Reviewer ’s report  
Title: Vulvovaginal candidiasis: Species distribution of Candida and their antifungal 
susceptibility pattern  
 
Version: 1 Date: 27 Feb 2018  
 
Reviewer: Brian M Peter s 
 
Reviewer's report:  
This is an improved version of the previously submitted manuscript and authors were largely 
responsive to reviewer critiques. The authors have performed a nice forward analysis of yeast 
species associated with vaginal symptoms. The anti fungal resistance data validates current 
thoughts in the field that fluconazole resistance is not considered a major problem for VVC, as it 
is for other forms of candidiasis. I still have a few reservations about the conclusions drawn from 
this manuscript:  
 
1. An association between vaginal symptoms (which are now accurately described) and 
yeast carriage does not establish causality. The authors would need to follow these patients post -
azole treatment to determine if symptoms resolved. The authors openly st ate that disease 
symptoms associated with VVC can in fact be caused by a variety of infectious and non -
infectious stimuli. Therefore, how are the authors convinced that vaginal symptoms experienced 
by these patients are due to identified fungi? Perhaps wom en are asymptomatically colonized by 
this fungus, but experiencing symptoms from another infection (e.g. bacterial) or cause.  
 
I think the authors can somewhat compensate by stating that their study assessed yeast carriage 
associated with vaginal candidiasis symptoms. While VVC is inferred, it is not confirmed nor 
were exclusionary tests performed.  
 
2. The authors should provide a  citation demonstrating that VITEK 2 antifungal 
susceptibility testing correlates strongly with CLSI methods.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify  which controls are required in your comments to the authors.  
No 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I recommend additional statistical review  
Quality of written English  
Please indicate the quality of language in the manuscri pt: 
Needs some language corrections before being published  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, fundi ng, or salary from an 
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from t he publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial com peting interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give de tails below.  
 
I declare that I have no competing interests.  
 
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