Species Distribution and Susceptibility to Azoles of Vaginal Yeasts Isolated Prostitutes

Abstract

Objective. We investigated the use of miconazole among female prostitutes in Costa Rica as well as the distribution of vaginal yeasts and the susceptibility pattern to azoles of strains obtained from this population. Our intention was to relate a frequent use of miconazole to occurrence of vaginal yeasts resistant to azoles. Methods. Vaginal samples were taken from 277 patients that have previously used azoles. Vaginal swabs were obtained for direct microscopy and culture. Yeast isolates were identified by germ tube test and assimilation pattern. Susceptibility testing was determined using a tablet diffusion method. Results. The number of clinical Candida isolates (one from each patient) was 57 (20.6%). C. albicans was the predominant species (70%), followed by C. parapsilosis (12%), C. tropicalis (5.3%), C. glabrata and C. famata (3.5% each), C. krusei, C. inconspicua and C. guilliermondii (1.7% each). The majority of vaginal Candida isolates were susceptible to ketoconazole (91%), fluconazole (96.5%), and itraconazole (98%). A lower susceptibility of some isolates to miconazole (63%) was observed as compared to the other azoles tested. Moreover, the strains, nonsusceptible to miconazole, were more often obtained from patients that have used this antifungal at least four times within the last year before taking the samples as compared to those with three or less treatments (P<.01). Conclusion. An indiscriminate use of miconazole, such as that observed among female prostitutes in Costa Rica, results in a reduced susceptibility of vaginal yeasts to miconazole but not to other azoles.

Prevalence and Antifungal Susceptibility of Candida Species Isolated from Women Attending a Gynaecological Clinic in Kumasi, Ghana

“…The high prevalence recorded among the contraceptive users in Enweani's study could be attributed to the presence of oestrogen and progesterone hormones in the contraceptive that increased glycogen level in the vaginal fluid and hence promoted the overgrowth of Candida species (Rippon, 1988;Njoku-Obi et al, 1976). However, the 21% prevalence reported in this study is consistent with findings from studies of the general female population (Gross et al, 2007;Mohanty et al, 2007;Falleiros de Padua et al, 2003).…”

Isolation, Speciation and Characterization of Candida Species in Clinical Isolates

“…In study done by Gross T Norma et al, (2007), C. albicans was the predominant species (75%) followed by C. parapsilosis (12%), C. tropicalis (5.3%) and C. glabrata and C. famata 3.5% each. Similar findings were seen in studies done by Jindal et al, (2006).…”

Candidosis vaginal. Segunda parte:diagnóstico, tratamiento y situación de algunos países latinoamericanos

“…Con excepción de C. glabrata, el resto de las especies asociadas a candidosis pueden formar seudomicelios y C. albicans y C. dubliniensis además son formadoras de hifas. C. glabrata es conocida por su resistencia natural a los antimicóticos azólicos mientras que cepas de otras especies, entre ellas C. albicans, C. krusei, C. parapsilosis, C. guilliermondii, C. famata, C tropicalis muestran variabilidad ante los azólicos [1,22,[28][29][30][31][32][33][34][35].…”

“…La transmisión sexual poscoital por Candida es más frecuente en mujeres en la segunda década de la vida y es posible la transmisión por relaciones oro-genitales [22,[32][33]45].…”

“…En el embarazo el tratamiento debe ser por vía vaginal por 7 días, prefiriéndose el uso de azoles sobre la nistatina. Debe evitarse el uso de azoles orales debido a los efectos teratogénicos que pudieran producir [32,35].…”