching the 6-month test. Of 65 participants who were negative for Candida at baseline and received the 6-month test, 24 (36.9%) converted to a positive culture, and multivariate analysis showed older age as an independent risk for developing Candida colonization. There were 18 participants (15.8%) who developed symptomatic vaginitis, and they showed similar characteristics to the 24 participants. Most of those with negative cultures at 6 months showed negative results at 12 months and vice versa. CONCLUSIONS: The rates of developing positive colonization and symptomatic vaginitis after starting SGLT2 inhibitors appear to be higher in real-world practice than the rates of 31% and 5-10% in clinical trials, respectively. Risk factors of vaginal Candida colonization might be different before and after taking SGLT2 inhibitors.


Assuntos
Biomarcadores/análise , Candida/isolamento & purificação , Candidíase Vulvovaginal/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/epidemiologia , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Glicemia/análise , Candidíase Vulvovaginal/metabolismo , Candidíase Vulvovaginal/microbiologia , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Incidência , Japão , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
11.
Sex Transm Infect ; 95(1): 60-66, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30228109

RESUMO

OBJECTIVES: We evaluated the relationship of sexually transmitted infections (STIs) and genital infections during pregnancy and subsequent risk for infant mortality and stillbirth. METHODS: This was a nested longitudinal analysis using data from a study of peripartum HIV acquisition in Kenya. In the parent study, HIV-uninfected women were enrolled during pregnancy and followed until 9 months postpartum. For this analysis, women who tested positive for HIV at any point, had a non-singleton pregnancy or a spontaneous abortion <20 weeks were excluded. At enrolment, laboratory methods were used to screen for bacterial vaginosis (BV), vaginal yeast, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV). Syphilis was diagnosed using rapid plasma reagin testing and genital ulcer disease (GUD) identified by clinical examination. Treatment of laboratory-confirmed STIs and syndromic management was provided per Kenyan national guidelines. Predictors of stillbirth and infant mortality were determined using logistic regression and Cox proportional hazards models. RESULTS: Overall, among 1221 women, 55% had STIs or genital infections detected: vaginal yeast (25%), BV (22%), TV (6%), CT (5%), NG (2%) and syphilis (1%). Among women with STIs/genital infections (n=592), 34% had symptoms. Overall, 19/1221 (2%) women experienced stillbirths. Among 1202 live births, 34 infant deaths occurred (incidence 4.0 deaths per 100 person-years, 95% CI 2.8 to 5.5). After adjustment for maternal age, education and study site, stillbirth was associated with maternal GUD (adjusted OR=9.19, 95% CI1.91 to 44.35, p=0.006). Maternal NG was associated with infant mortality (adjusted HR=3.83, 95% CI1.16 to 12.68, p=0.028); there was some evidence that maternal CT was associated with infant mortality. Stillbirth or infant mortality were not associated with other genital infections. CONCLUSIONS: STIs and genital infections were common, frequently asymptomatic and some associated with stillbirth or infant mortality. Expediting diagnosis and treatment of STIs in pregnancy may improve infant outcomes.


Assuntos
Mortalidade Infantil , Complicações Infecciosas na Gravidez/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Natimorto/epidemiologia , Adolescente , Adulto , Infecções Assintomáticas , Candidíase Vulvovaginal/epidemiologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Estudos de Coortes , Feminino , Gonorreia/epidemiologia , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Modelos Logísticos , Gravidez , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sífilis/epidemiologia , Vaginite por Trichomonas/epidemiologia , Vaginose Bacteriana/epidemiologia , Adulto Jovem
12.
J Med Microbiol ; 67(11): 1601-1607, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30248002

RESUMO

PURPOSE: Up to 75 % of all women develop vulvovaginal candidiasis (VVC), with symptoms such as vulvar erythema, pruritus and abnormal vaginal discharge. Despite the global distribution of Candida africana, its role in recurrent vulvovaginal candidiasis (RVVC) is still unclear and requires further investigation. Here, we report on the frequency of C. africana among clinical isolates from patients with RVVC in Bushehr in southern Iran. METHODOLOGY: Isolated Candida strains were identified by ITS-PCR-RFLP. Hyphal wall protein 1 (HWP1) was amplified to differentiate C. africana and the resulting sequences were subjected to phylogenetic analyses with a view to identifying similarities and differences in nucleotides. RESULTS: Ten out of 119 strains originally identified as C. albicans turned out to be C. africana. Pairwise nucleotide alignment of HWP1 DNA sequences showed 100 % similarity between C. africana strains. Inter-species variation between Iranian C. africana HWP1 sequences and the only three available C. africana type sequences in GenBank revealed 99.7-100 % nucleotide similarity. Phylogenetic analysis of the HWP1 DNA sequences of 10 Iranian C. africana isolates, the 3 C. africana sequences available in GenBank and 2 representative Iranian C. albicans sequences revealed that all 11 Iranian C. africana strains formed a well-supported cluster separated from the remaining C. africana. CONCLUSION: In our sample, C. africana was only isolated from 7.8 % of the patients with RVVC. While size polymorphisms in HPW1 genes allowed us to differentiate C. africana from C. albicans, no evidence of sequence variation within the Iranian C. africana isolates was observed.


