外阴阴道假丝酵母菌病的菌种与耐药性研究

目的:对复发性外阴阴道假丝酵母茵病(RVVC)、外阴阴道假丝酵母菌病(VVC)患者阴道分泌物进行培养、菌种分型及药物敏感试验,探讨其治疗策略.方法:用沙氏培养基35℃培养194例患者阴道分泌物,其中RVVC 97例,VVC 97例.用API 32℃假丝酵母茵鉴定板及ATBTM FUNGUS3 药敏板接种,在ATB Expression全自动微生物鉴定仪判读结果.结果:在培养检测的194例阴道分泌物中白假丝酵母菌156例,占80.41%(156/194);RVVC组中73例为白假丝酵母菌,占75.26%(73/97),VVC组中83例为白假丝酵母菌,占85.57%(83/97).RVVC组非白假丝酵母菌比例高,与VVC组比较差异有统计学意义(P＜0.05).RVVC组假丝酵母菌对氟康唑药物敏感率(68.04%)低于VVC组(86.60%)(P＜0.05).结论:VVC、RVVC的主要致病菌仍是白假丝酵母菌,RVVC组非白假丝酵母菌比例高于VVC组.RVVC组假丝酵母菌对氟康唑的敏感性明显低于VVC组.     

复发性外阴阴道假丝酵母菌病的菌群分析与治疗

目的:了解复发性外阴阴道假丝酵母菌病(recurrent vulvovaginal candidiasis,RVVC)的致病菌群情况,探讨时RVVC的治疗.方法:对108例RVVC患者进行阴道分泌物假丝酵母菌培养并做药敏试验,选择敏感药物进行有效的半年巩固治疗,治疗第3月结束、治疗第6月结束时进行假丝酵母菌涂片检查.结果:RVVC患者中81例(75.0%)为白色假丝酵母菌,19例(17.6%)为光滑假丝酵母菌,4例(3.7%)为近平滑假丝酵母茵,2例(1.9%)为热带假丝酵母菌,2例(1.9%)为克柔假丝酵母菌.药物敏感试验显示,在108例RVVC患者中80.6%、66.7%、65.74%、57.4%、8.3%、6.5%分别对制霉菌素、克霉唑、咪康唑、氟康唑、酮康唑、伊曲康唑敏感;7.4%的假丝酵母茵对所有列出的药物均已耐药.治疗3个月、6个月结束时症状体征评分都比初诊时有明显好转(P<0.0001).治疗3个月结束时假丝酵母茵转阴率为76.2%(80/105),治疗6个月结束时假丝酵母茵转阴率为64.8%(68/105).结论:①非白色假丝酵母菌的比例在RVVC患者中增高,可以占到25.00%,而其中17.6%的RWC是由于光滑假丝酵母菌造成的.②在治疗RVVC时,要根据假丝酵母菌培齐、药敏实验结果以及以往患者的用药经验及发作特点选择用药.     

外阴阴道假丝酵母菌病临床分离株的基因型和药物敏感性分析

目的:探讨外阴阴道假丝酵母菌病(VVC)患者阴道白假丝酵母菌分离株的基因型别特征及不同基因型别的阴道白假丝酵母菌的药物敏感情况。方法:(1)对211株阴道白假丝酵母菌进行25S rDNA基因分型;(2)采用NCCLS推荐的M27-A微量法测定阴道白假丝酵母菌对5-氟胞嘧啶、咪康唑、伊曲康唑、克霉唑、氟康唑和制菌霉素等6种药物的敏感性。结果:(1)211株阴道白假丝酵母菌分为3种基因型,A型189株(89.6%),B型19株(9.0%),C型3株(1.4%);(2)不含内含子组(A型)白假丝酵母菌对5-氟胞嘧啶、咪康唑、伊曲康唑、克霉唑和氟康唑的最低抑菌浓度值(MIC)高于含内含子组(B、C型)(P0.05);不含内含子组(A型)与含内含子组(B、C型)白假丝酵母菌对5-氟胞嘧啶和咪康唑的敏感率有显著差异(P0.01),前者显著低于后者。结论:不同基因型别的白假丝酵母菌在阴道内的分布具有独特性,A型为主要基因型;VVC白假丝酵母菌基因型别对不同药物的敏感率和MIC有影响。     

