VULVOVAGINAL CANDIDIASIS: PREVALENCE, SPECIES DISTRIBUTION AND RISK FACTORS AMONG NON-PREGNANT WOMEN, IN SANA'A, YEMEN
Authors: Al-Hatami Sameera Mohammad Mahdi , Al-Moyed Khaled Abdulkareem A , Al-Shamahy Hassan Abdulwahab , Al-Haddad Ahmed Mohammed , Al-Ankoshy Azhar Azher Mohammed 
Published: July 2021

Background and objectives: Vulvovaginal candidiasis is known to be a global issue of concern due to its association with economic costs, sexually transmitted diseases, and the escalation of genital tract infections.  This study aimed to determine the prevalence, species distribution and risk factors associated with Candida species causing vulvovaginal candidiasis.
Subjects and Methods:  Non-pregnant women attending routine antenatal visits at Al-Olaifi-Family Center in Sana'a were enrolled in a cross-sectional study conducted from June 2018 to March 2019. Laboratory work was carried out at the National Center of Public Laboratories (NCPHL). Vaginal swabs were sampled from participants after oral consent was obtained. The swabs were inoculated in Sabouraud glucose agar supplemented with chloramphenicol and incubated at 37°C for 24 to 48 h under aerobic conditions in order to perform a fungal culture. Candida species were determined by culturing on HiCrome Candida differential Agar at 35°C for 48 h to produce species-specific colours. Data on demographic, clinical, and risk factors were collected in a pre-designed questionnaire.
Results:  A total of 190 non-pregnant women were included. The prevalence of VVC was 22.1%. Candida albicans accounted for 16.3% and non-Candida albicans accounted for 5.8% of the isolates, mainly C. glabrata (3.2%), C. rugosa (1.05%), C. lipolytica (1.05%), and C. dubliniensis (0.53%). When VVC risk factors were considered, there were significant risk factors with age group 30-34 years (33.3%, odds ratio=2.1) and age group  ≥35 years (62.5%, odds ratio=10.3), residence in a rural area (39.5 %, OR=3.3), negative emotions (30.2%, OR=2.3), underwear replacement over 1 day (29.3%, OR=4.2), impure cotton underwear (29.4%, OR=4.9), while Condom use and vulvar cleaning before or after sexual life were found to be highly significant protective factors against VVC (p=0.008, 0.03, respectively).
Conclusions: Guidelines for the management of VVC syndrome in Yemen should be revised to include a protocol specifically for women over 30 years of age. VVC undoubtedly poses a significant threat to women's reproductive health. Risk factors for VVC are varied, and include ages, health habits, history of the disease, and other aspects. It is necessary to take appropriate measures to avoid risk factors and to help reduce the prevalence of VVC among women of childbearing age.
                  
Peer Review History:
Received: 3 May 2021; Revised: 23 June; Accepted: 30 June, Available online: 15 July 2021
Academic Editor: Dr. Ali Abdullah Al-yahawi, Al-Razi university, Department of Pharmacy, Yemen, alyahawipharm@yahoo.com
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Received file:                Reviewer's Comments:
Average Peer review marks at initial stage: 6.5/10
Average Peer review marks at publication stage: 7.0/10
Reviewer(s) detail:
Dr. Michael Otakhor Erhunmwunse, St. Philomena Catholic Hospital, Nigeria,dedoctor4life@yahoo.com
Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com
Dr. Wadhah Hassan Ali Edrees, Hajja University, Yemen, edress2020@gmail.com
 
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