article · Microbiology Spectrum
Vulvovaginal candidiasis affects a large proportion of women, with significant implications during pregnancy. A cross-sectional investigation of 205 pregnant women across all trimesters at two hospitals in Ghana revealed an infection prevalence of 50.7%. Although Candida albicans was the most frequently identified organism, several non-albicans species were also detected, including Candida krusei, Nakaseomyces glabrata, Candida tropicalis, and Candida dubliniensis. Laboratory testing showed that isolated Candida albicans strains were largely susceptible to clotrimazole and nystatin, but displayed markedly lower susceptibility to fluconazole and itraconazole. Complete resistance to fluconazole was recorded in Candida dubliniensis isolates. These patterns demonstrate the presence of diverse fungal species with varying drug responses, highlighting the importance of species identification, laboratory testing, and targeted antifungal choices to effectively manage infections and prevent the spread of resistance in maternal healthcare settings.
Untreated fungal infections during pregnancy can lead to complications such as preterm birth. Because common medications like fluconazole face emerging resistance, routine laboratory testing and species identification are vital. This ensures healthcare providers prescribe effective, targeted therapies rather than relying on standard treatments that may fail, ultimately protecting maternal and neonatal health.
This applied clinical surveillance research provides evidence that could guide diagnostic service providers, clinical laboratories, and antenatal clinics in adopting species-specific testing protocols. The findings are ready to inform local treatment guidelines and procurement decisions for maternal healthcare facilities, but the abstract does not describe a newly developed commercial product, device, or therapeutic candidate.
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ABSTRACT Vulvovaginal candidiasis (VVC) is a common fungal infection, affecting approximately 75% of women at least once in their lifetime. Candida albicans is the predominant pathogen, responsible for 85%–90% of symptomatic cases. This study assessed the prevalence and antifungal susceptibility patterns of Candida species isolated from pregnant women with VVC to determine species-specific resistance trends and treatment implications. A cross-sectional study was conducted between November 2020 and July 2023 at Ho Teaching Hospital and Ho Municipal Hospital, the primary referral health facilities in the Volta Region. A total of 205 pregnant women across all trimesters participated. Vaginal swabs were collected and cultured for Candida species isolation and identification. Antifungal susceptibility of the isolates was assessed using the Kirby-Bauer disk diffusion method against clotrimazole (10 µg), fluconazole (10 µg), itraconazole (10 µg), and nystatin (100 IU). The prevalence of VVC among participants was 50.7%. C. albicans was most frequent (22.9%), followed by Candida krusei (14.1%), Nakaseomyces glabrata (9.3%), Candida tropicalis (2.4%), and Candida dubliniensis (2.0%). C. albicans exhibited high susceptibility to clotrimazole (87.2%) and nystatin (87.2%) but lower susceptibility to fluconazole (44.7%) and itraconazole (44.7%). Resistance was observed, particularly in C. dubliniensis to fluconazole (100%). The findings highlight the diversity of Candida species in VVC and the necessity of species-specific antifungal therapy. Laboratory diagnostics are critical to guide treatment and mitigate antifungal resistance. Routine surveillance and judicious antifungal use are vital to preventing resistance, while antenatal visits offer opportunities for education on VVC prevention and management. IMPORTANCE Vulvovaginal candidiasis (VVC) is a common yeast infection that affects many women, especially during pregnancy. This study examined how often VVC occurs in pregnant women and how well different antifungal treatments work. The researchers who studied 205 pregnant women in Ho, Volta Region, Ghana, found that over half (50.7%) had VVC. The most common fungus was Candida albicans , but other types, such as Nakaseomyces glabrata and Candida krusei , were also present—and some were resistant to common antifungal drugs. While clotrimazole and nystatin were effective, many fungi were resistant to fluconazole and itraconazole medications, which are often used to treat infections. Since untreated VVC can lead to complications such as preterm birth, the study emphasizes the need for early testing and tailored treatments to prevent health risks, the importance of routine screenings during pregnancy, and better awareness about safe and effective antifungal treatments.
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DOI: 10.1128/spectrum.00787-25
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