title: Factors Associated with Symptomatic Vulvovaginal Candidiasis: A Study among Women Attending a Primary Healthcare Clinic in Kwazulu-Natal, South Africa.
abstract: BACKGROUND
  Symptomatic vulvovaginal candidiasis (VVC) is one of the most common problems leading women to seek advice in primary healthcare facilities.
  
  
  OBJECTIVE
  The aim of this study is to describe the associations between some hypothesized factors and the presence of symptomatic VVC.
  
  
  METHODS
  An analytical cross-sectional study was conducted. A total of 90 women diagnosed with symptomatic VVC and 108 women without symptomatic VVC were recruited when attending Umlazi D clinic, a primary health clinic in KwaZulu-Natal, South Africa between June 2011 and December 2011. Confirmed symptomatic VVC was determined by Gram stain and microbiological culture of vaginal swabs. For human immunodeficiency virus (HIV)-infected women, HIV ribonucleic acid load in plasma and genital fluid was determined by real-time-polymerase chain reaction (BioMerieux, Lyon, France). CD4 counts were obtained from patients' medical records. Data were analyzed using the statistical package for the social sciences (SPSS) version 21.0 (SPSS Inc.; Chicago, IL, USA). Multiple logistic regression models were used to exclude univariate confounders. All tests were two-sided and a P < 0.05 was considered to be significant.
  
  
  RESULTS
  A total of 90% (81/90) of patients with symptomatic VVC complained of vulval itching, soreness and vaginal discharge when compared to 75.9% (82/108) of patients without symptomatic VVC (P < 0.01). Whilst pregnancy was independently associated with symptomatic VVC (P < 0.01), the latter was inversely related to Nugent's scores (P < 0.01). When compared with HIV negative women, the odds for symptomatic VVC increased among women with HIV-associated immunocompromise (CD4 counts < 200 cells/mm(3), P < 0.001), significantly shedding HIV in their genital tracts (P = 0.04), with plasma HIV load > 1000 copies/mL (P < 0.001). There was a significant negative association between the use of highly active anti-retroviral therapy and the presence of symptomatic VVC in HIV-infected women (P < 0.01).
  
  
  CONCLUSIONS
  Although symptomatic VVC is not classified as acquired immunodeficiency syndrome-related condition, HIV-related immune compromised women and particularly those who are anti-retroviral therapy-naïve are likely to develop symptomatic VVC.
authors: Department of Infection Prevention and Control and Medical Microbiology, School of Laboratory-Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa ; Department of Medical Microbiology, Faculty of Health Sciences, Walter Sisulu University, Buffalo City, Eastern Cape, South Africa.
authors: T
authors: T
authors: Apalata
authors: Department of Medical Microbiology, Faculty of Health Sciences, Walter Sisulu University, Buffalo City, Eastern Cape, South Africa.
authors: B
authors: B
authors: Longo-Mbenza
authors: Department of Infection Prevention and Control and Medical Microbiology, School of Laboratory-Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors: Aw
authors: A
authors: Sturm
authors: Department of Pediatrics and Child Health, Nelson R Mandela School of Medicine, HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa ; Ragon Institute of MGH, Harvard and MIT, Boston, Massachusetts, USA ; Department of Biology, Medgar Evers College, City University of New York CUNY, Brooklyn, New York 11225, USA.
authors: Wh
authors: W
authors: Carr
authors: Department of Infection Prevention and Control and Medical Microbiology, School of Laboratory-Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors: P
authors: P
authors: Moodley
keywords: Human immunodeficiency virus-related immune suppression; Primary healthcare clinic; Vulvovaginal candidiasis