Assuntos
Candida/genética , Candida/isolamento & purificação , Candidíase Vulvovaginal/microbiologia , Genótipo , Fenótipo , Adulto , Antifúngicos/farmacologia , Candida/classificação , Candida/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candidíase Vulvovaginal/epidemiologia , DNA Fúngico/genética , Feminino , Proteínas Fúngicas/genética , Variação Genética , Humanos , Irã (Geográfico)/epidemiologia , Testes de Sensibilidade Microbiana , Técnicas de Tipagem Micológica , Filogenia , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Recidiva
13.
Lancet Infect Dis ; 18(11): e339-e347, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30078662

RESUMO

Recurrent vulvovaginal candidiasis is a debilitating, long-term condition that can severely affect the quality of life of affected women. No estimates of the global prevalence or lifetime incidence of this disease have been reported. For this systematic review, we searched PubMed, Embase, and Web of Science databases for population-based studies published between 1985 and 2016 that reported on the prevalence of recurrent vulvovaginal candidiasis, defined as four or more episodes of the infection every year. We identified 489 unique articles, of which eight were included, consisting of 17 365 patients from 11 countries. We generated estimates of annual global prevalence, estimated lifetime incidence and economic loss due to recurrent vulvovaginal candidiasis, and predicted the number of women at risk to 2030. Worldwide, recurrent vulvovaginal candidiasis affects about 138 million women annually (range 103-172 million), with a global annual prevalence of 3871 per 100 000 women; 372 million women are affected by recurrent vulvovaginal candidiasis over their lifetime. The 25-34 year age group has the highest prevalence (9%). By 2030, the population of women with recurrent vulvovaginal candidiasis each year is estimated to increase to almost 158 million, resulting in 20 240 664 extra cases with current trends using base case estimates in parallel with an estimated growth in females from 3·34 billion to 4·181 billion. In high-income countries, the economic burden from lost productivity could be up to US$14·39 billion annually. The high prevalence, substantial morbidity, and economic losses of recurrent vulvovaginal candidiasis require better solutions and improved quality of care for affected women.


Assuntos
Candidíase Vulvovaginal/epidemiologia , Adolescente , Adulto , Fatores Etários , Candidíase Vulvovaginal/economia , Candidíase Vulvovaginal/patologia , Efeitos Psicossociais da Doença , Feminino , Saúde Global , Humanos , Incidência , Pessoa de Meia-Idade , Prevalência , Recidiva , Adulto Jovem
14.
Niger J Clin Pract ; 21(8): 1017-1022, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30074004

RESUMO

Background: Clinical diagnosis of acute vulvovaginal candidiasis (VVC) depends on evidence of clinical symptoms, but symptomatic treatment widely practiced in low-resource area may lead to overdiagnosis and treatment. Objective: The objective of the study is to determine the prevalence of VVC among women attending gynecological clinic in University of Nigeria Teaching Hospital (UNTH) Enugu and the accuracy of clinical-based diagnosis versus laboratory test supported diagnosis and patients' characteristics that affect accuracy. Materials and Methods: This study surveyed patients seen in a gynecologic clinic for VVC using a semi-structured, pretested, and interviewer-administered questionnaire. Vaginal examination was done on each patient and findings documented. A pair of swabs was taken from the vagina and cervical os and cultured for Candida species using Sabouraud Dexttose Agar. Data were analyzed using statistical software, SPSS version 15 (SPSS Inc., Chicago IL, USA). P ≤ 0.05 were considered to be statistically significant. Results: The mean age of 209 women surveyed was 35.9 (standard deviation [SD] ±9.0) years. Their mean parity was 2 (SD ± 3). The prevalence of VVC was 17.7% based on symptoms and laboratory test. Clinically based diagnosis had a sensitivity of 70.3% and specificity of 83.7%. Forty-one (19.6%) of the study population had good knowledge of VVC. More than 44% of the women had self-reported and treated VVC within the year. Young women of 24 years or less (54.5%) and those who had reported other episodes of VVC within the past year (41.1%) were most commonly associated with inaccurate clinical diagnosis. Conclusion: Clinically based diagnosis of VVC has an unacceptably high false-positive rate which may encourage continued presumptive treatment with its attendant risks. Clinical evaluation and laboratory culture of vulvovaginal specimen should be the standard diagnostic method.