外阴阴道假丝酵母菌病致病菌株调查及药敏分析

目的探讨外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)致病菌株分布和药敏情况。方法对2003年12月至2005年12月,天津医科大学总医院、天津市中心妇产科医院及天津人民医院妇产科门诊390例有症状且真菌培养阳性的VVC患者进行菌株调查及药敏分析。结果VVC致病菌株白假丝酵母菌占94.4%(368/390),非白假丝酵母菌占5.6%,白假丝酵母菌菌株与非白假丝酵母菌菌株药敏无明显差异,氟康唑药物敏感率100%,VVC初发组与再发组菌株分布及药敏无差别。结论VVC致病菌株仍以白假丝酵母菌占优势。非白假丝酵母菌菌株对氟康唑耐药率无增加。     

外阴阴道假丝酵母菌病的致病菌研究

目的　了解中国外阴阴道假丝酵母菌病(VVC)的致病菌种,并评价阴道应用硝酸咪康唑 400mg3日疗法与 200mg7日疗法对VVC的疗效。方法　采用多中心大样本开放性研究,对 2003年 1月至 7月全国 6家医院 250例VVC患者进行阴道假丝酵母菌的培养,并比较硝酸咪康唑 400mg3日疗法与 200mg7日疗法的疗效及副反应。结果　 (1)白色假丝酵母菌仍是造成VVC最常见的致病菌,占 88.4%,而其他一些非白色假丝酵母菌依次为光滑假丝酵母菌 ( 5. 2% )、伪热带假丝酵母菌 ( 1.6% )、星型假丝酵母菌 ( 1.2% )、近平滑假丝酵母菌(1.2% )、平滑假丝酵母菌(0.8% )及季也蒙假丝酵母菌 (0.8% )等。(2)停药 10 ~14d时, 400mg组真菌阴转率为 89 9%, 200mg组真菌阴转率为 89 7% (P>0.05)。停药 28~35d时, 400mg组真菌阴转率为 96.1%, 200mg组真菌阴转率为 93 1% (P>0.05)。结论　(1)VVC的最常见致病菌是白色假丝酵母菌,机体的免疫异常及阴道环境的改变是VVC发生的重要原因。(2)硝酸咪康唑 400mg3日疗法与 200mg7日疗法在治疗效果上差异无显著意义。     

复发性外阴阴道假丝酵母菌病的菌种及药敏分析197例

目的:了解复发性外阴阴道假丝酵母菌病(RVVC)临床分离菌株构成及其对常见抗真菌药物的敏感性。方法:对确诊的197例RVVC患者和466例外阴阴道假丝酵母菌病(VVC)患者的阴道采集标本进行致病假丝酵母菌株培养分离、菌种鉴定和药敏试验。结果:①RVVC与VVC组在假丝酵母菌组成上差异无统计学意义;②RVVC组假丝酵母菌对制菌霉素、咪康唑、酮康唑和氟康唑的敏感性(51.6%、27.5%、30.8%、37.9%)显著低于VVC组(79.7%、47.5%、47.5%、55.1%);对两性霉素B、制菌霉素、咪康唑、益康唑的耐药性(12.1%、10.4%、50.0%、42.9%)显著高于VVC组(3.3%、1.7%、33.1%、22.0%)。结论:RVVC的致病菌株对抗真菌药物的敏感性全面降低而耐药性全面升高,应引起临床的重视。     

复发性假丝酵母菌性外阴阴道炎与肠道假丝酵母菌感染的同源性研究

目的:探讨复发性假丝酵母菌性外阴阴道炎与肠道假丝酵母菌感染的同源性。方法:分别采集和鉴定假丝酵母菌性外阴阴道炎(VVC)和复发性假丝酵母菌性外阴阴道炎(RVVC)感染者阴道和肠道的菌株,采用PCR方法进行阴道和肠道菌株同源性分析。结果:203例患者中VVC组158人,RVVC组45人。共有66例患者经菌株鉴定为阴道和肠道同时感染假丝酵母菌,其中VVC患者21例(13.29%),RVVC患者45例(100%)(χ2=120.013,P<0.01);肠道和阴道标本同源性占94.44%。结论:复发性假丝酵母菌性外阴阴道炎与肠道假丝酵母菌感染之间关系密切。     

