Identification of Candida Species in Patients with Vulvovaginitis Presenting Different Clinical Symptoms

Background and Objective: Candidiasis is one of the most important and common agents of vulvovaginitis in women. Various clinical manifestations of candidiasis in patients may be associated with different species of Candida. The present study was designed to accurately determine Candida species isolates from patients using culture methods and molecular analysis. Materials and Methods: In this cross-sectional analytical study, 350 patients with suspected vulvovaginal diseases who manifested various clinical symptoms were entered. Vaginal specimens from the patients were collected. Direct microscopy, primary and specific cultures using SDA, CRA and CMA media, germ tube test, as well as DNA based techniques targeting ITS1-5S-ITS2 fragment, were used for diagnosis and identification of Candida species. Results: 165 out of 350 patients (47.14%) were positive with Candida species including 71.5% recurrent candidiasis and 28.5% acute candidiasis. Characterization of the isolates in the specific sub-cultures and by PCR-RFLP resulted in identification of six different species consisted of Candida albicans (60.6%), C. dubliniensis (3.6%), C. glabrata (23%), C. krusei (10.9%), C. parapsilosis (0.6%) and C. tropicalis (1.2%). In the group consisting of 100 patients with C. albicans, 44% and 56% presented severe and mild to moderate clinical vulvovaginitis, respectively. In patients with non albicans candidiasis, 61.5% showed severe and 38.5% showed mild to moderate vulvovaginitis, significantly different from those of the former group (P =0.028). The results indicated significant involvement of some risk factors (i.e. diabetes and antibiotic consumption) in clinically different vaginal infections (P<0.0001) Conclusion: The study showed a high prevalence of candida infection in patients with vulvovaginitis in Southeast of Iran, involving several species, mostly C. albicans and C. glabrata. Considering the increasing prevalence of non-albicans species among these patients, precise determination of causative Candida species with more reliable methods such as molecular techniques are recommended.