Abstract:
Background: Candida is the leading cause of vaginitis, and 75% of women have at least one episode of infection
in their lives, with pregnancy being a predisposing factor. If left untreated, vulvovaginal candidiasis (VVC) can lead
to chorioamnionitis with subsequent abortion, prematurity and congenital infection of the neonate. We aimed to
determine the prevalence of VVC, identify the recent and most frequently occurring species of Candida in pregnant
women, and determine the most effective antifungal drug of choice for treatment.
Method: A prospective cross-sectional study in which 176 high vaginal swab samples of consented pregnant
women visiting the antenatal clinic from February 2018 to April 2018 were subjected to direct gram smear and
culture for Candida isolation. Candida isolates were identified using a germ tube test and HiCrome Candida
differential agar. Candida isolates were then subjected to a disk diffusion method using fluconazole (25 μg), nystatin
(100 units), and voriconazole (1 μg) on Mueller-Hinton agar supplemented with 2% (w/v) glucose and 0.5 μg/ml
methylene blue dye to determine the susceptibility pattern as per the guidelines of the Clinical Laboratory Standard
Institute (CLSI). Chi-square analysis was used to ascertain the significant association of participants’
sociodemographics and clinical presentations to VVC. A univariate logistic regression model was used to identify
potential risk factors of VVC.Results: The prevalence of VVC among our study participants was 30.7%. Non-albicans Candida (NAC) and Candida
albicans had a prevalence of 74.1 and 25.9%, respectively. Candida glabrata was the most common species,
followed by Candida albicans, Candida krusei, and Candida parapsilosis. 50.0, 18.5 and 3.7% of Candida species were
susceptible to voriconazole, fluconazole and nystatin, respectively, whereas 37.0, 48.1 and 9.3% of Candida species
were resistant to voriconazole, fluconazole and nystatin, respectively. The majority of isolates were susceptible dose
dependent to all three antifungal agents, with voriconazole being the most efficacious antifungal agent. There was
no significant association between participants’ socio-demographic information and clinical presentations to VVC.
Conclusion: The prevalence of VVC was high in the study area. C. glabrata was found to be the most common
cause of VVC among the pregnant women attending antenatal clinics, in the Ho Municipality region of Ghana. The
majority of the Candida isolates were susceptible and resistant to voriconazole and fluconazole, respectively.
