Baseline prevalence, factors associated and treatment outcome of symptomatic vulvovaginal candidiasis in non-pregnant women at Mwanza, Tanzania outpatient clinics

Abstract

Vulvovaginal candidiasis is a prevalent concern for women, affecting approximately 70–75% at least once during their lifetime, with recurrence rates ranging from 6 to 9%. However, there is a notable scarcity of data regarding its prevalence, contributing factors, and treatment effectiveness among non-pregnant women. A cross-sectional analytical study with short term follow-up for treatment outcome was conducted from May 2022 to May 2023, focusing on non-pregnant women attending outpatient clinics at Bugando medical centre (BMC), Sekou Toure regional referral hospital (SRRH) and Sengerema district designated hospital (Sengerema DDH). The research employed standardized questionnaires to gather social and clinical data, while high vaginal swabs were collected using aseptic techniques and processed following established laboratory protocols. Data analysis, aligned with the study’s objectives, was carried out using STATA version 13, with statistical significance determined at a 95% confidence level ( P ≤ 0.05). The study included 548 participants with the median age of 35 [IQR 28–43] years. The majority, 65.7% had history of vulvovaginal candidiasis at least once in lifetime. Notably, 69.9% practiced vaginal douching. Laboratory-confirmed vulvovaginal candidiasis was prevalent in 24.3% of recruited patients. Women presenting with curd-like vaginal discharge were seven times more likely to have positive culture results compared to those with other vaginal symptoms. After adjusting for potential confounders, prior antifungal use (OR 0.27; 95% CI: 0.11–0.77; P = 0.01), being a student (OR 3.0; 95% CI: 1.3–7.1; P = 0.01) and increasing age (OR 0.96; 95% CI: 0.94–0.98; P = 0.003) remained independently associated with vulvovaginal candidiasis. Approximately 20% of women continued to experience symptoms after a standard full dose of antifungal treatment. The study sheds light on the substantial burden of vulvovaginal candidiasis among non-pregnant women. Age, being a student, antimicrobial use history, and clinical symptoms were identified to be associated with candidiasis. Approximately one-fifth of women reported persistent symptoms following treatment. As treatment outcomes were assessed clinically without microbiological confirmation, these findings should be interpreted cautiously and warrant further investigation into the causes of persistent symptoms and optimization of patient management.