外阴阴道假丝酵母菌病123例临床分析

目的:探讨外阴阴道假丝酵母菌病(VVC)与致病菌种的变迁、药物敏感性的变化和性伴侣感染之间的关系.方法:对妇产科门诊123例VVC患者的阴道分泌物及其性伴侣龟头皮屑进行真菌培养和药敏试验.结果:VVC致病菌株白假丝酵母菌78.9%,光滑假丝酵母菌占18.7%,克柔假丝酵母菌占2.4%.对酮康唑药物敏感率高达75.6%,对特比奈芬耐药率高达75.6%.在随访的102例性伴侣中,有症状者44.1%,镜检阳性率为26.5%,培养阳性率为51.0%,菌种分布与性伴侣一致率为98.0%.结论:非白假丝酵母菌占VVC致病菌比例增加,而假丝酵母菌对唑类药物耐药性有增加趋势,性伴侣的感染可能是VVC复发的重要原因.     

复发性外阴阴道假丝酵母菌病治疗过程中复发的危险因素[英]／Pmel DA…／／Am J Obstet Gynecol

对复发性外阴阴道假丝酵母菌病(RVVC)维持治疗过程中外阴阴道假丝酵母菌病(VVC)复发的因素进行研究。自1998～2001年在Waney大学及Temple大学对RVVC进行研究。纳入标准：患者存在症状、假丝酵母菌培养阳性、在之前12个月VVC发病≥4次(包括本次)、年龄≥18岁。至少有1次VVC在过去被医生诊断。剔除标准：假丝酵母菌培养阴性；不能提供参加时或至少1个月随访资料。     

外阴阴道假丝酵母菌病的诊治

外阴阴道假丝酵母菌病(vulvovaginal candidiasis，VVC)也称外阴阴道念珠菌病，为常见的外阴、阴道炎症。约有10％的非妊娠妇女，30％的妊娠妇女阴道中有假丝酵母菌寄生而无症状。70％妇女一生中至少感染过一次。白色假丝酵母菌(candida albicans)是主要病原体(80％～90％)，其他如光滑假丝酵母菌(candida glabrata)、热带假丝酵母菌(candida tropicalis)、近平滑假丝酵母菌(candida parasilosis)等占少数。     

478例复发性外阴阴道假丝酵母菌病的病原菌分布及耐药情况分析

Objective?To investigate the pathogen flora and drug resistance of recurrent vulvovaginal candidiasis (RVVC). Methods?Fungal culture and drug sensitivity tests of vaginal secretion for 478 RVVC patients were performed in Beijing Tsinghua Changgung Hospital from April 2015 to March 2020. Results?According to the proportion of 5 fungal strains in the total number of isolates, candida albicans, Candida glabricis, Candida croce, Candida tropicalis and other candida accounting for 74.48%, 14.64%, 2.30%, 1.46% and 7.11% respectively, the difference was statistically significant (P<0.001). Through drug sensitivity test, it was found that the resistance rate of these five Candida species to to clotrimazole, flucanazole, miconazole, itraconazole and nystatin were 14.85%, 35.56%, 40.59%, 53.14% and 0.42% respectively (P<0.0001). Drug resistance rates of Candida albicans to to 5 kinds of drugswere 9.27%, 21.07%, 45.51%, 45.51% and 0.28% respectively. Drug resistance rates of Candida glabrata to these drugs were 40.00%, 91.43%, 25.71%, 85.71% and 1.43% respectively. Conclusion?The main pathogen of RVVC is Candida albicans. Among which, Candida glabrata accounted for the highest proportion. The drug resistance rates of different RVVC species to clotrimazole, flucanazole, miconazole, itraconazole and nystatin varies significantly. In the treatment of RVVC cases, the rational choice of antifungal agents according to the drug resistance situation can help improving the clinical efficacy.     

Can the diagnosis of recurrent vulvovaginal candidosis be improved by use of vaginal lavage samples and cultures on chromogenic agar?