Assuntos
Candida/isolamento & purificação , Candidíase Vulvovaginal/diagnóstico , Adulto , Candidíase Vulvovaginal/epidemiologia , Candidíase Vulvovaginal/microbiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Gravidez , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
15.
Biomed Res Int ; 2018: 9703754, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29977925

RESUMO

Purpose. To explore risk factors of vulvovaginal candidiasis (VVC) among women of reproductive age in Xi'an district and then to offer reference for clinical prevention and treatment of VVC. Methods. Patients from the outpatient department of gynecology and obstetrics in the First Affiliated Hospital of Xi'an Jiaotong University from June 2016 to May 2017 were recruited strictly according to the inclusion and exclusion criteria. Participants diagnosed as simple VVC were assigned to the case group, while women who underwent routine gynecological examination and had normal vaginal microflora were assigned to the control group. Then we conducted a questionnaire survey of the two groups and used the logistic regression model to explore the related risk factors of VVC. Results. In the present study, ninety-seven cases were sample VVC patients and eighty-seven cases were healthy women. This cross-sectional study showed that occasionally or never drinking sweet drinks (odds ratio [OR] =0.161, 95% confidence interval [CI] =0.056-0.462, P=0.001), occasionally or never eating sweet foods (OR=0.158, 95%CI=0.054-0.460, P=0.001), and the use of condom (OR=0.265, 95%CI=0.243-0.526, P=0.001) were regarded as protective factors for VVC. In addition, sedentary life style (OR=7.876, 95%CI=1.818-34.109, P=0.006), frequently wearing tights (OR=6.613, 95%CI=1.369-27.751, P=0.018), frequent intravaginal douching (OR=3.493, 95%CI=1.379-8.847, P=0.008), having the first sexual encounter when under 20 years old (OR=2.364, 95%CI=1.181-7.758, P=0.006), the number of sexual partners being over two (OR=3.222, 95%CI=1.042-9.960, P=0.042), history of curettage (OR=3.471, 95%CI=1.317-9.148, P=0.012), history of vaginitis (OR=8.999, 95%CI=2.816-28.760, P<0.001), and not cleaning the vulva before or after sexual encounters (OR=13.684, 95%CI=2.843-65.874, P=0.001) were considered to be risk factors of VVC. Conclusion. In conclusion, risk factors of VVC are various, involving ages, hygienic habits, disease history, and other aspects.


Assuntos
Candidíase Vulvovaginal/epidemiologia , Adolescente , Adulto , Fatores Etários , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Higiene , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Comportamento Sexual , Vaginite , Adulto Jovem
16.
Lett Appl Microbiol ; 67(3): 285-291, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29908032

RESUMO

Vulvovaginal candidiasis (VVC) is an inflammatory disease of the vulva and vagina caused by different yeasts of the genus Candida which is responsible for infection in pregnant patients who attended Maternidade Escola Januário Cicco, Rio Grande do Norte, Brazil. From 41 samples, 19 yeasts were identified phenotypically as Candida albicans and one as Candida glabrata which is reported as the non-albicans species most frequently isolated from vulvovaginitis. The susceptibility to selected antifungal agents (flucytosine, fluconazole, voriconazole, amphotericin B, caspofungin and micafungin) was determined, and the association between patient-related signs and symptoms aided the construction of an epidemiological profile. Antifungal susceptibility testing performed by automated method showed that all strains were sensitive to the drugs tested, including the C. glabrata specimen despite its known resistance or dose-dependent susceptibility to azole derivatives. Regarding patient signs and symptoms, no statistically significant association between these and the establishment of VVC was found. It can be concluded that the laboratorial diagnosis of VVC is necessary prior to the administration of treatment, since only 48·78% of the patients had VVC but for all of them antifungal therapy were prescribed. SIGNIFICANCE AND IMPACT OF THE STUDY: Vulvovaginal candidiasis (VVC) is a problem that affects a significant number of pregnant women worldwide. This type of fungal infection generates great discomfort due to the symptomatology and difficulties of diagnosis and treatment. In view of the scarcity of data in the State of Rio Grande do Norte, Brazil, regarding studies carried out on fungal populations of the genus Candida associated with VVC in pregnant women, this study considered relevant, the phenotypic and genotypic identification of the species, to estimate the prevalence, to determine their susceptibility to the antifungal and to correlate with signs and symptoms.


Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidíase Vulvovaginal/microbiologia , Complicações na Gravidez/microbiologia , Adolescente , Adulto , Anfotericina B/farmacologia , Brasil/epidemiologia , Candida/genética , Candida/isolamento & purificação , Candida glabrata/isolamento & purificação , Candidíase Vulvovaginal/epidemiologia , Equinocandinas/farmacologia , Feminino , Fluconazol/farmacologia , Humanos , Lipopeptídeos/farmacologia , Micafungina , Testes de Sensibilidade Microbiana , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Instituições Acadêmicas/estatística & dados numéricos , Adulto Jovem
17.
BMC Womens Health ; 18(1): 94, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29902998

RESUMO

BACKGROUND: Vulvovaginal candidiasis is a global issue of concern due to its association with economic costs, sexually transmitted infections, and ascending genital tract infection. The aim of this study was to determine species distribution and antifungal susceptibility pattern of Candida species causing vulvovaginal candidiasis. METHODS: A cross sectional study was conducted from November 2015 to December 2016 at the Family Guidance Association of Ethiopia. Vaginal swabs collected from study subjects that were clinically diagnosed with vulvovaginal candidiasis were cultured. Yeast identification and antifungal susceptibility testing were determined by the automated VITEK 2 compact system. The association of vulvovaginal candidiasis with possible risk factors was assessed and analyzed using SPSS version 20. RESULTS: The overall prevalence of vulvovaginal candidiasis was 41.4%. The association of vulvovaginal candidiasis was statistically significant with previous genital tract infection (p = 0.004), number of life-time male sex partners (p = .037), and number of male sex partners in 12 month (p = 0.001). Of 87 Candida isolates recovered, 58.6% were C. albicans while 41.4% were non-albicans Candida species. The highest overall drug resistance rate of Candida species was observed against fluconazole (17.2%), followed by flycytosine (5.7%). All Candida isolates were 100% susceptible to voriconazole, caspofungin, and micafungin. C. albicans, was 100% susceptible to all drugs tested except fluconazole and flycytosine with a resistance rate of 2% each drug. C. krusei, was 100 and 33.3% resistant to fluconazole and flycytosine, respectively. CONCLUSIONS: High prevalence rate of vulvovaginal candidiasis and observation of high prevalence rate of non-albicans Candida species in the present study substantiate, the importance of conducting continuous epidemiological surveys to measure changes in species distribution from C. albicans to non-albicans Candida species in Ethiopia. Although, fluconazole still appeared to be active against all isolates of C. albicans and non-albicans Candida species high resistance rate of C. krusei against the drug may demonstrate a search for alternative antifungal drugs when treating vulvovaginal candidiasis caused by C. krusei.


Assuntos
Antifúngicos/farmacologia , Candida albicans/efeitos dos fármacos , Candidíase Vulvovaginal/epidemiologia , Candidíase Vulvovaginal/microbiologia , Adolescente , Adulto , Candida albicans/isolamento & purificação , Caspofungina/farmacologia , Estudos Transversais , Farmacorresistência Fúngica , Etiópia/epidemiologia , Feminino , Fluconazol/farmacologia , Flucitosina/farmacologia , Humanos , Micafungina/farmacologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Infecções do Sistema Genital/epidemiologia , Parceiros Sexuais , Voriconazol/farmacologia , Adulto Jovem
18.
J Mycol Med ; 28(2): 345-348, 2018 Jun.
Artigo em Francês | MEDLINE | ID: mdl-29548876

RESUMO

AIM: To determine the prevalence and the associated risk factors of vulvovaginal candidiasis in pregnant women in Mauritania. PATIENTS AND METHOD: The study was carried out at the laboratory of the Mère et Enfant Center in Nouakchott, from November 1, 2016 to February 5, 2017. It concerned all pregnant women in the third trimester that came to the natal consultation at the gynecology service. These women must have given their informed consent in written form. After completing the survey to collect epidemiological and clinical data, a sample was collected to perform fresh direct examination and culture on Sabouraud-Chloramphenicol media. RESULTS: Two hundred pregnant women were included in the study. Culture on Sabouraud-Chloramphenicol media was positive in 52 patients corresponding to a prevalence of 26%. The germ tube test was positive for 61.5% of isolated Candida. Clinical signs are dominated by leucorrhea (56%), pelvic pain (25%) and vulvar pruritus (11%). Among women with positive culture, 55.76% had received local antifungal treatment in the form of an ovula during pregnancy. CONCLUSION: This study shows that vulvovaginal candidiasis is frequent in pregnant women attending gynecology at the Mère et Enfant Hospital Center in Nouakchott.


