Abstract:
BACKGROUND : Vaginal discharge syndrome (VDS) is a common condition. Clinical management targets sexually transmitted
infections (STIs) and bacterial vaginosis (BV); there is limited focus on Candida infection as cause of VDS. Lack of
Candida treatment coverage and, if present, antifungal resistance may result in VDS treatment failure. This study aimed
to determine the prevalence of Candida infection, antifungal resistance, and coinfections in Namibian women with
VDS.
METHODS : A cross-sectional study was performed using 253 vaginal swabs from women with VDS in Namibia. Demographic
data was collected, and phenotypic and molecular detection of Candida species was performed followed by
fluconazole susceptibility testing of Candida isolates. BV was diagnosed using Nugent score microscopy; molecular
detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis was performed.
RESULTS : Candida species was detected in 110/253 women (43%). Ninety women (36%) had Candida albicans and
24 (9.5%) had non-albicans Candida species. The non-albicans species detected were 19 (17%) Candida glabrata, 4.0
(3.5%) Candida krusei, and 1.0 (0.9%) Candida parapsilosis. Candida albicans were more frequently isolated in younger
(p = 0.004) and pregnant women (p = 0.04) compared to non-albicans Candida species. Almost all (98%) Candida
albicans isolates were susceptible to fluconazole while all non-albicans Candida species were fluconazole resistant.
STIs were diagnosed in 92 women (36%): 30 (12%) with C. trachomatis, 11 (4.3%) N. gonorrhoeae, and 70 (28%) T. vaginalis;
98 (39%) women had BV. Candida infection alone was diagnosed in 30 women (12%), combined with STIs in 42
women (17%) and was concurrent with BV in 38 women (15%). Candida infection was more often detected in swabs
from women without C. trachomatis detected (6.4% vs. 16%; OR 0.30; 95% CI 0.10–0.77, p = 0.006).
CONCLUSIONS : The high prevalence of Candida infection, especially those due to non-albicans Candida species that
are resistant to fluconazole, is a great concern in our setting and may lead to poor treatment outcomes. Access to
microbiological testing for Candida species in the context of syndromic management is warranted.