OBJECTIVE: To investigate if introital and vaginal flushing samples inoculated on chromogenic agar could increase the recovery rate and rapid identification of Candida and non-albicans species, as compared to culture of posterior vaginal fornix samples on Sabouraud agar and speciation of isolates by biochemical tests. METHODS: Samples from the introitus and the posterior vaginal fornix and vaginal lavage samples were collected from 91 women with a history suggestive of recurrent vulvovaginal candidosis (RVVC), and with a suspected new attack of the condition. The specimens were cultured on Sabouraud and CHROMagar. Speciation of yeast isolates was made on the chromogenic agar by API 32C kits and by an atomized system (Vitek). RESULTS: Forty-six (51%) women were positive for Candida from one or more of the samples. The introital cultures were positive in 43 (47%) women, both on Sabouraud and chromogenic agar. From the posterior vaginal fomix, 42 (46%) women were positive on the Sabouraud and 43 (47%) on chromogenic agar cultures, while the vaginal lavage cultures yielded Candida on those two media in 40 (44%) and 41 (45%) cases, respectively. Candida albicans was the most frequent species recovered, from 40 (87%) cases, followed by C. krusei in 4 (9%), C. glabrata in 2 (4%), and C. parapsilosis in one case. There was only one woman who had a mixed yeast infection, by C. albicans and C. krusei. There was only one discrepancy in the speciation as demonstrated by mean of chromogenic agar and API 32C kit. CONCLUSIONS: Neither cultures of introital nor of vaginal lavage samples increases the detection rate of Candida in RVVC cases as compared to cultures of posterior vaginal fornix samples. Use of chromogenic agar is a convenient and reliable means to detect colonization by Candida and differentiate between C. albicans and non-albicans species.     

复发性外阴阴道假丝酵母菌病的菌种及药物敏感性分析

目的:研究复发性外阴阴道假丝酵母菌病(recurrent vulvovaginal candidia-sis,RVVC)的致病菌种和药敏结果。方法:对2006年~2009年收治的RVVC患者547例行阴道分泌物真菌培养并做药敏试验。结果:真菌培养阳性率80.6%;441例阳性患者中387例(87.8%)为白色假丝酵母菌,49例(11.1%)为光滑假丝酵母菌,5例(1.1%)为克柔假丝酵母菌;药物敏感试验显示,制霉菌素敏感率96.2%,克霉唑89.0%,氟康唑79.2%,伊曲康唑54.0%,咪康唑敏感率48.6%。结论:白色假丝酵母菌是RVVC的主要致病菌,RVVC患者的首选治疗药物为制霉菌素。     

Determinants of different Candida species infections of the genital tract in women. Sporachrom Study Geoup

OBJECTIVE: We have analyzed the differences in the epidemiological characteristics of women with different Candida low female genital tract infection. STUDY DESIGN: Eligible for the study were 4228 women aged 18-70 years with symptomatic low gynecological tract infection and clinical findings suggestive for Candida infection consecutively attending during the study period first level outpatients gynecological services in Italy. CHROMagar Candida method was used to identify albicans and non-albicans species and among non-albicans ones Candida glabrata, tropicalis and krusei. RESULTS: Out of the 4228 women who entered the study, Candida infection was confirmed by CHROMagar test in 3351 cases (79.3%): Candida albicans was identified in 1431 cases (43%) and non-albicans in 1920. Among the 1920 women with non-albicans infection, Candida glabrata was identified in 1207 women, Candida krusei in 290, Candida tropicalis in 404 (in 19 cases other species or non-specified species were involved). Candida albicans infection was more frequently reported than non-albicans ones in diabetic women (Odds Ratio, OR=1.7, 95%, Confidence Interval, CI 1.1-2.7). Current oral contraceptive users tended more frequently to be infected with Candida albicans than non-albicans, however the estimated OR was only slightly above unity and of borderline statistical significance (OR 1.3, 9.5%, CI 1.1-1.5). Women reporting previous treatment with topic antimicotic reported more frequently non-albicans infection, than Candida albicans ones. However the association was limited and of borderline statistical significance (OR albicans vs. non albicans 0.7, 95% CI 0.5-1.0). Albicans infection was more frequently identified in women whose partner reported symptomatology for Candida infection (OR 1.7, 95% C.I. 1.4-2.0). CONCLUSIONS: This study shows that in this Italian population with symptomatic Candida infection of low female genital tract, there are some differences in the epidemiological characteristics of women with albicans and non-albicans infection.     