Assuntos
Candidíase Vulvovaginal/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Feminino , Humanos , Mauritânia/epidemiologia , Gravidez , Prevalência , Fatores de Risco
19.
Am J Reprod Immunol ; 79(4): e12811, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29469170

RESUMO

PROBLEM: Is sensitization to atopic reaction related to treatment response of recurrent Candida vulvovaginal (RVVC)? METHOD OF THE STUDY: Analysis of ReCiDiF trial data of optimal (OR) and non-responders (NR) to fluconazole maintenance treatment, to explore medical history, physical status, family history, and vaginal immune response for potential sensitization to atopic reaction. RESULTS: Sociodemographic characteristics of 33 NR women were not different from 38 OR. NR had received higher number of different treatments (mean difference 1.6 different treatments (95% CI: 0.20-2.97), P = .03) and had more episodes of disease (P < .05). Multivariate regression analysis showed that family history of atopy (OR: 4.9, CI 95%: 1.1-22.2), duration of symptoms (OR: 1.2, CI 95%: 1.02-1.5), and vulvar excoriation (OR: 3.6, CI 95%: 1.4-9.3) were related to non-response. Vulvar excoriation at entry was the only statistically significant predictive factor for non-response in multivariate analysis with specificity 77.8% and sensitivity 51.6%. CONCLUSION: Women with RVVC with vulvar excoriation, longer duration of disease, and family history of atopic disease are at increased risk not to respond to maintenance fluconazole treatment.


Assuntos
Candida albicans/fisiologia , Candidíase Vulvovaginal/epidemiologia , Hipersensibilidade Imediata/epidemiologia , Vagina/patologia , Vaginite/epidemiologia , Adulto , Candidíase Vulvovaginal/diagnóstico , Candidíase Vulvovaginal/tratamento farmacológico , Feminino , Fluconazol/uso terapêutico , Humanos , Hipersensibilidade Imediata/diagnóstico , Hipersensibilidade Imediata/tratamento farmacológico , Imunização , Valor Preditivo dos Testes , Recidiva , Risco , Sensibilidade e Especificidade , Vaginite/diagnóstico , Vaginite/tratamento farmacológico , Adulto Jovem
20.
J Mycol Med ; 28(1): 186-192, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28939305

RESUMO

INTRODUCTION: Pregnant women are more susceptible to vaginal colonization and infection by yeast. The role of Candida colonization in the occurrence of preterm birth is well established. The knowledge of local epidemiology and identification of risk factors for preterm birth is important for the prevention and management strategies. The purpose of the study was to determine the prevalence of Candida sp. in vaginal swabs of pregnant women. METHODS: Pregnant women attending routine antenatal visits in three primary health centres in Bobo-Dioulasso (Burkina Faso) were enrolled into a cross-sectional study carried out from February to April 2015. Vaginal swabs samples were taken from participants after obtaining oral consent. The swabs were inoculated into Sabouraud's glucose agar supplemented with chloramphenicol and incubated at 37°C for 24 to 48hours under aerobic conditions in order to perform fungal culture. The identification of the Candida species was done by culture on HiCrome Candida Differential Agar at 35°C for 48h for production of species-specific colors. RESULTS: A total of 229 pregnant women were included. The prevalence of vulvovaginal candidiasis (VVC) was 22.71%, (95% CI [17.45-28.69]). Candida albicans accounted for 40.39% and non-Candida albicans species for 59.61% of the isolates, with mainly C. glabrata (32.69%), C. tropicalis (15.38%) and C. krusei (11.54%). CONCLUSIONS: This study revealed a high prevalence of non-C. albicans species. The syndromic management guidelines for VVC in Burkina Faso will be revised to include a specific protocol for pregnant women.


Assuntos
Candida/isolamento & purificação , Candidíase Vulvovaginal/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Vagina/microbiologia , Adolescente , Adulto , Burkina Faso/epidemiologia , Candida/classificação , Candida/genética , Candida albicans/isolamento & purificação , Candida tropicalis/isolamento & purificação , Candidíase Vulvovaginal/microbiologia , Estudos Transversais , Meios de Cultura , Feminino , Humanos , Centros de Saúde Materno-Infantil , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/microbiologia , Prevalência , Fatores de Risco , Adulto Jovem
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