Vulvovaginal Candidiasis in Reproductive Age Women in Enugu Nigeria, Clinical versus Laboratory-Assisted Diagnosis
Open accessAbstract
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.
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Culture is the gold standard for VVC diagnosis.
“Although microscopy has been the standard used for years, culture still seems to be the gold standard [24,30].”
From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [24]
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“, the use of tight, synthetic underwear [31,33,34].”
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“Recommendations and guidelines require the collection of a vaginal swab for testing, pH assessment, odor test, and wet-mount microscopy [24,25].”
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“…54% of visits involving treatment without sufficient evaluation [16,17,21], indicating that appropriate treatment occurs in less than half of the cases, contributing to the growing problem of antifungal resistance mirrored in increasing azole refractory symptoms and recurrent disease (rVVC) [4,20].”
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“The analysis was done with the help of statistical software, SPSS version 22 (9).”
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“In the present study, accurate diagnosis of VVC necessitates the presence of symptoms as well as evidence of fungi in the diagnosis [16].”
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“According to Aniebue et al. (2018), clinical evaluation and laboratory culture of vulvovaginal specimens should be the standard diagnostic method to eliminate the risk of misdiagnosis and eliminate potential long-term consequences of incomplete treatment, balanitis in the males, and vulvodynia in…”
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- Authors
- Nwankwo, T., Aniebue, U., & Nwafor, M.
- Affiliations
- University of Nigeria Teaching Hospital (NG)
- Corresponding author
- Nwankwo, TO
- Venue
- Nigerian Journal of Clinical Practice
- Published
- 2018
- Volume
- 21
- Issue
- 8
- Pages
- 1017
- ISSN
- 1119-3077 (ISSN-L)
- OpenAlex
- W2893559998
- Cited by
- 21
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 3 · 2020: 1 · 2019: 3
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Nigerian Journal of Clinical Practice (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- vaginal candidiasis, diagnosis, laboratory diagnosis, diagnostic accuracy, prevalence, false-positive diagnosis, self-medication, women of reproductive age, Enugu
- MeSH terms
- Adult, Candida, Candidiasis, Vulvovaginal, Cross-Sectional Studies, Female, Humans, Middle Aged, Nigeria, Pregnancy, Prospective Studies, Surveys and Questionnaires, Prevalence, Young Adult
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