Prevalence of clinical vaginal candidiasis in a university hospital and possible risk factors

OBJECTIVE: The aim of this study was to evaluate the prevalence of symptomatic vaginal candidiasis and probable predisposing factors in a university-based hospital. STUDY DESIGN: A total of 576 cases of clinical vaginal candidiasis were enrolled in this survey and wet mount preparations, Gram-stained smears and vaginal cultures were assessed. Possible risk factors, such as pregnancy, diabetes mellitus, contraceptive and antibiotic use were evaluated. RESULTS: Clinical vaginal candidiasis was detected in 12.1% of the cases. Candida albicans was isolated in 80.2% of patients and non-albicans species in 19.8%. Pruritus was the most common symptom (85.9%), followed by vaginal discharge (66.1%), soreness (31.1%) and dyspareunia (5.0%). Reproductive age, pregnancy, diabetes, contraception as well as recent antibiotic use correlated positively with both C. albicans and non-albicans isolates. Soreness and dyspareunia were significantly related to non-albicans species. The overall recurrence rate was 8.5%. Recurrences correlated positively to non-albicans infections. CONCLUSIONS: C. albicans was, by far, the predominant yeast isolate. Non-albicans isolates caused significantly more frequent soreness, dyspareunia and recurrences than C. albicans. Clinical and laboratory findings, together with possible predisposing factors must be taken into consideration in order to achieve appropriate treatment.     

Torulopsis glabrata vaginitis: clinical aspects and susceptibility to antifungal agents

Torulopsis glabrata is second only to Candida albicans in frequency of isolation from the vagina in both asymptomatic women and patients with yeast vaginitis. We retrospectively studied 33 patients from whom vaginal isolates of T glabrata were obtained. Torulopsis glabrata caused symptomatic vaginitis in 42% of the patients but was unassociated with symptoms in 30%; in 27% of patients, its importance was uncertain because of concomitant pathology. Antifungal susceptibility testing was performed on 39 T glabrata strains isolated from 39 patients. The minimal inhibitory concentrations (MICs) of the majority of T glabrata isolates fell within the sensitive range of the antimycotic drugs tested; however, no correlation was found between in vitro antifungal MICs and the response to azole drug therapy. Clinical success was achieved in 67% of the patients although mycologic cure occurred in only 33%. A small number of patients developed recurrent and often chronic Torulopsis vaginitis unresponsive to conventional therapy. Limited experience suggests that vaginal boric acid therapy may be of value in these recalcitrant cases.     

Activated lactoferrin's ability to inhibit Candida growth and block yeast adhesion to the vaginal epithelial monolayer

OBJECTIVE: To study in vitro growth-inhibitory effects of activated lactoferrin (ALF) against vaginal isolates of Candida species and to measure the ability of ALF to block interactions of Candida albicans and Candida glabrata to the vaginal epithelial (VE) monolayer. STUDY DESIGN: In vitro effects of ALF on growth of C albicans and C glabrata in Sabouraud dextrose (SD) broth were measured as change in broth turbidity by microscale optical density assay. ALF was tested at 5 and 2.5 mg/mL concentrations against 105 yeast cell inoculum at 370 degrees C for 96 hours and compared with native lactoferrin and control (growth in broth without ALF). VE cells were isolated from human vaginal tissue biopsies to establish a functional monolayer for yeast interaction studies. ALF effects on Candida interactions with the VE monolayer were tested using 3H-thymidine-labeled yeast. Prophylactic (treatment prior to yeast inoculation onto VE) and therapeutic (treatment to detach VE-adherent yeast) potential of ALF (5 mg/mL) was evaluated against vaginal isolates of C albicans strain NTRL809A and C glabrata strain NTRL131G. RESULTS: Growth of Candida species indicated that a 105 yeast inoculum in SD broth proliferated to a stationary growth equilibrium (approximately 10(9) yeast cell density) in 18 hours (approximately 2 hours of generation time). ALF (5 mg/mL) elicited >96 hours of total stasis (100% growth inhibition) and was significantly effective against both Candida species (p < 0.0001). At 2.5 mg/mL dilution, ALF sustained total stasis activity to an average of 18 hours and 24 hours for C albicans (n = 5) and C glabrata (n = 5), respectively. Interaction studies indicated avid binding of C albicans (70 - 140 x 10(3) yeast) and C glabrata (50 - 75 x 10(3) yeast) per square centimeter of VE monolayer. ALF-treated VE showed significant blockade (p < 0.05) of yeast adhesion by 33% and 58% with C albicans and C glabrata, respectively. ALF treatment of yeast-VE complexes resulted in significant detachment (p < 0.05) of C albicans and C glabrata, by 58% and 51%, respectively. CONCLUSION: ALF is a natural fungistatic agent with potent yeast adhesion-blocking and detachment properties and is effective against the vaginal pathogens C albicans and C glabrata.     

