Vulvovaginal Candidiasis in Reproductive Age Women in Enugu Nigeria, Clinical versus Laboratory-assisted Diagnosis

Background: Clinical diagnosis of acute vulvovaginal candidiasis (VVC) depends on evidence of clinical symptoms, but symptomatic treatment widely practiced in low-resource area may lead to overdiagnosis and treatment. Objective: The objective of the study is to determine the prevalence of VVC among women attending gynecological clinic in University of Nigeria Teaching Hospital (UNTH) Enugu and the accuracy of clinical-based diagnosis versus laboratory test supported diagnosis and patients' characteristics that affect accuracy. Materials and Methods: This study surveyed patients seen in a gynecologic clinic for VVC using a semi-structured, pretested, and interviewer-administered questionnaire. Vaginal examination was done on each patient and findings documented. A pair of swabs was taken from the vagina and cervical os and cultured for Candida species using Sabouraud Dexttose Agar. Data were analyzed using statistical software, SPSS version 15 (SPSS Inc., Chicago IL, USA). P <= 0.05 were considered to be statistically significant. Results: The mean age of 209 women surveyed was 35.9 (standard deviation [SD] +/- 9.0) years. Their mean parity was 2 (SD +/- 3). The prevalence of VVC was 17.7% based on symptoms and laboratory test. Clinically based diagnosis had a sensitivity of 70.3% and specificity of 83.7%. Forty-one (19.6%) of the study population had good knowledge of VVC. More than 44% of the women had self-reported and treated VVC within the year. Young women of 24 years or less (54.5%) and those who had reported other episodes of VVC within the past year (41.1%) were most commonly associated with inaccurate clinical diagnosis. Conclusion: Clinically based diagnosis of VVC has an unacceptably high false-positive rate which may encourage continued presumptive treatment with its attendant risks. Clinical evaluation and laboratory culture of vulvovaginal specimen should be the standard diagnostic method.