Vulvovaginal Candidiasis, an increasing burden to women in the tropical regions attending Bharatpur Hospital, Chitwan

Anisha Subedi^1#, Milan Kumar Upreti^1#, Jid Chani Rana², Ram Prasad Sapkota², Upendra Thapa Shrestha³^*

¹Department of Microbiology, Goldengate International College, Battisputali, Kathmandu

²Bharatpur Hospital, Chitwan

³Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu

^#These authors equally contributed to the study

**^*Corresponding author:** Upendra Thapa Shrestha, Assistant Professor, Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal. Email: upendrats@gmail.com

ABSTRACT

Vulvovaginal candidiasis is a yeast infection commonly caused by the overgrowth of Candida species in and around the vulva and vagina. Abnormal vaginal discharge, itching and irritation, swelling and redness of the vaginal area, pain during sexual intercourse, and dyspareunia are important clinical findings of the infection. Currently, the infection is one of the growing burdens to married women. Moreover, the infection with antifungal-resistant Candida species adds challenges to managing the disease. Hence, this study was conducted to identify the different Candida species causing vulvovaginal candidiasis and to determine its susceptibility pattern against different antifungal drugs. A hospital-based cross-sectional and quantitative study was conducted for the period of six months from September 2022 to March 2023 among symptomatic married women in the Gynecology and Obstetrics Department of Bharatpur Hospital, Chitwan. A total of 300 symptomatic cases were enrolled in the study. Candida species were isolated from vaginal swabs following standard microbiological procedures and antifungal susceptibility testing was performed with different antifungal agents. The total prevalence of vulvovaginal candidiasis was found to be 37.3% (112/300). Among different isolates, Candida albicans was found to be the most predominant (52.6%), followed by Candida glabrata (29.3%) among non-albicans. Women from the age group 25-35 years were found to be more infected (47.3%) and the relationship between contraceptive use and vulvovaginal candidiasis was found to be statistically significant (p<0.05). Candida species showed higher susceptibility toward Amphotericin-B (68.1%), followed by Fluconazole (51.7%), and Clotrimazole (50.9%). Whereas the least susceptibility was observed to Voriconazole (27.6%) and Itraconazole (35.30%). Candida albicans was comparatively more susceptible to different antifungal drugs than non-albicans species. Candida parapsilosis was only susceptible to Amphotericin-B and the increasing incidence of vaginal candidiasis due to non-albicans Candida indicates the need for routine speciation of Candida.