Topical antiseptics as an alternative in the treatment of acute vulvovaginal candidosis

The aim of this prospective, multicenter, randomized, case-control study was to investigate the efficacy of a nonspecific mucosal antiseptic (octenidine dihydrochloride, phenoxyethanol) with proven antifungal effects, in patients with acute symptomatic vaginal candidosis, in comparison with a specific topical antifungal agent (clotrimazole), particularly in respect to non-Candida albicans yeasts. A total of 491 patients from 29 gynecological practices, who had new clinical vaginal mycosis, not treated with antifungal agents in the last 12 months, were included in the study. The diagnosis in each case was confirmed by microscopy or positive culture. The majority of the vaginal mycoses were infections with C. albicans (72%). In 28% of patients a non- Candida species (mainly C. glabrata) contributed to the infection. Except for vaginal discharge, the success of treatment was between 71% and 91% for both clinical and subjective parameters. The control preparation was significantly better than the treatment in the test group. Mycological cure rate on the basis of cultures was 78% in the test group and 87% in the control group. These results were also significantly different. The relatively high proportion of C. glabrata isolates in this study tended to be more successfully treated by the antiseptic (to 72%) than by the administration of clotrimazole (59%). Even though therapeutic success with clotrimazole was overall significantly better than with the test preparation, the success of treatment with the antiseptic used was within the range between 70% and 90% described for topical antifungal agents. Both the good efficacy of the topical antiseptic and the increased prevalence of non-Candida albicans species causing vaginal infections mean that the use of an antiseptic may be considered a suitable alternative therapeutic concept to an appropriate topical antifungal agent in the treatment of acute vaginal candidosis.     

Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole

OBJECTIVE: An attempt was made to validate recent recommendations that women with complicated Candida vaginitis (severe or recurrent, non-albicans Candida spp or abnormal host) require longer-duration antifungal therapy to achieve clinical cure and mycologic eradication. STUDY DESIGN: A prospective, multicenter, randomized, double-blind study was performed comparing a single dose of 150 mg of fluconazole with 2 sequential 150-mg doses of fluconazole given 3 days apart. RESULTS: Five hundred fifty-six women with severe or recurrent Candida vaginitis were enrolled, and 398 had at least one postbaseline evaluation (intent to treat) and of these 309 were fully evaluable (efficacy-valid). At baseline, 92% of vaginal isolates were Candida albicans. The 2-dose fluconazole regimen achieved significantly higher clinical cure rates in women with severe vaginitis when evaluated on day 14 (P =.015) and higher clinical and mycologic responses persisted at day 35. Women with recurrent but not severe vaginitis did not benefit clinically short term by the additional fluconazole dose. Multivariate logistic regression analysis showed that being infected with non-albicans Candida predicted significantly reduced clinical and mycologic response regardless of duration of therapy. Fluconazole therapy was well tolerated and free of serious adverse effects. CONCLUSION: Treatment of Candida vaginitis requires individualization, and women with severe Candida vaginitis achieve superior clinical and mycologic eradication with a 2-dose fluconazole regimen.     

Detection of Candida species in vaginal samples in a clinical laboratory setting

OBJECTIVE: To present the detection rates of Candida species in vaginal samples from patients visiting physicians. METHODS: The presence of C. albicans, C. glabrata, C. parapsilosis and C. tropicalis in 3978 vaginal swabs from patients in six US states was detected by PCR amplification. RESULTS: Candida DNA was detected in 33.1% of the population studied. Of the 1316 positive samples, 80.2% contained C. albicans, 14.3% contained C. glabrata, 5.9% contained C. parapsilosis and 8.0% contained C. tropicalis. Comparing samples by patients' state of residence revealed an association with the detection of C. glabrata (p = 0.029). Comparing samples by patients' age revealed a decrease in the overall detection of Candida (p < 0.001) and C. albicans (p < 0.001), concomitant with an increase in the detection of C. glabrata (p < 0.001) and C. parapsilosis (p = 0.025). CONCLUSIONS: These results provide geographic- and age-specific data on four Candida species associated with vaginitis.