Fungal Species Changes in the Female Genital Tract

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Abstract
Candidal vaginitis has traditionally been associated with Candida albicans. Two changes occurred over the past decade: first, the dispensing of over-the-counter (OTC) topical antifungals, and second, the approval of oral fluconazole 5 years later. Both have excellent activity versus C. albicans, but less activity versus nonalbicans species. To determine if there has been a shift in species causing vaginitis, swabs were obtained from 156 symptomatic patients during the period after the release of OTC antifungals, but before fluconazole's approval. Specimens were inoculated onto nonselective mycotic agar, with growth transferred to selective media. One hundred eleven patients had a diagnosis of vulvovaginal candidiasis confirmed with yeast isolated. Ninety (81.1%) were identified as C. albicans. Of the 21 nonalbicans species, 15 (71.4%) were Candida glabrata. Therefore, it appears that after decades of the predominance of Candida albicans, a change may be occurring resulting in an increase in nonalbicans species.

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