Vaginal colonisation with candida species with special focus on candida dubliniensis. A prospective study

Background: The incidence of vaginal Candida colonisation in asymptomatic women has not been prospectively investigated in Germany since about 20 years. Non-gynaecological specialties - e.g. intensive care medicine - report an increase in non-albicans species. Candida dubliniensis, which often occurs in HIV-positive male patients, is not known to cause vulvovaginal candidosis. Patients/Methods: Vaginal smears of 449 asymptomatic women aged 16-80 years (81 of them HIV-positive) were processed and differentiated. The susceptibility to fluconazole was determined in 75 isolates. Results: Candida species were found in 112 of 449 vaginal swabs (24.9%), 81.2% of them C. albicans and 18.8% non-albicans species; there was only one case (0.9%) of C. dubliniensis in a pregnant HIV-negative woman. Vaginal colonisation was significantly higher in HIV-positive women (36.4%) than in HIV-negative women (22.9%, p = 0.02), C. albicans was isolated significantly more frequently in premenopausal (24.3%) than in postmenopausal women (13.3%, p = 0.003), and also found more often in premenopausal non-pregnant (20.5%) women than in postmenopausal women (13.3%, p = 0.02). C. glabrata was the most common non-albicans species, which was found in 12.5% of all cases: in 6.8% of HIV-negative and in 33.3% (not significant) of HIV-positive women, in 4.9% of HIV-negative premenopausal and in 33.3% (not significant) of HIV-negative postmenopausal women. Apart from Candida krasei no isolate was resistant to fluconazole. Conclusion: There is no evidence of an increase of non-albicans Candida species in vaginal yeast colonisations. The proportion of C. albicans is positively correlated with oestrogen levels, and immunosuppressed women were more often colonised by non-albicans species. C. dubliniensis is insignificant as a pathogen in gynaecology and obstetrics. Despite the limitations of the small number of tested isolates in this study, we do not expect to encounter fluconazole resistance in vaginal yeast isolates.