Prevalence and Management of Non-albicans Vaginal Candidiasis

Overview & Synopsis

Objectives It is thought that widespread use of “over-the-counter” azoles may increase the incidence of resistant Candida species such as C glabrata. Infections with species other than C. albicans frequently do not respond to standard azole treatments. Intravaginal nystatin is an option but is no longer available in the UK. In this paper, we review the prevalence of non-albicans candida over the past five years, and assess the efficacy of amphotericin and flucytosine vaginal cream in the treatment of non-albicans VVC. Methods Retrospective review of all vaginal yeast isolates collected from women attending a city centre sexual health clinic between 2004 and 2008. The women prescribed amphotericin and flucytosine vaginal cream were identified through pharmacy records and their clinical notes reviewed for treatment outcome. Results Between 2004-2008, the number of isolates of all Candida species increased with the increase in workload of the clinic but the prevalence of non-albicans yeasts remained stable at between 0.87-1.06%. Eighteen patients were prescribed amphotericin and flucytosine vaginal cream. At follow up, all 18 were clear of the non-albicans yeasts. Six had residual symptoms but were persistently culture negative. Two had positive cultures for C. albicans. Conclusions There is no evidence of an increase in prevalence of non-albicans Candida species such as C glabrata. We have treated 18 women who had non-albicans VVC with amphotericin and flucytosine vaginal cream and achieved clearance of the non-albicans species in all of them.