ABSTRACT
Vulvovaginal candidiasis is characterized by curd-like vaginal discharge and itching, and is associated with considerable health and economic costs. Vaginal discharge is a common complain by sexually active women. High vaginal and endo-cervical swab samples were collected from 250 women who presented with or without vaginal discharge at the Akwa Ibom State University clinic. The data obtained was analyzed using SPSS 14.0 statistical software. Absolute numbers and simple percentages were used to describe categorical variables. The prevalence of vaginal discharge in this review was 25%. Candida albicans infection constituted 16% of cases presenting with or without vaginal discharge. Vulvovaginal candidiasis was commoner among those 18-30 years (23%), than those >40 years (2%). Moreover, the unmarried bear a greater burden of the infection (16.0%) than the married (7.2%) and 13.2% was recorded of marriageable group. Candida albicans infection is the commonest cause of pathologic vaginal discharge in Akwa Ibom State University, Nigeria and it is commonest among unmarried and in those within the reproductive age group.
CHAPTER ONE
1.0 Introduction
1.1 Background of the Study
Vulvovaginal candidiasis (VVC) is the second most common vaginal infection affecting women of reproductive age, mainly damaging the vulva and vagina. It is estimated that approximately 70-75% of women of childbearing age will have at least one episode of VVC during their lifetime and 40-50% will suffer from a recurrence (Gonçalves B et al., 2016). Almost 80-90% of vulvovaginal candidiasis is caused by Candida albicans except that only a minority of cases (10-20%) is caused by non-Candida albicans species, usually Candida glabrata. Candida albicans is part of normal vaginal microflora. It will become a robust opportunistic fungal pathogen and is the leading causative agent of Vulvovaginal candidiasis when the body lacks protective immunity and has recalcitrance to clearance (Peters B et al., 2014).
Moreover, the anus is close to the vagina anatomically, providing much convenience for the migration of gut organisms, including Candida, to the vagina. Vulvovaginal candidiasis gives rise to much untold discomfort in many patients, poses a threatening problem to clinicians, and generates considerable direct and indirect economic costs associated with medication and health-care visits. Apart from the above negative impacts, some emerging data also have suggested that Vulvovaginal candidiasis during pregnancy might be associated with increased risk of pregnancy complications, such as premature rupture of membranes, preterm labor, chorioamnionitis, and congenital cutaneous candidiasis (Meizoso T et al., 2008). At the same time, there was a potential relationship between Vulvovaginal candidiasis and preterm birth. In addition, several studies have suggested that Vulvovaginal candidiasis could contribute substantially to enhanced susceptibility to HIV infection (Simon V et al., 2006).
Vulvovaginal candidiasis (VVC) is a fungal or yeast infection of the fungal or yeast infection of the female lower genital tract, as described by (Marrazzo J. 2002;) it can be referred to as candidiasis or moniliasis. Vulvovaginal candidiasis can be recurrent or relapsing as described by (Ferris DG. et al., 2002). Recurrent or relapsing vulvovaginal candidiasis occurs when a woman presents with four or more episodes per year. This condition affects less than 5% of healthy women as described by (Rex JH, et al., 2000;). Candida spp are part of the lower genital tract flora in 20%-50% of healthy assyptomatic women (McClenlland RS, et al., 2009;). Candida albicans is the most frequent colonizer and is incriminated in most cases of vulvovaginal candidiasis (Singh SI, 2003;). Nevertheless, over the last ten (10) years research evidence, evidence has demonstrated an increment in the frequency of cases caused y non-albicans species, with candida glabrata consistently being the leading species (Ray D. et al., 2007;).
About 75% of women will experience at least one episode of vulvovaginal candidiasis during their life time. In fact, 70-75% of healthy adult women have at least one episode of vulvovaginal candidiasis during their reproductive life and half of college women will by the age of 25years have had one episode of vulvovaginal candidiasis diagnosed by a physical as described by (Sobel TD. 1997;). Vulvovaginal candidiasis is not considered a sexually transmitted disease because it does affect children and celibate women and also candida spp are seen as normal vagina flora in healthy women. However, this does not mean that candida cannot be sexually transmitted (Mardh PA, et al., 2002;). Diagnosis of vulvovaginal candidiasis based solely on patient history and genital examination is not possible because of the low specificity of symptoms and signs, since other causes mimic vulvovaginal candidiasis, like leucorrhea and pruritus vulvae; (Geiger Am, et al., 1995;). Therefore, to have a definitive diagnosis of vulvovaginal candidiasis, cultural isolation and identification of candida species are crucial. Previous findings have provided data on the incidence of vulvovaginal candidiasis. These suggested that approximately two-thirds of women experience at least one episode during their lifetime and nearly 50% of women had multiple episodes as describe by (Eschenbach DA. 2004;). Vaginitis occurs when the vaginal microflora have been altered by invading pathogens or biochemical changes in the environment. Changes in the vaginal environment encourage the candida population, as described by (Faro S. et al., 1998;). These changes may transform a symptomatic colonization into a symptomatic candida infection. Vulvovaginal candidiasis, like many vulva diseases has the potential to cause great psychological distress and negatively impact a patient’s quality of life.
1.2 Justification
This research project will justify the prevalence of vulvovaginal candidiasis among single and married women in Akwa Ibom South senatorial district, which will reduce the cause and produce possible solution to tackling this issue that has become one of the main problems in the world.
1.3 Statement of the Problem
Vulvovaginal complaints are the most common with symptoms that causes great discomfort, resulting in time lost from work. This research will great solution so as to guide against and prevent vulvovaginal candidiasis infection.
1.4 Aim and Objective
To determine the prevalence of vaginal candidiasis among single and marriageable women in Akwa Ibom South Senatorial district.
To determine the age specific distribution of vulvovaginal candidiasis among the subjects.
To determine the effect of the antibacterial therapy on the distribution of VVC.
