Keywords: Vaginal candidiasis; Women; Genital infection; Candida albicans; Yaoundé

Introduction

A condition of the female genital tract known as vaginal candidiasis is brought on by yeasts of the Candida genus. One of the most common causes of gynecological consultations, it presents a treatment and recurrence challenge and has an impact on a woman’s quality of life. Vaginal candidiasis, which is characterized by vaginal discharge and vulvovaginal irritation, often develops when the Candida fungus, which is naturally present in the body as a commensal, multiplies [1]. When vaginal mycosis is present, the leucorrhoea is white and lumpy, resembling curdled milk, and it is accompanied by burning and itching in the vulva as well as dyspareunia. Couples become tense as a result of all these symptoms, which also make women feel guilty since they can’t enjoy pleasant sexual encounters [2]. According to Denning et al. (2018), vaginal candidiasis affects approximately 138 million women worldwide each year [3]. Candida albicans is the species most involved in vaginal candidiasis, with a frequency of 75%, in contrast to known non-albicans species [4]. It has been observed that most women suffer from vaginal candidiasis at some point in their lives, and almost 50% of them experience recurrence or several episodes [5]. In sub-Saharan Africa, the prevalence of vaginal candidiasis is estimated to be 33% [6]. This prevalence is increasing dramatically and is attributable to the multiplication of endogenous and exogenous risk factors that predispose women to acute vaginal candidiasis, including hormonal modulations associated with pregnancy, the luteal phase of the menstrual cycle, the use of oral contraceptives, hormone replacement therapy, and non-hormonal factors, such as prolonged antibiotic use and uncontrolled diabetes mellitus [7]. In Cameroon, a study conducted in 2016 showed a vaginal candidiasis prevalence of 11% [8]. Women’s recurrent consultations for vaginal candidiasis constitute a public health problem in the community and show that its prevalence is still increasing. A pregnant woman with vulvovaginal candidiasis can infect her newborn at birth, causing respiratory tract infection (asphyxiating capillary bronchitis), endophthalmitis, and disseminated infection in the most severe cases, disseminated infection [9]. The aim of this study was to determine the prevalence of vaginal candidiasis and its risk factors among women attending the gynecology department of Efoulan District Hospital, Yaoundé.

Methodology

Type, period and study site

A prospective, cross-sectional study was conducted over a period of 5 months, from January 10 to May 15, 2021. It took place in the Gynecology Department of Efoulan District Hospital in Yaoundé. 

Study Population

In total, 187 patients were recruited. Our sample size was calculated according to the Lorentz formula with a prevalence of 11.0% of vaginal candidiasis reported by the study conducted in Cameroon by Mogtomo et al. (2016) [8]. Patients excluded from the study were postmenopausal women, menstruating women, and women undergoing treatment with antibiotics, vaginal ova, or other azole derivatives for a fortnight. All women aged between 18 and 45 years who visited the Gynecology Department for prenatal consultation or for burning micturition, vaginal ulceration, vaginal pruritus, or pathological leucorrhea, and in whom a vaginal and cervical swab had been recommended were included in the study.

Method of Data Collection

After informing the women of the purpose of the study, an informed consent form was provided to each participant to read and sign. Sociodemographic data were recorded in a questionnaire and included age, occupation, level of education, clinical symptoms presented, marital status, and medication taken in the last two weeks.

Cervico-vaginal sampling

We cleaned the vaginal margins with Dakin’s solution and performed vaginal swabs using a sterile speculum. Vaginal walls were scraped using a sterile swab. The samples were immediately sent to the microbiology laboratory of the hospital and processed. We performed a direct examination. Readings were taken with an X40 objective. Yeast and mycelial filaments were also examined.

Mycological Culture

Each vaginal sample was inoculated onto Chromagar Candida medium (Media Mage, Johannesburg, South Africa) and Sabouraud Chloramphenicol agar. This enabled us to isolate and identify various Candida species colonies according to the color obtained after 48 h of incubation on Chromagar agar. Candida albicans in this medium was green, Candida tropicalis was metallic blue, and Candida krusei was pale pink. Other Candida species were not identified because of the lack of reagents. A colony count of 10 or more in a cultured vaginal sample was considered pathological for the isolated yeast.

Ethical Considerations

Informed consent was obtained from each participant. Approval to conduct this research was obtained from the administrative management of the Efoulan District Hospital. Ethical clearance N. 2022/07/215/CNERSH/SP was obtained from the National Committee of Ethics in Human Health.

Statistical Analysis

Data were recorded and analyzed using the Epi Info 7.2 Software.

We used the chi-squared test to determine the relationships between vaginal candidiasis and the reasons for consultation and between vaginal candidiasis and the following risk factors: age, profession, region of origin, marital status, and level of education, with a significance level of P<0.05.

Results

Sociodemographic characteristics of the study population

In total, 187 patients met our eligibility criteria and were enrolled in the study. The average age of the population was 29 ± 1.38 years, with extremes of 18 and 45 years. The 25–31 years age group accounted for the majority (34.75%). Regarding sociodemographic characteristics, 60.96% (114/187) of the participants cohabited. Most women (46.53%, 87/187) had a university degree. The most common occupation was student (31.55%, 59/187). The majority of the women came from the central region of Cameroon (37.97%, 71/187). This study showed that 51 women (27.27 %) had vaginal candidiasis. The main species found were Candida albicans (36/51), with a prevalence of 70.59%, and Candida non-albicans (15/51), with a prevalence of 29.41%. Among the non-albicans Candida we had Candida tropicalis 13.23%, Candida Krusei 4.56%, and other unidentified Candida 11.62%. Of the women suffering from vaginal candidiasis, 45.09% had come for an antenatal consultation, and their prevalence was statistically higher than the 15.68% who complained of pelvialgia and pathological leucorrhea, and 11.76% who presented with pruritus (Table 1). In the study population, women from the western region of Cameroon suffered more from vaginal candidiasis (30/51; 58.82%), and the difference was significant compared with women from other regions of Cameroon (p=0.0000). The age group most exposed to vaginal candidiasis was 25-31 years (23/51; 45.09%). Cohabiting and married women suffered more from vaginal candidiasis, with a prevalence of 94.56 (48/51). Women at the university level and students were more likely to suffer from vaginal candidiasis, with prevalence rates of 64.70% (33/51) and 35.29% (18/51), respectively. Female students suffered more from vaginal candidiasis, and the difference from other professions was statistically significant (p=0.002) (Table 2).

Table 1: Distribution of vaginal candidiasis according to reason for consultation.

Table 2: Distribution of vaginal candidiasis according to socio demographic characteristics.