Vulvovaginal candidiasis in female sex workers

Abstract

Vulvovaginal candidiasis is a frequent inflammatory process in women but it has not been widely studied in female sex workers (FSWs). To estimate the frequency of Candida species infection in FSWs and to identify related risk factors and clinical findings, we carried out a retrospective study of 1923 FSWs over 11 years. We also performed a prospective study of 163 consecutive FSWs with a history of candidiasis during a 4-year period. Candida species were isolated in 1967 samples (18.5% of the total). Candida albicans (89.3%) was the most frequent species, followed by Candida glabrata (2.7%), Candida parapsilosis (1.2%) and Saccharomyces cerevisiae (0.4%). In the prospective study of 163 patients, we found vaginal discharge in 76.1% of cases, soreness in 52.1% and vulval pruritus in 32.5%. We identified 12 patients (7.4%) with recurrent vulvovaginal candidiasis. No statistical difference was found between recurrent vulvovaginitis and the use of oral contraceptives, oral sex, tight-fitting clothing and synthetic underwear. FSWs have the same prevalence of candidiasis as other groups of women described in published literature. The proportion of albicans and non-albicans species does not differ between women with recurrent and non-recurrent vulvovaginal candidiasis (VVC).

Facts and myths on recurrent vulvovaginal candidosis—a review on epidemiology, clinical manifestations, diagnosis, pathogenesis and therapy

“…Similarly, a prospective case± control study of 163 Spanish female sex workers followed up over a period of four years found no statistically signi® cant association between RVVC and the use of tight-® tting clothing and synthetic underwear 180 .…”

Candida parapsilosis, an Emerging Fungal Pathogen

“…In a study involving 163 female sex workers with histories of candidal vaginosis over a 4-year period in Spain, Candida species were isolated in 1,967 samples (18.5% of the total), of which C. albicans accounted for 89.3% of isolates while C. parapsilosis was rarely identified (1.2%) (204). Lower incidences of C. albicans were found among pregnant Tanzanian women with vaginal candidiasis (66.2%), although C. parapsilosis was still isolated rarely (2.2%) (187 (195).…”

Species distribution and antifungal sensitivity patterns of vaginal yeasts

“…albicans is responsible for most cases of VVC (2,3); the rest are caused by non-albican species of Candida which include C. glabrata, C. krusei, and C. tropicalis. Non-albican species of Candida have demonstrated decreased susceptibility to commonly used antifungal agents (5).…”